Do your HCPs REALLY listen to good news?

[Snodger]

As a HCP perhaps I can give a perspective from the other side!

Yes most of us do feel pleased when pts get good results but have to be very professional about it. As far as feeding results back well in way that happens - most surgeries have computerised systems so it records HBA levels, wt etc so if you want to look at results you can pull off all pts with a recorded wt or cholesterol etc. This data is fed into government stats . It is probably true that there are still some arrogant HCP but not so many but it works both ways - there are some equally arrogant pts! In general the people I work with are hard working and approachable - but then the Welsh are a chatty bunch!

ally5555, it's great that you aren't an arrogant HCP. As I understand it though, this thread is about patients feeding back HOW they got those good results. Eg if a patient is not following standard medical advice, but is achieving excellent outcomes, then that feedback needs to spread in the medical community and doctors' advice should be adapted to take account of what the patients have found out for themselves.
Usually, though, patients might suggest to their GP that they have successfully tried a particular treatment regime, a good GP will be pleased like you.... but the info is still not fed back into research or to medical textbook writers or policy makers. The good blood test result is fed back into government stats, but the process that enabled the patient to get that result is not.
As far as I'm aware there is no easy standard way for HCPs to feed this kind of data back from the patient, and as others have said, helping with research is only useful if the researchers are already asking the right questions in the first place.

The James Lind Alliance works to try and get particular questions on the big research agendas. They've just done a research priority setting exercise with Type 1s (I took part, it was v interesting). It might be worth writing to them to ask when/if they plan to do the same for Type 2s? http://www.lindalliance.org/

 

[LittleGreyCat]

As a HCP perhaps I can give a perspective from the other side!

Yes most of us do feel pleased when pts get good results but have to be very professional about it. As far as feeding results back well in way that happens - most surgeries have computerised systems so it records HBA levels, wt etc so if you want to look at results you can pull off all pts with a recorded wt or cholesterol etc. This data is fed into government stats . It is probably true that there are still some arrogant HCP but not so many but it works both ways - there are some equally arrogant pts! In general the people I work with are hard working and approachable - but then the Welsh are a chatty bunch!

Please understand I am not knocking the HCPs - just the system.
The results from the practice system get fed up the chain, but the detailed reasons behind the changes often (I suspect) do not go into the system.

Also, I wonder if the numbers alone go on for further analysis?
They are easy to analyse and aggregate but side notes from the care team are a much more difficult subject.

The thing prompting my speculation is the current state of low carbing.

More and more people on this forum (myself included) seem to be finding that lowering carbs improves control. Now this may just be localised to this forum because it has attracted active low carbers because it has a low carb forum - sort of reinforcement mechanism.

I know low carbing isn't for everyone and have been irritated by some evangelists in the past.

However what I have seen on this forum is at least a few posters who have said things like "I didn't tell my HCP I was low carbing" with the implication it would not be well received.

I know my diabetes nurse was very pleased with my results but concerned that I didn't cut my carbs back too far.

I received very good support when first diagnosed including a session with a dietician (two, actually, because there was a trainee and her supervisor) and all the usual booklets but the advice was pushing the 'balanced diet' line with healthy carbs as part of every meal.

What I would like, I suppose, is to be asked in detail how I achieved the improvements so that they could be fed back into the system.

:lol: :lol: Picture the GP rushing in and saying "You did what? Let me takes some notes and I'll write it up for the Lancet! Hold the front page!" :lol: :lol:

All very self centred and childish, I suppose

Miss, Miss I've painted the very best picture ever Miss!
Oh. Yes, dear, vey nice. Now get on with your spelling.
Ohhhhh Misssssss!

So perhaps there isn't the mechanism in place to rapidly flag particularly good or bad results up the chain above the local GP surgery.
If there is it would be nice to have more visibility of it.
Our local practice has just initiated an online forum to encourage patient feedback so I could raise this there - but I am the only one on there apart from the Admin at the moment

It is difficult to see how the current system can respond speedily to new information about patients health, but the amount of information gathered each day must be vast across the country.

Anyway, got it off my chest ;-)

Cheers

LGC

 

[ally5555]

There is a way of feeding back info - on the system we use there is a section on lifestyle so you can put in info about diet. It uses a system called "read codes" so it can record specific data but in practice I do not think I have ever been asked by a pt to put in anything specific.

I work closely with dietitians across Wales and there is a lot of work going on looking at innovative ways of using scarce resources in the diabetes field. I also go to diabetes meetings and this notion that everyone is just pushing starchy foods does not seem to be happening! I think the problem arises when pts get sent to a general dietetic clinic and not to a specific diabetes dietitian. I use a moderate approach and have many pts with HBa1 in the 5s. I generally see pts within a few weeks of diagnosis - I think that makes a huge difference. many diabetics get no input or see a nurse - they are not specialists in diet. In the UK there are only 6000 qualified dietitians - as a profession we are drowning in referrals and in many depts in England there has been a reduction in services. Graduates this year are really struggling to get jobs!

 

[Sid Bonkers]

If information on low/reduced carbs does not get fed back into the system why would the dietician I saw last year tell me that "low carb was the way forward"?

Someone or something had to be behind that statement, I seriously doubt that she said it just to appease me

Perhaps you may be being a little unkind to HCP's LGC. BTW thats enough acronyms, IMHO, TTFN

 

[Ka-Mon]

I know my diabetes nurse was very pleased with my results but concerned that I didn't cut my carbs back too far.

I received very good support when first diagnosed including a session with a dietician (two, actually, because there was a trainee and her supervisor) and all the usual booklets but the advice was pushing the 'balanced diet' line with healthy carbs as part of every meal.

Do you still get good support from your HCPs LGC or has this support stopped?

What I would like, I suppose, is to be asked in detail how I achieved the improvements so that they could be fed back into the system.

The problem I see here is that they don't have the time to ask each patient how they achieved their good results without making the waiting times even longer than they are now.

:lol: :lol: Picture the GP rushing in and saying "You did what? Let me takes some notes and I'll write it up for the Lancet! Hold the front page!" :lol: :lol:

All very self centred and childish, I suppose

Miss, Miss I've painted the very best picture ever Miss!
Oh. Yes, dear, vey nice. Now get on with your spelling.
Ohhhhh Misssssss!

The only people who tend to get on the front pages of anything (medical) are those whom are more or less described as "freaks of nature" who achieve something that (probably) no one has achieved before them or are very rare. All I am interested in is looking after my health and I am happy if/when I have achieved good health/BG levels. Whether my HCPs are happy or not I'm really not interested but from experience I know that if I am happy so are they because we have worked together to make me healthy and happy plus they don't have to see me any more which then makes them happy again cause they will have time to work with someone else who is not healthy/happy.

Our local practice has just initiated an online forum to encourage patient feedback so I could raise this there - but I am the only one on there apart from the Admin at the moment

It is difficult to see how the current system can respond speedily to new information about patients health, but the amount of information gathered each day must be vast across the country.

Anyway, got it off my chest ;-)

Cheers

LGC

Patient feed back is a good idea but then they have to have someone read all the info, categorise it and analys each praise/complaint or whatever and then re-educate all their stuff to follow the results of that "study". The thing is, if they find that only a few people had success with low-carbing and more people had success following their "normal" advice then low-carbing advice will not be taken into any consideration at all and they will carry on business as usual. Meaning that they will only either consider low-carbing if the success is in the majority or they just as they are doing it now only work with and support those patients like yourself who have told them how you achieved your numbers. But most HCPs probably will not support low-carbing for the simple reason because it is not adviced by the NHS and should something happen then low-carbers can't put the blame on their HCPs claiming that they were told to low-carb by their HCPs.

In short, anyone who does not follow their HCPs advice, on any illness and not just diabetes, are pretty much on their own and should something happen to them then they can't point their fingers at anyone else but themselves.

It's the same as when a car mechanic says that you need oil in your engine but you don't listen to him and keep driving your car, he can not be blamed when your engine eventually seizes up. (I don't mean you personally BTW, it's just a general use of the word).

 

[LittleGreyCat]

There is a way of feeding back info - on the system we use there is a section on lifestyle so you can put in info about diet. It uses a system called "read codes" so it can record specific data but in practice I do not think I have ever been asked by a pt to put in anything specific.

<snip>/quote]

That is very useful information

I will try very hard to remember to check with my diabetic nurse the next time I have a checkup (September some time) and see if the local GP system has this field.

Do you ask each patient if they want to put something specific in this field and they decline?

Cheers

LGC

 

[jopar]

Problem will always be that a very high percentage of patients will tell the HCP what they think they want to hear!

If you look around this forum you will see that different members will consider different amount of carbs being low carb or not... Some consider the low carb diet to be a carb restriction to 50g or under, to me this is extreme low carbing! You've then got to add onto this how accurate is the information about carb consumption is...

How accurate is the carb count!

As some people are actually eating more carbs than they percieve they are, two reasons for this, 1) being that they only count visable carbs 2) The dish is low carb but due to the portion size the individual is eating a lot more carbs than they think they are..

You could have a T2 diet controlled sat in the consultanting room saying I've achieve this by following a extreme low carb diet I only eat 30 or 50g of carbs a day etc... But if you weighed all what they ate because they have large appetite, not counted in the extra carbs due to this, nor have they've counted hidden carbs they eating over double that in reality!

Nothing wrong for the individual, as what they doing is working for them, but for somebody else it may be very misleading information and not work so well for them!

It's no suprise that when it comes to taking the word of a patient to spread around to others isn't always the wisest thing, but to take information on board and treat with caution is far better..

 

[ally5555]

Hi Jo - hope you are well.

You are right about some pts bending the truth - I always ask them to be honest as it is not for my benefit. When I input data I put the amount of carbs etc but for many pts they would not have a clue how much they are eating if you asked them.
However some people will get more from a HCP if the practitioner is interested and listens but sadly pt time is being eroded because of cutbacks - it is happening everywhere.

 

[robertmiles]

A similar problem here in the US - the ADA is rather slow at recognizing the research on how much low-carb diets can help. So far they've only gone as far as relaxing their reccommendations on avoiding low-carb diets.

This may be partly because someone high up at the ADA some time ago had the idea that all complex carbohydrates would digest slowly enough that they didn't need to be counted, and this was so obvious that no research was needed to check if it was correct. Well, guess what - the research was finally done anyway, and it showed that many of the common starchy foods digest about as fast as table sugar, and into a similar mixture of simple sugars.

I suspect that the NHS is largely following the ADA in this, and simply hasn't recognized that the ADA is SLOWLY moving toward recognizing low-carb diets as useful.