I have a confession to make. Sometimes I am not completely honest with my health care professionals (HCP\u2019s). I am not proud of this. I try not to lie outright to anyone but I definitely withhold some truths. I feel it is important to talk about this, because I know I am not alone.<\/p>\n
Here is one secret. I don\u2019t tell my endocrinologist about how often my blood sugar goes low, because I don\u2019t believe there is much she can do.\u00a0 It is the downside of trying to achieve that elusive A1C.\u00a0 Of course I try not to go low. And I suffer the consequences when I do. Why have frustrating conversations about this unfortunate side effect of living on insulin?<\/p>\n
I used to be more open. Then when I was pregnant with my twins a few years ago, I had a very upsetting conversation with a medical resident who kept focusing on my recorded lows. She made an ominous reference to the long term effects of hypoglycemia. It had not occurred to her to balance her comments with some kind of positive feedback about everything I was doing to keep healthy while I managed my diabetes and carried two babies. My endocrinologist came in to chat with me next, and she was much less anxious about my lows. However, I left with a lump in my throat and drove to my husband\u2019s office to have a good cry. I kept hearing the resident\u2019s words all day and couldn\u2019t help but think ahead to my future. There is so much fear in diabetes health care.<\/p>\n
I have other secrets but I am not comfortable revealing them.\u00a0 I am also an HCP, a clinical psychologist, and I wonder sometimes how honest my patients feel they can be with me.<\/p>\n
Practising clinical psychology means that my job is to help people solve their problems. I can\u2019t solve problems unless I listen to my patients.\u00a0 After all, they are the experts on their own thoughts and emotions. I listen to people talk about loss and heartache, and about challenges and victories. Sometimes my patients cry, but a lot of times we laugh too.\u00a0 It feels like such a privilege to be trusted with their most private thoughts and feelings.<\/p>\n
As a patient with Type 1 myself, I understand the emotional impact of dealing with the physical and psychological demands of diabetes all day.\u00a0 From counselling other people with diabetes, I also recognize the impact of the health care system on the health of those of us with diabetes. I know I am not the only patient who keeps secrets from HCP\u2019s.\u00a0 I hear other patients\u2019 secrets.<\/p>\n
Some patients have admitted to me that they do not test when they think their blood sugar is really high. Usually it is because they feel guilty about their lack of control and therefore are reluctant to see the evidence on their glucometer.<\/p>\n
One woman admitted that she does not test when she thinks her result would be very high because when she meets with her diabetes team, the data is downloaded from her glucometer.\u00a0 She feels she must hide the hyperglycemia.<\/p>\n
I have certainly heard many people admit to altering data on paper records.\u00a0 Not because they want to appear perfect. It is because they find the searches for answers frustrating and a waste of time.\u00a0 They are not comfortable saying so, or telling their specialists how they really want to spend their appointment time.\u00a0 They want their doctors to converse and to listen. \u00a0“I’m listening,”: the two words patients most want to hear.<\/p>\n
Eating disorders are common amongst women with diabetes.\u00a0 Many of these women would never tell their doctors or nurse educators that they struggle with disordered eating, or that part of the reason for their high A1C\u2019s is that they go to bed with a high blood sugar after bingeing on carbohydrates.\u00a0 Their self loathing and shame leads to feeling so worthless that they do not bother taking insulin to cover the binge.<\/p>\n
Patients have concerns that could be respectfully communicated to their diabetes team, but they usually keep these thoughts secret.\u00a0 They comment on how busy their clinics are, and how they wait so long to be seen, and then their appointments only take 5 minutes. One patient recently described waiting three hours to be seen by her endocrinologist! However, there is a power imbalance between patients and their HCP\u2019s and it is hard to assert ourselves as patients.<\/p>\n
Many people with diabetes describe feeling scolded sometimes, or judged.\u00a0 They feel rushed through their appointments. And they often note that they do not have much chance to talk about how they actually feel. They are directed, they are advised and they are sometimes silenced. Of course, these are their perceptions of their interactions with HCPs and I am not saying that they reflect the intentions of their HCPs. Of course perceptions are sometimes coloured by our own hurt, fear and anger about living with diabetes. However, patients should not leave their appointment thinking and feeling that way and being unable to share their emotions and feedback.<\/p>\n
When I speak with patients who do feel supported, and heard, they are generally more motivated and engaged in their diabetes care. There is no doubt that having this kind of support helps patients cope with the challenges of diabetes.\u00a0 So what do we need to focus on to create more of this support in diabetes care?<\/p>\n
Those who specialize in diabetes care genuinely care about their patients\u2019 well being.\u00a0 However, they want to make them better and this \u201crighting reflex\u201d gets in the way of listening to their patients. Nurses, doctors, dieticians and other HCP\u2019s do not always understand how important empathy and good communication skills are.\u00a0 Without them, their ability to use all their other medical knowledge is greatly diminished.\u00a0 Almost as important is the fact that when they connect with their patients, HCP\u2019s enjoy the interaction more as well.\u00a0 The benefit does not just belong to the patient. Listening enriches the experience of the listener.\u00a0 One nurse educator told me, \u201cIt doesn\u2019t feel like work because I do lots of listening. I enjoy it.\u201d<\/p>\n
The most effective method of improving management of Type 1 diabetes will not look the same for every patient because everyone\u2019s experience of Type 1 is unique.\u00a0 Additionally, each person\u2019s situation can change. What works for a patient now may not work next year.\u00a0 In many cases, we jump in too quickly to try to \u201cfix\u201d the blood glucose control.\u00a0 Patients are directed, advised, educated…. but none of this will work as well if they do not feel connected to their health care team.<\/p>\n
HCP\u2019s need to ask their patients questions in order to determine the next step in treatment. The questions should be focussed on the patient\u2019s expertise and knowledge.<\/p>\n
\u201cWhat would you like to work on today?\u201d<\/p>\n
\u201cWhat baby steps could you take to tackle this problem?\u201d<\/p>\n
\u201cHave you tried anything in the past that helped with this problem?\u201d<\/p>\n
Consider opening up to your doctor about how you feel in appointments.\u00a0 If you feel there is not time to talk about more than the numbers, say so.\u00a0 Don\u2019t criticize their approach. (Always avoid statements that start with \u201cYou….\u201d. Make an \u201cI statement\u201d and assert yourself.\u00a0 For example, \u201cI have something important I want to talk about with you. Do you have a few minutes to listen?\u201d)<\/p>\n
I made a reference earlier to the negative conversation I had with a resident at my diabetes clinic.\u00a0 I later told a nurse manager about how those conversations can people with diabetes feel. My advice was to encourage residents to ask more questions.\u00a0 Suppose the resident had said to me, \u201cI know it is hard when you are trying to keep your readings in range, but is there anything you can do to reduce the number of lows?\u201d \u00a0I would have had some ideas.\u00a0 And it would have been good for me to say them out loud and then put them into practice.\u00a0 However, the approach the resident used came across as shaming or judging, and it totally silenced me.<\/p>\n
I have often heard HCP\u2019s talk about their limited time for counselling, given all the other information they need to cover. I would suggest that with some patients, it would be better to put all the education aside for an appointment, and just connect with them. Connect before you correct.<\/p>\n
If you are unsure what your patient needs, ask him. Involve your patient in agenda setting by asking, \u201cHow can we best use our time today?\u201d I guarantee that this would grab your patient\u2019s attention. \u00a0You are correcting the power imbalance when you turn to your patient as the other expert in the room. If there are items you absolutely must include, then explain that you would like to share some information or ask some questions, but let your patient decide whose items come first on the agenda.<\/p>\n","protected":false},"excerpt":{"rendered":"
I have a confession to make. Sometimes I am not completely honest with my health care professionals. I am not proud of this. I try not to lie outright to anyone but I definitely withhold some truths. I feel it is important to talk about this, because I know I am not alone. <\/p>\n","protected":false},"author":46,"featured_media":41834,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"image","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1460],"tags":[],"yoast_head":"\n