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Re: [IP] The pump IS for everyone



Randall,

    As a community college teachers these characterizations scare me a good
deal.  They allow us to write off people who at a given time don't behave
according to the strictures we believe are best for them.  What you see just
isn't always the whole person and allowing medical staff to rest easy with
those kinds of characterizations strikes me as wrong.  For instance, I often
have students early in the semester who turn in little sloppy work, sit in the
back of class and can't seem to intelligently answer a question at the
beginning of the semester.  It is always tempting to conclude they just don't
or won't care and write them off.  It's often amazing how those students
change in the course of the semester and when I have them examine their own
work for changes (this week -- finals, in fact), they are able to articulate
all kinds of confusion and lack of understanding or how to solve problems that
made them look so unmotivated.  In fact, sometimes you discover that the most
unmotivated students have been so busy beating themselves up about their lack
of ability to do anything right and their lack of knowledge about what to do,
that they have formed a far more negative opinion of their own work then even
the harshest teacher/critic.

    I am not advocating withholding criticism (positive criticism of course)
or letting people know when they are not doing the right thing.  I am
suggesting that there may be many causes for seeming lack of motivation and
perhaps medical staff needs to learn to help diabetics identify those causes,
help them understand ways to effectively address their problems,  and make
informed decisions about if and how they will address them.

I see little evidence that the medical system does this more than once and a
while.  Too many medical people are not well informed or jump to conclusions.
There is little guidance available when you have a problem you can't solve.
Thus, I think we end up with a group of listserve people who have learned how
to solve problems and where to get help and are, happily, eager to address
them -- mostly those in the #1 group I think..  This sorts out those who
aren't sure or perhaps lack any adequate support to find answers.  There are
many people who probably do choose not to care.  There are probably many
others who do care, can't fix it and are petrified.  They probably often get
written off as #2s or #4s.  Do we really want to write them off so flippantly?

Ruth

Randall Winchester wrote:

> On 15 Dec 97 at 20:51, Susan Jordan wrote:
>
> > Buddy and all
> >
> > I must jump in and say whole heartedly that not everyone should use a
> > pump.  I agree that it is wonderful for those that are willing to put
> > forth the effort and have the intelligence to deal with the more complex
> > issues involved.  REMEMBER, not all are as intelligent as we are that
> > have DM.  I say that sincerely, with out sarcasm and not in a
> > condescending manner.
> >
>
> My doctor told me that he has 4 types of diabetic patients:
>
> 1. Intelligent, motivated person - interested in tight control
> and able to handle the discipline to maintain it.  Doesn't require
> close daily support to maintain control.
>
> 2.  Intelligent, unmotivated person - understands tight control, and
> the benefits but  unwilling to maintain the discipline.  Unwilling to
> cooperate with medical staff.
>
> 3.  Less intelligent, motivated - interested in good control and
> willing to attempt the discipline to maintain it.  Requires more
> support but cooperative and willing.
>
> 4. Less intelligent, unmotivated - may not understand tight control,
> consequences or diabetes and its treatment.  Unwilling or unable to
> attempt control.  Requires much support, usually in the form of
> emergency calls or ER support.
>
> Only types 1 and 3 are candidates for the pump at all.  Many of
> the type 4 patients are either illiterate, poor, or have been told
> by another doctor that "there's not much that can be done."  One of
> the goals is to move the category 4 patients to at least a 3, and
> maybe even a 1.  My wife has mentioned the same type of groupings of
> diabetic and non-diabetic patients she has encountered as a home
> health nurse.
>
> Randall Winchester
>
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> * The views expressed here are mine and do not necessarily *
> * reflect the official position of my employer.            *
> ************************************************************
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