If you’ve been around diabetes for a while, you’ve surely heard the term “non-compliant.” This is the label that doctors, nurses and other health professionals have used for years to describe patients who don’t follow orders: don’t take medications as directed, don’t stick to meal plans, or generally fail to implement the prescribed treatment regimen.
You and I both know there are lots of reasons why diabetes patients don’t always do exactly what we’re told. And most of them have nothing to do with being just plain lazy or stubborn, as the term “non-compliant” implies. This term not only places a heap of blame and guilt on the patient, but it also reinforces a patronizing doctor-patient relationship; they give us commands, and we should obey.
I’m happy to report there’s been quite a backlash in recent years against this terminology, and the mentality that goes with it.
I’ve been to numerous health conferences in the past months, and one after another, experts — including MDs, health plan executives, and health policymakers — take the stage and talk about “understanding patients’ values” and “working with patients as partners.” Just buzzwords? Hopefully not. At least talking about it is a good start.
Christi Dining Zuber, an innovation expert at Kaiser Permanente, put it this way: “The traditional notion of a doctor’s role was: ‘you tell people to do stuff, you push them to do it, and then you track it.’ That’s just not working anymore.”
Funny that when large numbers of people failed to perform the “stuff,” no one seems to have thought about critiquing the methods. But again, that appears to be changing.
The medical establishment seems to be finally recognizing that we “patients” are people just like them. We have children, and high-pressure jobs, and financial woes, and family stresses, and food hang-ups, and God-only-knows-what-else to deal with in our lives. So don’t just hand me a print-out of a meal plan and expect me to go home and follow it to a T. What if it turns out that I work in a bistro and I’m around rich foods all day? Maybe this meal plan is a complete mismatch for my lifestyle… Did you ask about my lifestyle?
And there’s more to it than that. It’s the way that a doctor or nurse or CDE treats me. First, do they view me as an equal? Second, I need to believe that their concern is genuine.
“Health care is humans giving care to other human beings. It has to be about compassion, an appeal to the heart,” says Kaiser’s Zuber. What a wonderful concept – one that seems to get lost in all the process around health care these days.
Another expert, a researcher and designer named Maggie Breslin at the famous Mayo Clinic in Rochester, MN, spent years studying every imaginable sort of patient interaction at the million-square-foot clinic. What do you think her conclusion was about what good healthcare looks like?
The answer: A satisfying conversation!
“Conversation is how people determine quality and value,” she says. “People love the Mayo Clinic not because of all their state-of-the-art treatments and procedures, but because doctors take the time to talk and answer all patients’ questions.”
A good conversation is the essence of human compassion, I’d say – and oftentimes what we need most from the person helping us manage our diabetes.
A Compliant Doctor?
Finally, veteran diabetes writer David Mendosa reminds us that medical professionals not only need to work better WITH us, but they actually work FOR us. “We hire our doctors. We can fire them too,” he writes. So why not shop around for a “compliant” doctor?
“A compliant doctor is one who not only talks at his patients but who also listens to them. Nowadays, many doctors are too busy processing insurance paperwork to spend much time listening to us… It's our body, and we are responsible for it. One of the ways in which diabetes differs from other diseases is that between rare visits to our doctor's office, we are in control. We have the right to set our own goals and decide how we will manage our diabetes because we have to live with the consequences,” Mendosa says.
Too true. We can be angry with our doctors. Or we certainly have the right to switch doctors if we’re unhappy. Either way, I think we’d ALL be better off if we dropped the “compliant” term altogether and focused on injecting more compassion into the mix.