Patients are not designed to self-destruct
Often a patient with diabetes is brought to me and an accompanying family member will complain:
- they keep eating rice
- they cheat and eat sweets
- they overeat
- they don’t walk or exercise no matter how much I tell them
- they drink soft drinks
- they don’t take their insulin
- I had to drag them here
- they don’t check their sugars
- they just don’t listen
I hear this everyday. My role is specifically to NOT gang up with the relative/well-wisher to put the patient in the “naughty corner” or add to the laundry list of “faults” in this person sitting before me. I believe my duty to this human being suffering with diabetes is to understand WHY they are having difficulty taking optimum care of themselves. That’s what I believe is my first role as a health care provider: to establish a relationship with this person. Scribbling a prescription, threatening them with dire health consequences, judging them as “non-compliant”, labelling them as “severely depressed” or rushing on to see the next patient who is willing to do exactly as I say and let me feel “good” about myself as a doctor: these are much too easy and shut down effective communication with someone who needs compassion and help. If they wanted to self-destruct they wouldn’t come to a doctor, right?
In my over ten years of taking care of people with diabetes, I have made a consistently humbling discovery: that without exception, each person with diabetes is a wonderful human being who deep down inside truly wants to get better, and what they need from me is that respect, trust and space to express why they feel unable to adopt healthier behaviors.
“Barriers to change” as we call them in the medical profession, are most often emotional, social or financial. Once we identify the major barriers, then half of the struggle is over. Then we function as a team, as partners, and I request the family member to surrender their “police hat”, and if possible, I ask them to take on a role as a loving supporter of this person on their journey towards better self-care. This very often eases the tension in my office and the patient becomes a more involved decision maker.
