Author Topic: Don't judge me  (Read 753 times)

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Offline Pattidevans

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Don't judge me
« on: 01 August 2016, 05:10:56 PM »
I came across an article recently that really resonated with me because it addresses the problems a lot of members have in dealing with the attitudes of the health care professionals we all come across in the course of our diabetic care.  It was very American, but I have "translated" it as it would apply to us in the UK and our HCPs.

 No More Shame and Blame: Helping Your Health Care Professional Learn How to Give You the Support You Need

It’s easy to forget that the NHS employs the Health Care Professionals to help you.   They should not be treating you as though you were a nuisance.  You are the reason they have a job, not an interruption to it. Your HCP’s role is to help you and support you in the totally overwhelming task of managing blood sugar levels. So, if your appointments leave you feeling shamed, guilty, powerless, and void of any motivation, there may be a few things youcan do within the conversations you have with your HCP that can give you the jolt of power you need to maximize your results. And here’s a little hint: they involve you being in charge of that conversation, not the other way around.


 The “Non-Compliant” Diabetic: A Term That Should Be Obliterated From the Medical World

Every three/six/twelve months you have an Hba1c that essentially gives your HCP the information they need to make a big judgment, even if that judgment is never said aloud: good diabetic or bad diabetic. Or, my least favourite term: noncompliant diabetic.
The problem with any of the above (good, bad, or non-compliant) is that they all imply that managing diabetes is easy. That all you have to do is follow the rules and—poof—your blood sugars will be what they ought to be.
The moment you feel judgment coming from your HCP is that same moment you might be tuning out, because that feeling of judgment actually reveals a lack of empathy for just how overwhelming diabetes can be every single day—no matter what your A1C is. If it were easy then the profession of being a DSN probably wouldn’t even exist.
If you’re feeling judged at your next appointment, try saying something like this when your A1C comes back at a higher number than your goal: “Okay, I want you to know that I know this is high, and I know my blood sugars have been high. But this stuff isn’t easy….”
Give your HCP a moment to think about this, and even to hopefully reply with empathy: “You’re right—managing diabetes is not easy!”
Then, ask for the help you need. Too often, at the doctor’s office we’re made to feel as though what they give us is all they have to give, but it’s quite possible that they have another version to give… you just need to ask for it. (They aren’t psychic!)


Here are a few ways to ask for that help:
 
  • “I’m having a hard time with my diabetes right now because ______(personal example goes here)__________. Instead of focusing on the A1C right now, I think it would really help me to focus on trying to _____(examples: take daily walks, eat breakfast regularly, cook more meals at home, start meeting with a therapist, repair my relationship with my parents, get a healthier job, etc.)____.”
  • “The reason my blood sugars are so high lately is because ____(examples: I’m binge-eating every night and I can’t stop, I hate taking injections, I’m afraid to see the number on my meter so I don’t check, I’m feeling really depressed and I don’t have the energy for diabetes right now, I’m so overwhelmed by diabetes responsibilities that I just give up). Instead of focusing just on the A1C, could you help me figure out how to address this other issue that’s inevitably having a huge impact on my blood sugars?”
  • “To be really honest, the reason I haven’t felt motivated to manage my diabetes lately is because my appointments leave me feeling guilt-ridden, like I’m a horrible person because I can’t be the perfect diabetic. I really want to look forward to meeting with you, and I want to feel like we’re on the same team instead of feeling judged. Can we talk about how to change that so it doesn’t feel that way?”
This is about you taking control of the conversation. Standing up for yourself. Expressing yourself. If you were at a restaurant and your meal was served cold, you would do something about it, wouldn’t you? You would let them know that that’s not what you ordered and definitely not what you’d like to eat or pay for. The same simple logic applies at the doctor’s office, too—bearing in mind of course that an adequate amount of thoughtful respect should be applied in both the restaurant and the doctor’s office!
Your HCP is there to help you, but they aren’t mind-readers either, and their schedules are jam-packed, and they’re juggling a whole lot of personalities throughout the day as they meet with their patients. You need to take control of the appointment by expressing your needs, explaining your obstacles, and asking for the help you want instead of just accepting the version of help they’re serving.
If the idea of actually speaking up (like, really speaking up) at your next appointment feels like something you can’t do… you can always just send this article anonymously, too. You never know, you might accidentally help change the way your HCP communicates with several patients instead of just how they communicate with you. (And simple tip for any HCP who is reading, just ask: “What can I do to help you?” and then… listen.)
 
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Quantum Learning

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Re: Don't judge me
« Reply #1 on: 01 August 2016, 06:05:35 PM »
Very helpful, thanks Patti  :)
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9% Chol
Metformin SR 2000mg, Candesarten Cilexetil 4mg Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

Offline himtoo

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Re: Don't judge me
« Reply #2 on: 01 August 2016, 09:06:52 PM »
great topic and post Patti -- worthy of a sticky
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Pattidevans

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Re: Don't judge me
« Reply #3 on: 01 August 2016, 10:06:50 PM »
OK I cannot claim authorship of the original but it hit such a chord as I have been saying stuff along these lines for the whole time this forum has been live.  I will make it sticky.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline nytquill17

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Re: Don't judge me
« Reply #4 on: 02 August 2016, 10:59:02 PM »
I love it! Have finally made my next appointment after almost a year off the radar - expecting A1c will, as usual, not be stellar. Am going to have to gear myself up to have a conversation like this one instead of the usual! :)

Is the original US-oriented article still around? I'd like to see it!
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

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Re: Don't judge me
« Reply #5 on: 02 August 2016, 11:15:11 PM »
Yes... let me find it.. ah here http://asweetlife.org/feature/how-to-get-the-right-support-from-your-diabetes-educator/
Of course we do not hire CDEs and there are limitations on what we can call on.  I think similar with you Nyt...but much of it is appropriate.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline nytquill17

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Re: Don't judge me
« Reply #6 on: 02 August 2016, 11:52:23 PM »
I presume that's a bit metaphorical. In my experience in the US you don't literally hire a CDE to work for you; you get referred to one or sign on as a patient with one, same as any other HCP.  But thinking of the patient as a client who is "hiring" HCPs sort of as contractors is a common metaphor in the world of patient advocacy; people speak of "firing" your doctor if you don't agree on important issues, which just means to stop seeing that doctor and find a different one! But the idea being to emphasize that the doctor-patient relationship is ultimately a service relationship, not an authoritarian relationship, and one that is meant to serve the patient, not the doctor. It's a very US metaphor, because there is a bit more of a free-market system in terms of who sees what doctor. While in Quebec, at least, you see whichever doctor will agree to see you, IF you're lucky enough to find one that has room to take you on, and you don't look a gift horse in the mouth once they have! (Though as a diabetic at least you can't legally be turned away, but the quality of care may not be top notch if they are stretched to the limit...)
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

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Re: Don't judge me
« Reply #7 on: 03 August 2016, 09:17:10 AM »
I wasn't 100% sure of the system over there.  Here you also pretty much get the Dr who will take you.  It used to be that you ŵent to the Dr in whose catchment area you live, but that has changed slightly recently and you can see a Dr from another area should you wish.  However as you've likely seen on this forum, patients are somewhat reluctant to change Doctors if they disagree/dislike them.  I think there's a feeling that they will be seen as carrying a stigma.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline GrammaBear

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Re: Don't judge me
« Reply #8 on: 03 August 2016, 06:14:36 PM »
There is a free-market system here in the US, but it is not without its flaws if you might call them that.  The Doctor/patient relationship is marketed as a "service" relationship, when in fact it can and often is the other way around - very authoritarian in nature.  I have been "fired" as a patient because I refused to take a statin drug and I suspect that somewhere in my medical records there is a label of being non compliant. 

Type 1
Tandem Tslim pump Oct 2015
Dexcom G4 CGM Sep 2007
A1C 6.5%~ Sep 2017

Offline Pattidevans

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Re: Don't judge me
« Reply #9 on: 03 August 2016, 07:25:53 PM »
Thank goodness it's not the same over here Kathy.  I have been refusing statins for years now!  I am still welcome at my GP's surgery.

Incidentally (and I will post this elsewhere) for anyone wishing to refuse statins here's a good article written by a doctor which may help bolster your refusal.  http://kellybroganmd.com/cracking-cholesterol-myth-statins-harm-body-mind/
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans