[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IPk] human doctors

Hey, Abigail, that was ME you're talking about!!!!

Not quite deliberately missing insulin, but I do remember staying at parties
rather than go home to take my evening insulin. I smoked through college,
and simply ignored anyone who told me to give up. So the pontificating
approach of many professionals is ineffective to start with. So is nagging
or the 'scare the living daylights out of you' approach, which turns people
off and simply insults them.

So I've adopted a much softer approach, which ethicists like because it
respects autonomy. I basically present information and let people make up
their own minds, and I can live with their choice even if it isn't the one
I'd make.

I like this approach, because it prevents arguments, saves me a lot of
stress, and takes a lot of responsibility off my back. Instead of feeling
bad if things don't go well, we can both take comfort from the fact that it
was the 'best fit' decision at the time.

In normal working any method will do, but this approach really works when we
have differing views, so if as you mentioned someone simply isn't ready to
give up smoking, I've replaced co-ercion with negotiation or even
acceptance, with a hope in the background that we can always revisit the
subject at a later date.

I often have heated discussions about this with medical students, who say,
but it's your job to cajole people into giving up or following a 'rational'
treatment plan. But they've never met the people who refused simple surgery
because someone they knew died having the same op, or people who beat the
odds by not falling over when they were supposed to! I use the classic
scenario of 'patient wants antibiotic, doctor thinks it's a virus' to
explain this. They say, put your foot down and say 'No', but I say fine, but
how sure are you that it is a virus, what harm does it do to capitulate, and
what harm will it do to the therapeutic relationship to dig your heels in
about it.

(by the way, I still think most of my colleagues capitulate a little too
readily, in Ireland I believe GPs sometimes prescribe an antibiotic with no
discussion simply to justify a private fee!).

Anyway what I'm hoping is that our future care will be characterised by
discussion, negotiation of agreed management plans, consideration of quality
of life issues and shared responsibility when it isn't all going according
to plan. For me, this means less medical input and more involvement and
responsibility for nurses, psychologists certainly, and for US, not just
helping ourselves but each other as well. If it all seems too different for
you, I attended a meeting in Stockholm recently at which doctors from across
Europe listened to a lecture by a patient on diabetes care, and felt it was
the best talk of the conference. Times really do change, and that
organisation (Primary Care Diabetes Europe) is chaired by a GP from the UK.

----- Original Message -----
From: "Abigail King" <email @ redacted>
To: <email @ redacted>
Sent: Monday, June 24, 2002 6:00 AM
Subject: [IPk] human doctors

> Yes Jenny
> Some of us may be abrupt on occasions when really pushed or plagued by
> daft patients
> like " Dr X was going to refer me to the hospital/ physiotherapist but I
> haven't heard anything yet" when the patient only saw Dr X 6 days ago and
Dr X
> only had time to type the letter 3 days ago
> I'm a doctor who sometimes gets annoyed with really silly patients but
> gets annoyed with other doctors when they need a bit of a reality check
> I find it hard to believe that someone would mouth off at someone in such
> unsubtle way about a disease that is as life altering as DM, however
> they were
> Unless perhaps they were deliberately omitting insulin/ overdosing on a
> regular basis/ eating crap all the time or smoking and not even
> quitting
> I think you were talking about a test called fructosamine , and I
> this is the percentage of another protein ( ? albumen) which becomes
> glycosylated. It is cheaper than A1c and only reflects glycaemic control
> the past 3 weeks. 500 is high ( I think normal is around 200), but she let
> without even bothering to explore why: had you had an infection, what
> were you on, did you need some dietary input/ had you developped a phobia
> hypos etc
> ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml