• ulcerative colitis
• self management

Ivan Illich believes that “the medical establishment has become a major threat to health”.¹ He reasons that the rise of modern medicine has encouraged a culture of dependency on the medical establishment rather than promoting self caring approaches to illness. This extreme viewpoint has a surprising number of supporters,² perhaps because it contains a grain of truth. Clinicians can be paternalistic and often set up services with little regard to patient preferences or whether this is the most cost effective method of delivering health care.³ It is therefore refreshing to read the paper by Robinson et al comparing guided self management with usual care for ulcerative colitis (UC) patients in a randomised controlled trial.⁴ Patients were more satisfied with guided self management, and patients with relapses took steroids earlier. There was also a statistically non-significant trend for relapses to be of shorter duration. The results seem compelling, so should there be widespread implementation of this management strategy for UC?