When we don’t get our blood glucose levels low enough or take the diabetes medicine that our doctors prescribe, they often complain about our noncompliance. Particularly when we follow a very low-carb diet and are unlucky enough to have a nutritionist on our medical team, she is almost certain to give us a hard time.
When doctors and nutritionists do that, they are forgetting their place. The doctor-patient relationship is a status thing. While medical professionals usually earn more money than we do, they work for us. We are the ones who make them well off, if not rich.
We hire our doctors. We can fire them too. Several years ago when Byetta first came on the market, I knew that taking it would help me control my blood glucose and lose weight. The doctor I saw at the time had never heard of Byetta, so he had to read up on it. When he did, he refused to give me a prescription for it because he was sure that I would lose only a few pounds. I fired him and proved him wrong after I hired 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. But when our doctors are not on the same wave length as we are, they often blame the victim – us – when we don’t do what they want us to do.
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. We go to our doctors because we want them to help us. I’m not writing about those unfortunate people who are in denial and don’t see their doctor or go only under duress from others. Nor am I writing about misguided people who seek quack cures from so-called natural remedies.
But I know that almost all readers of my articles are trying their best to control their diabetes. I know too that our doctors try during the few minutes we have with them to help. Why then do we so often fail to communicate?
With most doctors those of us with diabetes have to take the lead to change our relationship. It has to become a partnership, as Jane Jeffrie Seley writes so well. We need to be firm with our doctors to disabuse them of their view of themselves that they are the experts whose job is to get us to behave in ways that reflect that expertise. If these experts fail to work with us, we have the duty to our bodies to find someone who will.
For most of us, to be labeled noncompliant is a worse slander than being called a diabetic. This is particularly true when health care people criticize us for not doing things that they haven’t clearly explained or which we think are wrong. An endocrinologist friend wisely says, "The ‘noncompliant’ label always grated on me – it’s assuming a model of health care delivery that the doctor is the captain of the ship and the patients are chained to the oars." Update October 27, 2009: A new article on the website of The Los Angeles Times Jessica Bernstein beautifully illustrates out this problem of communication that we have with our doctors. The address is "Diabetes may create a chasm between patient, doctor." Update July 17, 2012 Dr. Kyle R. Peters gives his professional support to the thesis of my article in his article in the July 2012 issue of Clinical Diabetes. Dr. Peters is a clinical pharmacist at the Siouxland Community Health Center in Sioux City, Iowa, and a clinical assistant professor at the University of Nebraska Medical Center College of Pharmacy in Omaha. The title of his article is “‘Diabetic’ and ‘Noncompliant Diabetic’: Terms That Need to Disappear” and you can find the full-text online at http://clinical.diabetesjournals.org/content/30/3/89.full
David Mendosa is a journalist who learned in 1994 that he has type 2 diabetes, which he now writes about exclusively. He has written thousands of diabetes articles, two books about it, created one of the first diabetes websites, and publishes the monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, current A1C level of 5.3, and BMI of 19.8 keep his diabetes in remission without any drugs. He can be found on Twitter @davidmendosa and on Facebook at David Mendosa.