BMJ on what happens when we know more than HCPs

shared this with my two brothers in law who are both GPs,

I think it's a very interesting article but could go even further exploring the threat to the assumed expert role of the GP and the potential reactions

ElyDave said:

shared this with my two brothers in law who are both GPs,

I think it's a very interesting article but could go even further exploring the threat to the assumed expert role of the GP and the potential reactions

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FergusCrawford said:

BMJ research on the effect of "expert patienting" http://bmjopen.bmj.com/content/3/11/e003583.short

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What did your GP relatives make of the article? I'm well read and I 'think' it irks my GP a little but I have a great r/ship with the nurse.

Everyone I speak to about my diabetes (GP/DSN, etc...) see's me as being awkward.

It infuriates me that their method of "trial and error" has to be follopwed by a patient in order to be seen as being "compliant".

Sorry Patch but your typo follopwed is just spot on
CAROL

This is one of the reasons that I want to get this thing under control before I get anywhere near a DIabetes Diagnosis.. It must be so difficult for patients to explain certain things to their GPs. i would find this very difficult as I would hate to undermine my GPs knowledge in his presence!

ElyDave said:

shared this with my two brothers in law who are both GPs,

I think it's a very interesting article but could go even further exploring the threat to the assumed expert role of the GP and the potential reactions

Click to expand...

Expert role? A common misconception. General Practitioner. The GP who diagnosed me did so with a simple urine test, had the knowledge to register that frequent urination, weight loss and high BG levels in a 30 year old = T1 diabetes. He immediately sent me off to hospital. Job done.

GP's are the front line and it's up to them to get you to the experts.

Personally, I believe that diabetics (any type) that can achieve a hba1c of 6-ish without debilitating hypo's are more experts than any health care professional. To me HCP's do not live with Diabetes 24/7... Yes, those with high hba's or hypo's etc may benefit from HCP's help... However, I have to say that I have not met any pump consultant or dsn that has actually lustened fully to me or acknowledged that twice now .. When I have told the HCP's that equipment is faulty, they have basically td me I was wrong, that I was at fault. NO, twice now I have identified problems with a cgm and sets. Both times I told Nhs Staff there were problems. Thankfully I reported these faults to the correct channels and I was proved correct.

Health care people can help, but personally I think that it is down to them to listen more to patients that achieve good results, and to pass our learnings on... Not their theory read journal information....


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That's because you get treated to the unsaid moralising attitude that's 'it's all your fault', and they are annoited by god and therefore know it all!

I note that one of the comments left indicates similar frustrations experienced by informed MS sufferers, so it's not just us. I accept that GPs are 'generalists' but they should know enough to understand what they know and what they don't know (apologies to D Rumsfeld) and if necessary engage in constructive discussion with their patients rather than adopting a holier-than-thou approach. And with T2 cases growing rapidly they should make more effort if needed to understand the condition more and start questioning NICE.

The problem is that us lot are really motivated, intelligent, people with enquiring minds. That's why we post on this forum and ask questions. We ask questions about stuff we don't know, share experience out of a genuine desire to help others and find stuff out. Although this forum is big, we are only a tiny percentage of diabetics out there. Unfortunately not all diabetics can or want to do something about it. It's such an insidious disease. If I eat a cream cake, bar of choccie, whatever as a type 2 , other than feeling a bit dizzy, I do not see an immediate effect. So some people will carry on. Over a period of time, damage is then done. It can take years before there are visible effects and by then it's too late. Obviously, it doesn't help when you are told, this is a progressive disease and you will end up on insulin. (I am quoting my own DN here!) people then feel depressed, think what's the point and carry on eating as they were. The other belief, often spread by HCP, according to posters here,is that the medicine takes care of everything.
So docs write us all off, rather than judge us as individuals. I have only recently been given a monitor and even then it was made clear to me that the strips would be provided on a month by month basis and not for ever. Yesterday the doc finally put them on repeat. I am sure that this is because I was able to provide evidence to show that I monitor what I eat and use the monitor to help work out what I can and can't have over a period of 6 months. My doc was impressed about my knowledge of HDL, LDL and triglycerides. Info I have found out from all you boffy scientists on this forum. Broken down into simple chunks so that even I could understand! However if you want it translating into Swedish......

Certainly an interesting article. Will need to save that link so I can send it to my Dr's when they try pulling some of their tricks.

I think I made a comment on another topic relating to this. GPs aren't really experts, as has already been mentioned, and are the first line of defence for the NHS. That my GP was able to turn around and say, "You've got way beyond what I know, I'll refer you to the specialists." was a great result and shows him in a good light.

Some don't take it as well as that though, and feel very threatened that their whole position in society is eroded by "pseudo medical professionals with too much access to information they don't properly understand" (A statement taken form an older generation Mr. So-and-So, a Consultant friend of the parents.

Having said this, I don't believe it applies only to GP level services. Having received the advice from Professor Graham Macgregor (a very well known man in Hypertension circles, google him) that blood pressure would kill me before blood sugar control and that it was more important to manage that (I actually made a complaint to the hospital after receiving this advice), I'd say that there are plenty of disciplines in the medical world where the intelligent, questioning patient probably has as good a knowledge about what affects them as anyone else, whether they be an endocrine specialist or a hypertension specialist. Very few seem to properly take into account looking across conditions and seeing the holistic view, and the GP doesn't have enough knowledge to do that.

As a result it is left to those patients that want to to have that level of knowledge, control and power, and you have to plough on regardless (and clash heads when necessary) rather than accept the wrong advice.

Interesting article/abstract, and I agree with above posters about the increasing challenges doctors will be facing when confronted with patients which may know more about their individual disease than the doctor.

In this context I thought it might be interesting to tell that I have been screened to participate in a 'patients as coeducators' programme at the main University Hospital in Denmark where graduate soon to-be doctors get 'hands-on' with real patients (and not mock-up situations).

This is mainly a programme about communication skills – doctor to patient – and not especially diabetes. ( We are usually four with conditions of T1, T2, heart or Col in a team).

I recently went in for an all day evaluation meeting of the past semester with all patient-coeducators where we learned that the med students had given high scores to the course (mandatory for the med students).

In the course, there are first individual confrontations in a make-believe consultation ('doctor-soon-to-be' facing a 'real' patient – in my case playing the role of a newly diagnosed, somewhat scared and bewildered Type 2). After each 'consultation', we will give direct and as far as possible constructive face-to-face feed back to the 'doctor', i.e. your take on what you thought went well, and what you think might be improved regarding communication skills.

- Then there will be a plenum where we tell our real story about personal experiences in doctor-patient communication situations as we know it from our real life situations. - Mine have often elicited somewhat incredulous laughs! How could a doctor do or say this? – But I think that they take it to heart. – I will stop here – already too long – but could write pages and pages …

Annelise

- by the way, all sessions are videotaped (somewhat scary for me at first as I am usually rather a private person!) - But then, OK for me if it will help future doctors to get better communication skills.