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"poorly controlled" = our fault

There was a research study done by Southampton Uni last year I believe.
Talking to a chap that was analysing the results he said that patients outlook on life -whether they had a negative ir positive outlook was key to how they handled the way they are told "your medical condition is uncontrolled" etc...
 
It is my understanding that when a HCP uses the term " poorly controlled", it means exactly that - that the person concerned does not have their blood glucose levels within a certain parameter. However, in a case such as this, or in a report, that statement needs further expansion, such as " this is possibly/ probably due to " . Sometimes this expansion could imply patient error, disregard or ( hated term!) " non compliance " , but in itself " poorly controlled" is Insufficient.

Where there is an investigation/ complaint or legal issue, extra care really does need to be taken to dot the i's and cross the t's so it is absolutely clear whether or not the patient is poorly controlled due to brittle diabetes etc, or because they simply refuse to take their insulin or any other scenario in between these two examples.

Otherwise, it's merely a statement , such as Mr.M. is experiencing such and such complications, probably
due to his diabetes being poorly controlled " thus excluding other pathologies .

Signy
 
gemma6549 said:
I don't think the term "poorly controlled" is a statement of blame at all.

How else would you want it to be described?

How can it be describe in a way that someone won't interpret it offensively?
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But we are dealing with the legal profession, where they are trained to twist the tiniest blemish into a gaping wound!
 
Some of my posts have been removed from this thread. How do I find out why?/ who do I contact
 
gemma6549 said:
But what is being discussed is still the same. The control is still poor whatever the intent of how it is being said.

Asking whether it is someone's fault or if someone is placing blame when describing something is just never going to be answered, only speculated on.
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On the contrary, it's a very simple question as to what HCPs mean by "poorly" controlled. If there is an objective definition then it is either based on outcome, and thus blame free, or based on compliance, and thus (also) a statement of blame.

It's possible, as you suggested, that there is no accepted objective definition amongst HCPs, but I very much doubt that that they get to subjectively define the meaning of important clinical diagnostic terms. And if they do, that's a big problem.

Of course their diagnosis will always involve a subjective element, but they must work within agreed objective definitions. Otherwise they are not practicing medicine.
 
gemma6549 said:
Thanks, for some reason the mobile version displays multiple versions of the same thread, not all with the same posts!!

Thank you very much for checking
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Sometimes when using the mobile app it does not refresh the pages to reflect new posts. This sometimes causes posts to appear lost. If you refresh the pages that usually works.
 
Spiker said:
On the contrary, it's a very simple question as to what HCPs mean by "poorly" controlled. If there is an objective definition then it is either based on outcome, and thus blame free, or based on compliance, and thus (also) a statement of blame.

It's possible, as you suggested, that there is no accepted objective definition amongst HCPs, but I very much doubt that that they get to subjectively define the meaning of important clinical diagnostic terms. And if they do, that's a big problem.

Of course their diagnosis will always involve a subjective element, but they must work within agreed objective definitions. Otherwise they are not practicing medicine.
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Sadly the majority of the human race spend their lives being subjective
 
Yes I agree, I find it highly offensive at times when I might have a hypo or my sugars are higher than they should be and someone says "your not looking after your diabetes" or "your diabetic control is bad !"

It's true, some have absolutely know idea. We can be ill if we are too low and ill if too high (or dead either way!)

We have to keep our levels in between 4 and 7 for us to be declared as having good control. For crying out load non diabetes levels are only between 4 and 6 ! That's how tight we must keep things with an organ that can't produce insulin !

Asthmatics have asthma attacks, epileptics have seizures, people with mental health issues can have the occasional relapse but we seem to be singled out for some reason.

They are also constantly talking about how much diabetes costs the NHS and they have hour long Panorama specials that make us all look like the Yorkshire Ripper and twice as evil ! OK maybe a little OTT there but it is really frustrating.

Though I do have to be totally honest and say that there are some times when my control hasn't been good and I know it is directly due to me !

Good thread !
 
@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.

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.
 
I like what the Australians have suggested, essentially dropping the confusing term "control". Instead, use emotionally neutral terms describing the A1C/ BG levels as within the target range, high or low etc. which cannot be interpreted as pointing the finger at anyone.
 
As a layperson (non diabetic, and before I even knew that there were different types of D) I heard the phrase 'poorly controlled' about a diabetic at work.

My immediate assumption was that they were careless, lazy or both, and didn't bother to look after themselves. I hardly knew them, but had seen them putting sugar in their tea. And all I knew about D was that sugar was a no no. So of course their lack of control was self inflicted. Just like people being fat is all their fault.

Unless I had learned better (and I HAVE learned better on both the sugar and the fat thinking!) I would have applied that thinking to any other D I would ever have met... But then, I am no longer a lay person. And I'm also older, and a bit less judgemental. I hope.
 
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donnellysdogs said:
There was a research study done by Southampton Uni last year I believe.
Talking to a chap that was analysing the results he said that patients outlook on life -whether they had a negative ir positive outlook was key to how they handled the way they are told "your medical condition is uncontrolled" etc...
Click to expand...

Yep, that's why I trawl through this thread & air toward the "wisdom" in @gemma6549 's comments...

I'm a cup half full kind of guy...! :D
 
Spiker said:
Doctors are trained to attempt to be in the minority who aren't.
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Then I guess like everyone else they don't do their job perfectly 100% of the time.

I think I've exhausted my opinion on this thread.

I always try to be objective on most things but it seems to get shot down a lot.
 
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