How can someone who only sees you once or twice a year for roughly 15 minutes at a time really ‘get’ what your experience of diabetes is like? Perhaps I am being a little controversial but I believe that, although you might expect them to, the diabetes doctor, nurse, or dietician can’t. However, here’s something you may not have thought of — they are not really there to.
Let me explain. Of course your healthcare team wants you to be in control of your diabetes and be in good health. They are passionate about helping you to manage the delicate balance between food, medication, and activity, so your blood glucose control is just right. This is fantastic — it is where their skills and expertise lie and they can advise you based on their expert knowledge of the inner workings of the human body.
However, as committed and as dedicated as they are, they are not your psychologist, your counsellor, or your friend. They aren’t there to help you work on the other ‘inner workings’ of your body — your emotions. That’s why there can be a disconnect between your experience of being heard in your diabetes appointments. It’s thankfully becoming more and more recognised that managing diabetes takes an emotional toil as well as a physical one. Government health guidance is calling for greater access to psychological therapies. Yet, a recent survey in the UK showed that less than one third of Diabetes Centres have access to specialist psychological services (Diabetes UK, 2008). There are just not enough Clinical Psychologists to go around unfortunately!
Potential Challenges in the Patient — Healthcare Professional Relationship
Common experiences of relating to healthcare professionals from the patient perspective are:
- Feeling rushed.
- Being patronised, unintentionally or otherwise.
- Not being ‘heard’.
- Feeling misunderstood.
- Not feeling free to talk about what is really of concern, e.g., that diabetes is getting you down.
- Feeling scolded or made to feel like a ‘bad’ patient.
- A pressure to lie about your blood glucose results or other health behaviour.
- Feeling the healthcare professional is an ‘expert’ and can’t be disagreed with.
- Not attending health appointments at all and avoiding healthcare professionals entirely.
Some common challenges from the healthcare professional’s point of view are:
- Not having as much time to spend with patients as they’d like.
- Feeling pressure to be the ‘expert’.
- Feeling at a loss to know how to help.
- Working within an environment with scarce or stretched resources.
- Team conflict amongst colleagues.
- Working to meet government targets, which prioritise ‘hard’ data such as blood glucose levels of their patients over ‘soft’ data such as psychological wellbeing or quality of life.
- Realising they are not able to fully appreciate the lived experience of diabetes (being an ‘expert’ rather than an ‘expert by experience’).
- Having to maintain the caring role at work when experiencing personal challenges in their lives outside of work.
How does it feel to read these two lists? Do any of them resonate with your experience or surprise you? Just viewing the relationship from the perspective of the ‘other’ can be helpful.
There are practical steps you can take today to feel more in control of this relationship. Here are the three P’s of improving your relationship with the individuals in your healthcare team:
- Plan: The first step is to plan for your appointment. Think back over the last month. What has confused you, or surprised you, or encouraged you, or frightened you about your diabetes? What are the three things you would like to know or say to your health professional?
- Participate: The second step is to be an active participant in your appointment. Polonsky (1999), suggests using the ‘ABC’ of effective communication to aid you:
- Assertiveness: express yourself with confidence.
- Brevity: speak as briefly as you can, staying to the point at all times.
- Clarity: express yourself clearly, using short sentences and simple words.
Often writing down some bullet points before the appointment can be helpful, covering the main topics of what you would like to talk about. You can then choose to bring them to the appointment with you, or simply have them in mind to recall them.
- Partner: The third step is to understand and keep in mind that you and the healthcare professional are equals. Rather than feeling like a passive recipient of expertise, remember you are two adults with an immense wealth of expertise. The healthcare professional has expertise of diabetes and the physical aspects of the condition; and you have extensive expertise gathered through your lived experience of daily life with diabetes. Together, you can share that expertise with one another to work towards the benefit of your health.
You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist registered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.