"poorly controlled" = our fault

[gemma6549]

I say keep it up with the sunshine & sugar free lollipops.. Not everybody sees you as target practice...

Ha ha.

I just think if I was saying "yeah HCP's blame us for everything it's so unfair" it would go down better!

 

[tim2000s]

I think that's the crux of the issue though Gemma. Although the words themselves should be objective, as with many things relating to diabetes, they are also subjective and even in the hands of a person trained in being supposedly objective, they can and will be interpreted that way. And as we are seeing even in this thread, people read emotion into them.

It is unfortunate but also very much the way of the world.

 

[gemma6549]

I think that's the crux of the issue though Gemma. Although the words themselves should be objective, as with many things relating to diabetes, they are also subjective and even in the hands of a person trained in being supposedly objective, they can and will be interpreted that way. And as we are seeing even in this thread, people read emotion into them.

It is unfortunate but also very much the way of the world.

"It is unfortunate but also very much the way of the world"

That's the problem!

 

[donnellysdogs]

Unless we totally become a cloned species we are all going to interpret the written and spoken word differently.

 

[Jaylee]

Ha ha.

I just think if I was saying "yeah HCP's blame us for everything it's so unfair" it would go down better!

I look at it this way.. My HSBC was a 6.4 count on the last visit which caused concern as "too low"... We respectfully disagreed.. I have a great relationship with my health team!
Now. Looking at my log book & a day of consistent highs stand out for instance..? What happened here? I came down with flu so corrected the basal wile I was rough for 3 days.. (Lack of appetite.) & on the 4 Day in the morning you had a couple of hypos here??? Yep I felt better from the flu & carbed up to keep things sane till the end of the day... That's fair enough.. Back to normal on the fith..
However If these results had come about because I went on a weekend bender with the lads neglecting the basics..? I only have myself to blame.

 

[Spiker]

@Spiker - is your concern for your friend what is actually written in the document, and what the HCP meant when he/she wrote it, or how it will be interpreted by the person assessing the litigation at the "end game", as these have potentially radically different outcomes or answers.

Good question. It's both really, and they are related. I want to know what the HCP meant, assuming (hoping) that there is an objective definition. I want to know that generally, because I've had that finding given to me from time to time, always assumed it was "blame free" in the eyes of the HCPs, but now I am wondering. I want to know specifically for this guy's case so I can advise him on how best to counter the negative interpretation being put on the phrase "poorly controlled". Obviously that will be more difficult to do if the negative (blame) interpretation is actually correct, or is possibly correct!

 

[Spiker]

I have just asked my OH how he would interpret the phrase, if it were included in a written text. Like me, he suggested he would want more context, but if none were available, he would apply at least some weighting to the patient not playing their part in the control process. To be fair, he is a completely lay person, both medically and legally, although is a savvy character, with his head screwed on to meanings and implied meanings.

Yes I think that is how most non-diabetic lay people would interpret it too. It's so odd that the 'blame' interpretation never occurred to me before.

 

[Yelekreb]

Two thoughts. The HCP could give evidence in person or an independent expert witness could be called.

 

[AndBreathe]

Good question. It's both really, and they are related. I want to know what the HCP meant, assuming (hoping) that there is an objective definition. I want to know that generally, because I've had that finding given to me from time to time, always assumed it was "blame free" in the eyes of the HCPs, but now I am wondering. I want to know specifically for this guy's case so I can advise him on how best to counter the negative interpretation being put on the phrase "poorly controlled". Obviously that will be more difficult to do if the negative (blame) interpretation is actually correct, or is possibly correct!

OK. Thanks for that clarification.

I'd want to look for the definition of the poorly controlled, well controlled etc. I've seen a coloured chart with bands marked up on it, but can't find it right now. I'd want to see who that was attributed to. I'm guessing NICE, perhaps.

Sounds like if this is material to the case, then there may be a disagreement about who did what; in terms of your friend managing his condition, and his employer making suitable allowances for his T1 status.

Who asked for the Consultants opinion? If it was your friend, I'd suggest he ask the Consultant to clarify how he defined the value he has attributed on the spectrum of control. Is it your friend's own Consultant, or someone "independent"?

.

 

[Spiker]

Who asked for the Consultants opinion? If it was your friend, I'd suggest he ask the Consultant to clarify how he defined the value he has attributed on the spectrum of control. Is it your friend's own Consultant, or someone "independent"?

It's his own consultant and I think you are absolutely right, the thing to do is to go back to the same Consultant for a clarification.

 

[AndBreathe]

It's his own consultant and I think you are absolutely right, the thing to do is to go back to the same Consultant for a clarification.

I'd do a bit of research first, to see if there is a definition anywhere. I don't know if Diabetes UK would be able to help out with that bit? If I could, I'd want to read any official definition before asking for clarification, so that if it is well defined; for example, purely focusing on bands of,HbA1c, I could ask the Consultant to confirm he was defining "poorly controlled" in line with the definition, and include the definition. People (even Consultants) look for the easy answer,

 

[Spiker]

OK, lmgtfm ( * )

http://en.wikipedia.org/wiki/Diabetes_management#Glycemic_control (definition in last paragraph)

this study (for T2) gives an HBa1c based definition and says that those that are poorly controlled have "resistant diabetes"
http://www.ncbi.nlm.nih.gov/pubmed/24567193

this study (also T2) http://www.cardiab.com/content/11/1/70
also gives an HBa1c based definition, says that no predictors could be found to design interventions to improve control, and that the majority of "poorly controlled" diabetics were rated as having "very good or good" compliance with their care plan.


* = let me google that for myself

 

[Spiker]

So a quick literature check suggests that the clinical meaning is just that BG and HBa1c are outside of target, and that (at least some) evidence shows that this is independent of the patients' compliance and behaviour.

 

[AndBreathe]

So a quick literature check suggests that the clinical meaning is just that BG and HBa1c are outside of target, and that (at least some) evidence shows that this is independent of the patients' compliance and behaviour.

Excellent. In which case, I would choose a definition, ideally as defined by someone the Consultant might have heard of, and have your friend ask him to confirm his definition of "poorly controlled" is aligned to the x, y, z study, and outlined in the document/papers he encloses. Hopefully, just a brief paragraph will come back saying "yes".

Who defined it, or did you find lots of definitions, in broad agreement?

I hope your friend has a nice file with all these papers and/or links in. It's a b}#^^*\ when you can't find something that was evidential gold dust, a couple of months after finding it.