'A Straight Talk' or 'A Straight Listen'?

A health professional at a recent workshop passionately exclaimed, ‘sometimes I have to give my patients a straight talk!’ By ‘straight talk’, the health professional meant telling the person exactly where they were going wrong with their diabetes management and what the consequences would be if they did not change their ways.

I do not doubt for a moment, the health professional’s motivation of concern for the health of those on the receiving end of the ‘straight talk’, nor the desire to help achieve the diabetes recommendations which are widely published and to which such health professionals, among others, are often held responsible.

Rather, what struck me about this encounter was the idea, in our evidence-based world, that such a strategy would work to improve the situation. In fact, evidence suggests exactly the opposite, that is that a telling off (for that is what was really meant by a ‘straight talk’ in this case – I knew it because the words were accompanied by a wagging finger) is likely to make people highly disinclined to make changes and distinctly unwilling to return to the clinic or a consultation with such a health professional.

What might be a more helpful and effective strategy is one I encourage any health professional in such a situation to consider, and that is a ‘straight listen’. This consists of asking a few interested open questions and actively listening to the answers, with the aim of experiencing the world through the eyes of the person with diabetes and to help address the challenges they face. ‘A straight listen’ has many advantages, among them:

It engages the person in talking honestly about their concerns about their diabetes and their thoughts and wishes about addressing them
It is more friendly and less stressful
It creates an equal contribution and participation in the consultation
It results in increased motivation to take action outside of the consultation
It takes less time and energy and gives much more satisfaction

Sometimes, listening is thought of as a ‘soft’ skill or ‘a bit touchy feely’ as described to me by another health professional recently. However, in survey after survey of people, especially those with long-term conditions, active listening and being non-judgemental are cited as missing, and strongly wished for from health providers. A recent example is a survey published in Diabetes Update. How can it be that something so apparently simple and so desired, is so comprehensively overlooked?

In my experience, there is no shortage of health professionals expressing a desire to be better communicators or listeners, but a common reason given for not investing in actually using these skills more, is a lack of time in consultations. This is interesting, since there is evidence that consultations can be shorter where there is more listening on the part of the health professional and this also brings increased satisfaction on the part of the person with diabetes. There must be something else. I find myself wondering if part of this ‘something else’ is that being a health professional is so intrinsically linked to being an ‘expert’ and an ‘advisor’, that ‘simply listening’ means to give up these roles with the perhaps consequent loss of status or even competence? Another reason may be that, among health professionals, the skills of listening are much less practised, hence less habitual, than those of talking or telling, and so their confidence in using them is less.

As I continue my musings as to the underlying causes are of the continuing need among health professionals to deliver a ‘straight talk’ against much good evidence of its ineffectiveness, I have a new offering to try and make ‘a straight listen’ more accessible and easier to learn and practice.

From today, SD’s latest download is ‘A Little Book of Listening’, a booklet with some inspiration, ideas and practical ways to use listening in consultations – and indeed in other areas of life, too. I hope that providing and spreading the word about this will go towards helping some poor souls avoid being on the receiving end of any more ‘straight talks’ next year!

Sincerely wishing you a listening 2014

Grant, P. (2013). What do Patients want from their Diabetologist?. Diabetes Update, Winter 2013

Successful Diabetes (2013). A Little Book of Listening

Diabetes Rules?

Self-monitoring for long term conditions like diabetes is all the rage in the new NHS. To be fair, it has long been advocated, but it is, happily, really centre stage at the moment. The idea that looking after your own health, taking responsibility and being personally involved in decisions about treatment, is central to the NHS reforms, summed up by the phrase ‘no decision about me, without me’.

It’s a welcome change from historical services for people with long term conditions, (which, incidentally, they have always managed themselves for the most part, so the idea is not new, just reality being acknowledged). The previous approach was based on following ‘doctor’s orders’ and woe betide you if you got it wrong as this would lead to a ‘telling off’ appointment with a penance of more rules to follow until the next time. For many, ‘getting it wrong’ was most of the time because doctor’s orders (often without explanation) is one thing, but having the tools to do the job, such as information, testing equipment and discussions with others, is quite another. There used to be way too much of the former ‘rules’ and not nearly enough of the latter ‘means’. Thankfully that has all changed now, or at least is in the process of changing, as we have discussed regularly on this blog.

But have new rules replaced the old ones, bringing their own difficulties in applying them? For example, Diabetes UK have an admirable website, which includes a great deal of information for all ages and types of diabetes. On there is a page called ‘monitoring your health’, which sets out the need for ‘knowing your blood glucose, your blood pressure and blood fat levels, as well as the condition of your feet and getting your eyes screened for retinopathy’. While this may be accurate, it is a pretty tall order to hold in your mind every day whilst trying to juggle the usual demands of family, work and social life. It’s possible that someone could get it equally ‘wrong’ with knowledge as they may previously have done without it!

It was with these thoughts in mind that our latest ebook was born. Trying to address the question ‘how do I remember what’s important about managing my diabetes whilst getting on with my life?’, one answer has come in the form of ‘Diabetes ‘Forget-Me-Nots’, a bright and friendly little ebook with a mission to act as a spare diabetes memory! We hope it’s going to live on people’s ebook reader, tablet or computer so that when it comes to following the ‘rules’ of the moment, it can offer that extra bit of help and confidence to get it right - for a change.


References
Diabetes UK: Monitoring Your Health
Diabetes 'Forget-Me-Nots'

Mind your language – Oz Style!

Anyone who followed the recent debate about the actor Ricky Gervais’s use in tweets of the word ‘mong’ will be in no doubt that the terminology we use is under scrutiny everywhere, and people can be touched personally by terms even though they may have been given a new meaning by a new generation. It’s the same with diabetes – do you shudder at the word ‘diabetic’, shout aloud at the television when presenters talk about ‘non compliant patients’ or simply shrug your shoulders and say “they’re just words, get over it”?

Whatever your view, there are some strong feelings about language and diabetes. One in particular is that the language we use reflects the views we hold and these can slip over into how we treat people – for example in hospital, someone being referred to as ‘the diabetic in bed 5’, or in a clinic as ‘the patient’, suggests they are talking about objects rather than actual individuals. We once heard someone describe this experience in a clinic as “they might as well ask for the ‘next pancreas’ please”! 

Now Diabetes Australia have published ‘A new language for diabetes’, a position statement that aims to improve communications with and about people with diabetes. Its 10 summary recommendations include:

• Avoid jargon
• Avoid judgemental terms
• Be holistic – don’t just consider the medical aspects
• Focus on what’s achievable
• Use language that is positive and supportive, and forward rather than backward-looking

Pretty straightforward stuff you might think, but for anyone remaining in any doubt, the report also includes some helpful examples to show exactly what words and expressions could be used as alternatives to those which don't. For example:

instead of:                                    use this:

diabetic/sufferer/patient         person living with diabetes

diabetes control                           diabetes management

failed to / failure                           has not, did not

blood testing                            self monitoring or checking

There’s nothing not to like about this document – with the possible exception of the sadness that it needs to exist at all. It seems such a shame that people need to be reminded of the very personal nature of diabetes and the efforts that people make day in day out to keep on top of a condition that most definitely does not keep to the ‘rules’ - as a lady with type 2 diabetes once put it to a health professional “I’m afraid my body hasn’t read your text book!”

We welcome this statement with open arms, particularly as it is so consistent with our own philosophy of personal, individual care and attention, which we apply to all our own writing and publications.

Our Australian colleagues have given an example to all other countries and we hope many others will adopt this idea. Diabetes Australia - in the plainest possible language - thank you!

The full statement is available to download FREE from the ‘SD Focus’ section of our website home page. For your copy, simply go to www.successfuldiabetes.com and log in or register and log in.

Reference

Diabetes Australia. A new language for diabetes: improving communications with and about people with diabetes.

How much does the language people use in relation to diabetes matter to you? We'd love to know, so feel free to share your thoughts in the discussion below…