Last week we discussed issues one through five and strategies conducive to a healthy therapeutic relationship. Today, we will discuss more issues that have the potential to negatively affect the relationship between you and your diabetes team.
5. Poor communication between the diabetes team and family: Ineffective communication leads to ineffective, at best, or poor care, at worst. It is important that you and your family be able to communicate with your team. This effort may involve some advance planning on your part. It will help you to write down a list of concerns, needed prescriptions, and other appropriate information. Therefore, bringing logbooks, all meters and pump information, etc., to the appointment is essential so that the team may recommend the appropriate course of action. Incorrect or fabricated information makes things dangerous. Communicate your needs soon in the relationship and ask your diabetes team to do the same. Lack of communication provides the basis for unhappy and non-productive therapeutic alliances.
6. Inability to compromise and negotiate a treatment plan: This is often one of the major roadblocks to a working, productive alliance. The success of arriving at the best possible medical plan is based on the willingness of the patient/family and team to work together in the best interests of the child or teen. Twenty-eight years of experience has led me to believe that no therapeutic plan succeeds without the input of the child or teen/family members and diabetes team. Keep in mind that, in general, there is never one clear correct path to achieve stable diabetes control. Every family/child is unique and has its own constellation of considerations.
7. Roadblocks: or perceptual differences between the diabetes care team and family, may occur. In such cases, if no compromise may be negotiated after multiple attempts and significant effort it may be prudent to switch providers or diabetes teams. Examples include unwillingness to be flexible in regard to timing or different insulin regimes, nutritional philosophy, etc.
8. Lack of empathy and understanding: by the provider and healthcare team may compromise the therapeutic relationship. It is very difficult to be heard by a healthcare professional if the provider is unwilling to listen and truly engage in what the child or family is trying to communicate. Once again, if the provider of diabetes care will not attend to the issues that the family prioritizes, little will be gained in the medical encounter. Diabetes education and treatment is best served when the healthcare providers are tuned into the patient and family's agenda, not the reverse. A child/teen/family is ready to learn when they feel it is necessary and prudent to do so, not when the MD/CDE decides it is so (unless it is a medical emergency).
9. Inability to discern body language and the hidden agenda between the diabetes healthcare team and the family: This is a huge deterrent to effective communication and treatment. It is important to try to develop some form of emotional intelligence by both parties to truly understand the whole picture. Words do not always convey what is truly meant. A teen who verbally agrees to overhaul their present insulin regime of two shots per day to transition to basal/bolus therapy all the while sitting back in her chair with steely eyes and arms crossed is not exactly on board with the new program. It is important that both diabetes providers and parents actually pay attention to what the child is saying without words. The ability to truly tune into what is actually being felt by the child will reap multiple therapeutic rewards and avoid major disappointment.
10. Know when to ask for psychosocial support: My last issue that divides providers and families is the most difficult to navigate. Oftentimes, despite multiple attempts to medically treat the child with diabetes, we are unable to regulate blood sugars, improve quality of life or help families adjust to the new normal. At these junctures, we call upon other members of our diabetes team, which include psychologists, social workers, and dietitians, etc. As doctors and nurses, we are not always equipped to handle psychosocial concerns in the most efficacious manner. As such, we call for help. In most cases, families are aware of the need for psychosocial support, but resist in either asking for assistance or accepting an appointment. Other obstacles include the lack of qualified behavioral consultants in a geographic area making travel inconvenient. Diabetes is a complex constellation of associated medical and psychosocial issues. In order to fully appreciate and take advantage of an equipped diabetes team, it is essential to call upon each and every member when there is the need. Resistance to such assistance will not solve the underlying medical problems.
I appreciate your comments (especially with these last two blogs) to discuss additional issues that are relevant to the diabetes team/patient/family therapeutic dyad.