#HAWMC: I Wish I Would Have Known

There’s a reason why we have the saying, “Hindsight is 20/20.” What do you wish you had known at the beginning of your patient journey that would have made it easier and less scary?

I differ from the rest of the #HAMWC community because I’m a doctor. I was a patient once but I’m ok now. The blogging prompt made me think though of how I talk to my patients about diabetes complications.

I must confess I find myself slipping into scare tactics sometimes. I’m happy to report I catch myself in time more often.

Sige kayo, pag hindi po natin naayos ang blood sugar ninyo, baka ma-dialysis kayo. Mahal po yun!

Translation: If we don’t fix your blood sugar, you might end up on dialysis. That’s expensive! I tend to have an apologetic smile when saying this. One of my patients asked me, You are different from my other doctors. You don’t get mad when my blood sugar is not controlled. And even when you warn me of complications, you smile at me. I said, I’m not trying to scare you but I am warning you. I don’t get mad because this is not about me but about you. Although I feel a certain sadness I am not able to help you enough, getting angry will only increase my wrinkles! Oh, we can’t have THAT Doctor 🙂 he said and smiled back at me.

My husband is a nephrologist. I refer diabetic patients to him when their kidneys start failing. I overheard my patients at the waiting room once, saying to each other – You better listen to Dr. Iris and make your sugars better. If you don’t, you’ll get referred to her husband the nephrologist. And you know what that means!

I also receive referrals from general internists. There is one particular internist who before referring patients to me says, Your blood sugar is uncontrolled. I can’t do anything more for you. You need to see Dr. Iris. When I get these patients, most are dejected. They feel like a truant child sent to the principal’s office. I tell them that we will work together and bring the blood sugar down, after which I will send them back to their internist. They can be referred back if my help is needed again. That makes them feel better – there is hope. I have had a few sent back and a few who came back to see me of their own accord. Somehow, knowing that this is a temporary arrangement until they get back on track motivates these patients.

Here’s a list of what NOT to do (from Alan Delamater in Improving Patient Adherence Clinical Diabetes April 2006 vol. 24 no. 2 71-7) –

Do not establish rapport.

Tell patients what to do.

Take control away from patients.

Misjudge patients’ sense of the importance of behavior change and their confidence in achieving change.

Overestimate their readiness to change.

Argue with patients.

Blame them for not taking better care of themselves.

Use scare tactics.

Note the last item on the list.

I’ve met many amazing people on Twitter who live with diabetes. Through them, I was able to better understand the patient perspective, which can radically differ from mine. I find this research by Hunt, Arar and Larme (Contrasting Patient and Practitioner Perspectives in Type 2 Diabetes Management West J Nurs Res December 1998 vol. 20 no. 6 656-682)  particularly illuminating –

To evaluate the success of their disease management, patients did not rely primarily on glucose concentrations, but were more concerned with how well they felt and how well they were able to maintain their normal activities. For practitioners, success was based on blood glucose concentrations (glycated haemoglobin or fasting glucose concentrations). They also felt that poor glucose concentrations implied poor behaviour control by patients… Some practitioners felt frustrated and used threats, negotiation, and scenarios to scare patients.

Is your doctor scary? Do scare tactics work? Leave a comment and let me know.