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"poorly controlled" = our fault



But this case is in written form and therefore tone being relevant cannot be accounted for.

Therefore in the form of a written letter I think "poorly controlled" can be considered more objectively and as a way of describing it than as a form of blame
 
Surely poorly controlled, to most people, would suggest blame.
It also suggests one has the power/tools/ability to control, but somehow fails to do so.
If one has no power/tools/ability to control then they cannot be accused of poor control.
Their health care provider, on the other hand, could be accused of poor control if they fail to offer advice/services/monitoring in respect of any illness.
 


Exactly because your experience means that when that term is used towards you it evokes a negative emotion/feeling

Our personal experiences are what we go by but sometimes that can hinder us too.

What I am saying is that because people have said it negatively in the past doesn't mean we can generalise that everyone is saying it with that meaning.
 
It's going to be different for everyone and I can only go from limited personal experience.

My father is type II and has always followed the guidelines dished out by his nurse as far as diet and exercise is concerned. Taking statins has stopped him from walking, even to the shops 150 yards away, although he does get to the bus stop for GP appointments. He is now taking insulin and trying to follow the guidelines diet wise but his BG is all over the place. Being scared of needles and only now taking his BG once a day doesn't help, but I would say "poorly controlled".

I have a cousin with a similar story to tell although there are other reasons for him not exercising, a lot to do with the weight he gained when taking aural medication, sadly therefore also "poorly controlled".

If I had religiously followed my previous GP's advice I could easily be in the same place, but my carb restriction allowed me to avoid insulin, and throw away Gliclazide, Januvia and Atorvastatin. Since lowering my carb intake my HbA1c has been so good that the doctor puts well done in my notes. Sometimes I feel like I'm back at school. So in my case, well controlled.

Are they to blame for their poor control? Sadly, because they believe their professional advisers without question, it wouldn't be fair, they've done exactly as they've been told. I sometimes feel that I had a lucky escape because I lowered the carbs to lose weight initially. I knew my BG would also drop but I never realised I'd be able to throw away so much medication.
 
I guess in the same way that our negative experiences with HCP's can make us feel we are being blamed when those words are used we also have to remember this:

That HCP's are also human so base a lot of their thoughts and feelings on experience. They see diabetics day in and day out and there will be ones who choose not to control their diabetes.

Knowing the strains of their job and the NHS means they probably feel like blaming people they come across with poor control.

Just shows we all need to treat people and cases on an individual basis
 

Actually my November hba1c result was 7.0 which was acceptable to my consultant, but the constant highs for months and with some plummeting lows gave this overall figure, but certainly not good for my diabetes.
 
Robinredbreast said:
Actually my November hba1c result was 7.0 which was acceptable to my consultant, but the constant highs for months and with some plummeting lows gave this overall figure, but certainly not good for my diabetes.
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That's why it's good to keep a diary too or take your blood tester so they can be aware of all the figures rather than an average and then be more helpful.
 
Even in the written word, controlled is the past participle of the verb "To Control". On its own, controlled is shortened form of the expression "I, you, he, she, they or it controlled" something.

Therefore by use in conjunction with the adverb "poorly", the statement "poorly controlled" is a derivation of "He/She/I/You/They/It controlled [something] poorly" . As a statement it is a very strong one that apportions that lack of control squarely on the subject of the conjugation.

Therefore, as written or said, it is a statement of blame of the controller.
 


Think we will just have to agree to disagree here
 
gemma6549 said:
That's why it's good to keep a diary too or take your blood tester so they can be aware of all the figures rather than an average and then be more helpful.
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He was reading my notes before I went in and before I told him what was going on, the first thing he said was how sorry he was and was full of empathy and concern. I did raise the subject of how bad the readings were at times ( but was not always able to write them down )
 
gemma6549 said:
Also there is a lot to be considered. Did your friend ask for more help? Say he was concerned his levels weren't what they should be etc?

There has to be a balance and accountability on both parts
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Yes he's fully engaged with his clinic, doing what they ask, asking for help, etc.
 
tim2000s said:
And what is the HCP definition of "Poorly controlled"? Certainly in this case it sounds like a way of putting the blame squarely on him.
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I genuinely thought the term did not carry any implications of blame from HCPs. Only now, with this opposite interpretation being argued in his litigation, am I starting to wonder what HCPs do mean by the term.
 
Spiker said:
Yes he's fully engaged with his clinic, doing what they ask, asking for help, etc.
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Well it sounds like he's doing what he should be. I hope that they can work together to get things working more effectively for him.

Without knowing the full story or content of the letter its hard to know why this letter came about and how the "poor control" description fits in with the rest of the letter.

I just hope it all gets sorted
 
I'm asking a general question about what HCPs mean by the term so the specifics of any one case don't matter really.
 
From my own experience I believe HCPs will use the term based purely on outcomes, ie HBa1c and variability. So I believe that they think the term itself is neutral. Even if as individuals they may suspect a lack of effort on the part of the patient, and sometimes voice that suspicion, or even state it as a fact.
 
Spiker said:
I'm asking a general question about what HCPs mean by the term so the specifics of any one case don't matter really.
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Well i guess only they know, each one of them individually, what they mean by what they say.

Not what we interpret what they say to mean.

The only way to get the real answer is to ask the particular HCP
 
The Australian diabetes association has produced a position statement about the use of language in diabetes. It's not just doctors many of us use negative language or llanguage that implies a moral judgement or failure (good/bad glucose levels/HbA1c is a prime example, .)
It's worth reading, I won't attempt to summarise. (

Here is what they say about using 'control'.

AVOID:
He or she is … poorly controlled,
cooperative, uncooperative’)
USE
Words that describe outcomes or behaviours (‘his or her blood glucose is high’)
Describing the person rather than the behaviour implies the behaviour will not and cannot change. It has a fatalistic connotation. People with diabetes need to think of HbA1c and blood glucose levels as changing indicators that respond to a variety of factors. When health professionals use such labels, it suggests that they may have given up. Furthermore, it is futile to try to ‘make’ people change their behaviour or self-care activities. Diabetes care requires a collaborative approach, not persuasion or coercion.
AVOID
Poor control, good control, well controlled (referring to HbA1c or blood glucose levels)
USE
Stable / optimal blood glucose levels, within the optimal range, or within the target range; suboptimal, high/low
Referring to ‘poor’ or ‘good’ control infers a moral judgment about the outcome, i.e. the person with diabetes has been good orbad. No-one needs
criticism when things are not going well. Taking the judgment out of the language acknowledges that a variety of factors affect optimal diabetes
management, many of which are beyond the person’s control. Furthermore, the individual’s efforts need to be acknowledged regardless of the outcome.
AVOID
Control (e.g. diabetes control, blood glucose control, controlling diabetes)
USE
Manage, influence
The idea of controlling blood glucose levels is great in theory, as few people would want to be ‘out of control’. However, assuming that true ‘control’ can be achieved dismisses the fact that blood glucose levels are influenced by many factors outside of the person’s direct control (e.g. hormones, illness, stress, prolonged / delayed effects of physical activity, other medications). Continually striving to ‘achieve control’ or ‘maintain control’ is ultimately a recipe for feelings of guilt, despair and frustration when it cannot be achieved. Instead, we need to acknowledge that blood glucose levels can be influenced by the person with diabetes but not expect that they can ever be truly ‘controlled’.
https://www.diabetesaustralia.com.au/PageFiles/1584/DA Language position statement.pdf
 
gemma6549 said:
Well i guess only they know, each one of them individually, what they mean by what they say.

Not what we interpret what they say to mean.

The only way to get the real answer is to ask the particular HCP
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I really, really hope that's not the case. Diagnostic terms such as this that are routinely used in official medical records and for clinical decisions *must* have an objective and agree[d] meaning.
 
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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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