Professor Philip Home , Professor of Diabetic Medicine at the University of Newcastle Upon Tyne , UK
From the moment of diagnosis, people with diabetes are faced with a barrage of information and choices. There's the technical aspect of diabetes to explain as well as all the lifestyle issues that have to be communicated. Professor Philip Home acknowledges that the initial meeting with a diabetes specialist can be daunting.
«When first diagnosed, the major problem is that people are in shock. It's not easy to listen and take in all the facts and it's hard to appreciate the position you are in. So, one of my major frustrations is that I'm aware that there is a good deal that people should be taking in but they are not able to do that at this time. All I can do is deal with the critical issues at that first consultation.»
Of course, over time, the shock subsides, and it's then that doctors, such as Philip, try to move the agenda on to talk in more depth about what diabetes means to someone and how they should begin to change their lifestyles to accommodate the condition.
«I explain that they are only going to see the diabetes team once every three months or so, and in the meantime diabetes will be with them. In this way I try to impress the logic of them taking control of managing their condition,» he says.
Most people accept this reasoning and Philip doesn't think that, for the most part, there is a problem with people understanding the technical issues and grasping the knowledge associated with diabetes. «I find people pick up the understandings and knowledge quite quickly. What people have problems with is building those understandings into their current lifestyles,» he says.
Philip agrees that there are always those situations where everything has been explained to the patient, they seem to have understood what is needed, but when this person returns for their next check-up it is obvious that they have not been following the recommendations.
«When that happens, I feel guilty,» he says. «It's a sign that the system is failing somehow. We should be able to help these people achieve good health and for some reason it's not happening. »
Part of the problem is time - time that many consultants don't have. It's a lengthy process to explain all these elements to people, and it takes time to talk to them and explore their current situation in enough depth to make sure that the advice given is relevant to them.
The most common request we have is to help people find way to manage their diabetes that fit into their lifestyle. We need to explore their lifestyle in detail, maybe look for other insulin dosing arrangements, really explore these solutions on an individual basis. But this tares a lot of time.”
The psychology of the patient is also something else that Philip has to keep in mind. Some people can become so stress with their condition over a period of time that they are not taking in any of the information given to them. «Bad news is always a worry,» Philip says, «and it's difficult to avoid that. We have a duty to tell people what is happening to them - to off them ways of improving their health. At the other end of the spectrum, you have patients that are so laid back that all the information just rolls off them like water from duck's back. They don't take the information in ether -that's their choice. Of course most people sit somewhere in between and take some information in, but maybe not all of it. »
For the future, Philip would like to see a complete sit to patient-centered treatment. «While we talk a lot about patient-centered care, it's obvious to me, at present time, that we are not making a lot progress achieving that. I think we have to disseminate the concepts and spread them out as widely as possible. Only then will we have a system that can provide proper individualized care. »
