<<Disclaimer: Verify this information before applying it to your situation.>>
This might be of interest to Celiac-Diabetes List subscribers. The
referenced magazine/newspaper is a good source for current information.
Sara Jones
Houston, Texas
<mailto:[log in to unmask]> [log in to unmask]
-----Original Message-----
From: [log in to unmask] <mailto:[log in to unmask]>
Sent: Sunday, April 04, 1999 5:52 AM
To: [log in to unmask]
DIABETES
INTERVIEW
NEWS a weekly e-newsletter for people with
Copyrighted 1999, Diabetes Interview
Diabetes Interview newsletter #160
"My Own Injection," Scott King's April column
DON'T Call Me Noncompliant!
Has your doctor labeled you "noncompliant?" Has he or she written
this down in your chart? This might serve as a basis to deny you medical
education. In the August 1998 Diabetes Care, physicians were surveyed about
what hinders proper diabetes care. Most doctors blamed the patient's lack of
compliance with suggested treatments.
Doctors rampantly label people noncompliant in offices across the
country, but nobody really knows what the definition really is. Is it a
diagnosis? Basically, if the doctor perceives that you are not doing what
he or she tells you, then you are noncompliant. This is bad enough, but now
we have word that health education is being withheld from people whose
doctors label them as noncompliant. Their argument is, "If patients are not
going to do what I tell them, what good will it do to refer them to diabetes
teaching centers? They won't change their behavior anyway."
Because there is no constant definition for this term, Mike Taylor,
RN, BS, CDE, of Northridge Hospital in California, is seeking professional
clarification from the American Association of Diabetes Educators.
Taylor leads a support group for people with diabetes. At a recent
meeting, one of the women attending the group said that she had been told by
her MD that she was noncompliant because her blood sugar was uncontrolled.
She was upset because she had done everything he had suggested, but it
didn't make a difference in her blood sugar control. The woman requested a
referral to the local diabetes management program, and her MD refused
because she is noncompliant.
It's Basically a Power Issue
"What if the doctor tells you to test four times a day, and you only
test three times a day?" asks Taylor. "Are you noncompliant?"
A doctor can use a term like noncompliant to blame a patient for
high blood sugars. Is this a form of discrimination? It's really a power
issue, if you think about it. If you have done something against your
doctor's recommendations (whether these recommendations were correct or
not), he or she may label you noncompliant.
"To label someone as being noncompliant takes away their rights of
autonomy, which is a basic principle of medical ethics," says Taylor.
"Sometimes, noncompliant is just 'we don't have a good relationship.'"
Robert Anderson EdD, University of Michigan, is a leader in diabetes
education and patient empowerment who defines the term noncompliance not as
a patient's refusal to comply with the advice of a health care provider, but
as "two people working toward different goals."
Patients are often blamed and criticized for their efforts at
self-care. As a result, we may hesitate to visit professionals and honestly
discuss our daily activities. Because of past negative experiences with
health care professionals, we may hold back from expressing disagreement.
The first (and possibly the most important) principle is that nearly
100 percent of diabetes care is provided by the patient, not the health care
professional. Diabetes care is not as easy as "take two of these and call me
in the morning."
Instead, patients make the decisions and control the success or
failure of regimens. If we are to be successful, we must have a great deal
of understanding of the disease and its many forms of treatment.
"I'm interested in seeing if we can get a discussion going about
this among professionals," says Taylor.
Maybe we should label doctors (or health agencies) noncompliant if
they don't provide the standard of care required for people with diabetes.
Are you provided with plenty of test strips, regular education about
exercise and diet, updates on complication prevention, and all the blood,
eye, kidney, heart and nerve tests needed every year?
Instead of writing "noncompliant" on a person's chart, how about,
"needs more information," "needs a new approach," "needs an exercise
consultant," "needs a new doctor," or "needs family counseling"? I believe
that we should completely abolish the term noncompliant.
Scott M. King
Editor-In-Chief, Diabetes Interview
Type 1 diabetes-23 years
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************************************************************************
Ralph C. Laube
Post Office Box 79 Times are bad.
Thirroul, 2515 Children no longer obey their parents,
NSW Australia and everyone is writing a book.
Phone 0 416 147 047
Phone 02 42 840 833 - Marcus Tullius Cicero
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