Brilliant this week, to see a UK Government Health Committee report into the management of Long Term Conditions. It’s very long, over 200 pages and contains some very fine words indeed, based on a great deal of evidence gathered from a large number of organisations and individuals. It’s a fascinating read, including the transcripts of the discussions between the committee members and those giving evidence.
The committee gives its view that care for people with long term conditions cannot fit into the traditional model of health care, which is based on curable, ‘single episode’ illnesses. It says that more time is needed to hold more personalised discussions with people about their wants and needs, that the person, as well as the condition, needs to be treated, and that care planning, including results sharing and giving people access to their medical records is an appealing way forward. It urges NHS England to take note of their findings and implement new ways of long term conditions care. It seems to challenge the Government and NHS England’s response to the growing numbers and needs of people with long term conditions by describing their strategic response as unclear and insufficiently urgent.
This is very welcome news, and absolutely bears out our own experience when offering our training and skills development, which is that the rhetoric of policy is very far removed from the reality. This is particularly noticeable in relation to promoting person-centred approaches, and collaboration in care. Practitioners understand the need for this and are keen to put it into practice, but the systems that they are working in and with (for example the targets to be achieved to receive funding and payment) simply do not support it. A particular example recently has been cited in a number of our workshops. It concerns the target to reduce unplanned hospital admissions among older people. Each organisation needs to identify a certain percentage of people, upon which they are rigorously measured. It is taking up a great deal of time and effort, to the extent that trying to discuss, let alone implement, any other practices (for example care planning among the younger, able bodied) that might actually prevent people in future being vulnerable to admission, is almost impossible. The short term nature of these kind of initiatives is striking and the idea of ‘cart before horse’ often springs to mind, as does the expression ‘what gets measured, gets done’ (and, sadly, its reverse)
Two passages of the report are worthy of reproducing here as they so resonate with the above:
‘We are not convinced that focusing on measures to reduce admissions to the acute sector will effectively address the underlying issues in management of long term conditions which seem to be driving patients….into acute care (Page 5, Summary)
and
‘we have been struck by the mismatch between the needs of 15 million service users with one or more long term conditions, and the design of health and care system set up principally to treat and cure episodes of ill-health’ (page 43)
Although reports such as this one take time to circulate and get attention, we are at least cheered that it seems that some aspects of Government are not only listening, but hearing, and producing strong words. Seeing those words turned into action – and quickly – could really make a difference. We watch and wait, while continuing to spread the word about these important issues in our own publications. Well done, that Health Committee.
References
House of Commons Health Committee (2014). Managing the care of people with long-term conditions. London. The Stationary Office.
Person-Centred Practice for Long Term Conditions: a Concise Guide to Success
Sunday, 6 July 2014
Thursday, 22 May 2014
Patient Activation – is this what we need?
The Kings Fund has released an interesting and, in relation to our last blog post, extremely topical, report, called ‘supporting people to manage their health’. You can probably see immediately why it caught our eye and attention here at SD.
The report is all about a measuring tool, a questionnaire called the Patient Activation Measure (PAM). People are asked to state in percentage terms, the extent to which they agree with a number of statements in relation to taking charge of their health and healthcare. The higher their score, the more ‘activated’ they are, for example to undertake healthy behaviours, seek help more promptly and stay out of hospital. The reverse is true, with low scorers tending to be more passive or ignoring of their health, resulting in more emergency visits, appointments or not taking prescribed medication. The implications of these different activation levels may make a profound difference to health outcomes.
The PAM has been around for a while, and it has been used successfully to show relationships between activation scores and health related behaviour in a variety of different populations and conditions. It’s a very useful measure, especially in the current health climate of encouraging more participation in healthcare and the need for active self management of long term conditions, such as diabetes. These conditions require relentless decision-making and action on the part of the person with it, day in and day out, 365 days a year. Knowing who is more likely to take this action and who needs more support to be successful is surely a good thing, and where this measure can deliver, right?
Well, that all depends on if the information from the measure is actually acted upon, and what approaches are used to intervene. So often, knowing something because it’s been measured and acting on it are two very different things and of course it’s much, much more difficult to take the required action than to measure it. For example, it’s one thing knowing that a group of people are at risk of diabetes (because their blood glucose has been measured) than it is to put in place the changes needed and the intensive support for those people to make the changes and sustain them to prevent their developing diabetes.
Arguably, we know more now about ‘the state of the art’ of diabetes care and education than ever in history, but despite these figures, there are still tens of thousands of people with the condition who are not receiving basic care and even more not receiving any formal learning programme, such as a structured education programme. This is despite care and education programmes being tried, tested and available.
One of the mechanisms for measuring outcomes in the NHS is the Quality and Outcomes Framework (QOF), which, briefly, gives points to health providers for taking certain actions. The points translate to payment. The QOF has recently had an overhaul for the year starting in April 2014 and now includes points for referring people to education programmes. Note, for referral, not attendance. The former can perhaps be measured much more easily, even though it is only the attendance at programmes that will deliver the positive outcomes to the people attending. To us at SD, this seems a triumph of measurement over gaining benefit and as far as we are aware, there are no plans to change the QOF to measure attendance, although we sincerely hope that will come to pass.
So, we have to be careful about reports such as about the PAM which extol the virtues of measurement, and be sure to ask much more searching questions about how the resulting data will be used.
To be fair, the report does mention the kind of interventions that will help people to become more activated. Unsurprisingly, these are all well-known and frequently mentioned here, and in other places: building confidence; coaching; encouraging learning and mastery of their condition; peer support and attention to emotional care and stress reduction. These are not widely commissioned in the present NHS. In diabetes care, they are often the very components of the education courses, mentioned earlier, which people are not receiving, which seems to be an ironic twist.
On a linguistic note, which you may know we consider very important, it is a shame that the measure and such a well-titled report which is about all our lives and strives as humans, still refer to ‘patients’. This persists the apparantly patronising delusion in healthcare circles that there is some divide between ‘patients’ and ‘others’. Unless there is to be a sibling measure entitled ‘a health professional activation measure’ or ‘a non-patient activation measure’, perhaps a more accurate title might be the more neutral and accurate ‘health activation measure’?
Having said all that, it’s always welcome to have a publication which cites evidence and good practice to add to the many ‘arms’ who push for change and implementation of effective practices that people benefit from so successfully. In that respect it is a valuable addition to the literature and SD is already ‘activated’ to help spread its words very widely.
Supporting people to manage their health: an introduction to patient activation. London. The Kings Fund. May 2014.
Mind Your Language – Oz Style! Successful Diabetes Blog December 2011
The report is all about a measuring tool, a questionnaire called the Patient Activation Measure (PAM). People are asked to state in percentage terms, the extent to which they agree with a number of statements in relation to taking charge of their health and healthcare. The higher their score, the more ‘activated’ they are, for example to undertake healthy behaviours, seek help more promptly and stay out of hospital. The reverse is true, with low scorers tending to be more passive or ignoring of their health, resulting in more emergency visits, appointments or not taking prescribed medication. The implications of these different activation levels may make a profound difference to health outcomes.
The PAM has been around for a while, and it has been used successfully to show relationships between activation scores and health related behaviour in a variety of different populations and conditions. It’s a very useful measure, especially in the current health climate of encouraging more participation in healthcare and the need for active self management of long term conditions, such as diabetes. These conditions require relentless decision-making and action on the part of the person with it, day in and day out, 365 days a year. Knowing who is more likely to take this action and who needs more support to be successful is surely a good thing, and where this measure can deliver, right?
Well, that all depends on if the information from the measure is actually acted upon, and what approaches are used to intervene. So often, knowing something because it’s been measured and acting on it are two very different things and of course it’s much, much more difficult to take the required action than to measure it. For example, it’s one thing knowing that a group of people are at risk of diabetes (because their blood glucose has been measured) than it is to put in place the changes needed and the intensive support for those people to make the changes and sustain them to prevent their developing diabetes.
Arguably, we know more now about ‘the state of the art’ of diabetes care and education than ever in history, but despite these figures, there are still tens of thousands of people with the condition who are not receiving basic care and even more not receiving any formal learning programme, such as a structured education programme. This is despite care and education programmes being tried, tested and available.
One of the mechanisms for measuring outcomes in the NHS is the Quality and Outcomes Framework (QOF), which, briefly, gives points to health providers for taking certain actions. The points translate to payment. The QOF has recently had an overhaul for the year starting in April 2014 and now includes points for referring people to education programmes. Note, for referral, not attendance. The former can perhaps be measured much more easily, even though it is only the attendance at programmes that will deliver the positive outcomes to the people attending. To us at SD, this seems a triumph of measurement over gaining benefit and as far as we are aware, there are no plans to change the QOF to measure attendance, although we sincerely hope that will come to pass.
So, we have to be careful about reports such as about the PAM which extol the virtues of measurement, and be sure to ask much more searching questions about how the resulting data will be used.
To be fair, the report does mention the kind of interventions that will help people to become more activated. Unsurprisingly, these are all well-known and frequently mentioned here, and in other places: building confidence; coaching; encouraging learning and mastery of their condition; peer support and attention to emotional care and stress reduction. These are not widely commissioned in the present NHS. In diabetes care, they are often the very components of the education courses, mentioned earlier, which people are not receiving, which seems to be an ironic twist.
On a linguistic note, which you may know we consider very important, it is a shame that the measure and such a well-titled report which is about all our lives and strives as humans, still refer to ‘patients’. This persists the apparantly patronising delusion in healthcare circles that there is some divide between ‘patients’ and ‘others’. Unless there is to be a sibling measure entitled ‘a health professional activation measure’ or ‘a non-patient activation measure’, perhaps a more accurate title might be the more neutral and accurate ‘health activation measure’?
Having said all that, it’s always welcome to have a publication which cites evidence and good practice to add to the many ‘arms’ who push for change and implementation of effective practices that people benefit from so successfully. In that respect it is a valuable addition to the literature and SD is already ‘activated’ to help spread its words very widely.
Supporting people to manage their health: an introduction to patient activation. London. The Kings Fund. May 2014.
Mind Your Language – Oz Style! Successful Diabetes Blog December 2011
Sunday, 16 March 2014
Being Person-Centred – Are We Nearly There Yet?
Regular readers will know that Successful Diabetes is firmly founded on a person-centred philosophy, following the principles originally articulated by Carl Rogers and more recently described in diabetes care specifically, as empowerment, by Bob Anderson and Marti Funnell and their colleagues.
Our person-centred philosophy informs all SD’s activities, including the structure and format of our books and workshops. The central question in designing any of our activities is ‘how can this material be made meaningful to the individuals experiencing it?. Answering that question gives rise to the order and type of activities included for learners in a workshop, for example and to the language and style of the writing in our books. As described by Rogers himself, a person-centred approach is not something to be applied, but ‘a way of being’. In this way, work flowing from philosophy feels very natural and it also offers a ready made source of evaluation and quality assurance.
As previous SD blogs have mentioned, with such a philosophical background, it is extremely welcome to see the current emphasis on personalisation in UK health policy, with documents describing and exhorting the importance of prioritising a person’s own wishes and needs, and sharing decision making, especially for long term conditions. Evidence supports the positive impact of this on people’s health and health service use and also on cost and satisfaction with their experience of care.
The Health Foundation in particular has released a number of practical reports on the subject, including the recent review ‘Helping Measure Person-Centred Care’ which includes detailed descriptions of the measures and tools available, advice for undertaking measurements locally and several hundred references. The same organisation also recently launched a dedicated online person-centred care resource centre, which seeks to promote the approach throughout the health system.
Our own contribution to spreading the word about person-centred care is embodied, for example, in our recent ebook about person centred practice, in other books and in training for personalised care planning (PCP). The latter is a way of organising care for those with diabetes and other long term conditions to prioritise their thoughts, wishes and needs as much as those of the health professional. It contrasts with the traditional model of the health professional being the dominant force in the relationship, with their knowledge and opinion prized more than that of the person consulting with them.
The PCP approach has been born out of the changing world of health, with people no longer suffering predominantly with acute, ‘fixable’ or short term conditions, but increasingly living with incurable but long term conditions that require a multitude of their own daily decisions to be made, without the guidance of a health professional. Hence, care services must be geared towards promoting such decision-making skills for self-management.
Most recently, it was a privilege to be a co-presenter of a workshop about consultations at the Annual Professional Conference of Diabetes UK*. Our 5-strong team created an experience for the participants, which enabled them to reflect on their own struggles with consultations and consider them through the issues raised in short but ‘real life’ scenarios by the presenters. Much discussion and insight ensued, especially about the final scenario which focused on ‘why isn’t a person-centred way of consulting more prevalent in diabetes / long term conditions care, given all the encouraging documents and evidence as to its success?’
The opinions given in response included that there is a gap between the rhetoric and the hectic reality of everyday practice, that change among health professional practice takes time and that reflection on practice to plan and evaluate changes is not valued sufficiently. Most memorably, the comment that we are so busy trying to listen well, that we may forget to shout about the importance of our consultations and their style. It was also a conclusion that showing person-centred practice by example could be powerful.
While we may not be able to directly change others, we can indeed change ourselves and / or continue to be true to our principles and philosophy. In that spirit and to answer the question in the title, no, we are not yet at our destination, but the activities described in this blog and others, are one more contribution to continuing the journey.
References
Health Foundation Person Centred Care Website
Person Centred Practice: A Concise Guide to Success
Personalised Care Planning Workshops
*You can download the ‘take home messages’ of workshop participants from this page
Our person-centred philosophy informs all SD’s activities, including the structure and format of our books and workshops. The central question in designing any of our activities is ‘how can this material be made meaningful to the individuals experiencing it?. Answering that question gives rise to the order and type of activities included for learners in a workshop, for example and to the language and style of the writing in our books. As described by Rogers himself, a person-centred approach is not something to be applied, but ‘a way of being’. In this way, work flowing from philosophy feels very natural and it also offers a ready made source of evaluation and quality assurance.
As previous SD blogs have mentioned, with such a philosophical background, it is extremely welcome to see the current emphasis on personalisation in UK health policy, with documents describing and exhorting the importance of prioritising a person’s own wishes and needs, and sharing decision making, especially for long term conditions. Evidence supports the positive impact of this on people’s health and health service use and also on cost and satisfaction with their experience of care.
The Health Foundation in particular has released a number of practical reports on the subject, including the recent review ‘Helping Measure Person-Centred Care’ which includes detailed descriptions of the measures and tools available, advice for undertaking measurements locally and several hundred references. The same organisation also recently launched a dedicated online person-centred care resource centre, which seeks to promote the approach throughout the health system.
Our own contribution to spreading the word about person-centred care is embodied, for example, in our recent ebook about person centred practice, in other books and in training for personalised care planning (PCP). The latter is a way of organising care for those with diabetes and other long term conditions to prioritise their thoughts, wishes and needs as much as those of the health professional. It contrasts with the traditional model of the health professional being the dominant force in the relationship, with their knowledge and opinion prized more than that of the person consulting with them.
The PCP approach has been born out of the changing world of health, with people no longer suffering predominantly with acute, ‘fixable’ or short term conditions, but increasingly living with incurable but long term conditions that require a multitude of their own daily decisions to be made, without the guidance of a health professional. Hence, care services must be geared towards promoting such decision-making skills for self-management.
Most recently, it was a privilege to be a co-presenter of a workshop about consultations at the Annual Professional Conference of Diabetes UK*. Our 5-strong team created an experience for the participants, which enabled them to reflect on their own struggles with consultations and consider them through the issues raised in short but ‘real life’ scenarios by the presenters. Much discussion and insight ensued, especially about the final scenario which focused on ‘why isn’t a person-centred way of consulting more prevalent in diabetes / long term conditions care, given all the encouraging documents and evidence as to its success?’
The opinions given in response included that there is a gap between the rhetoric and the hectic reality of everyday practice, that change among health professional practice takes time and that reflection on practice to plan and evaluate changes is not valued sufficiently. Most memorably, the comment that we are so busy trying to listen well, that we may forget to shout about the importance of our consultations and their style. It was also a conclusion that showing person-centred practice by example could be powerful.
While we may not be able to directly change others, we can indeed change ourselves and / or continue to be true to our principles and philosophy. In that spirit and to answer the question in the title, no, we are not yet at our destination, but the activities described in this blog and others, are one more contribution to continuing the journey.
References
Health Foundation Person Centred Care Website
Person Centred Practice: A Concise Guide to Success
Personalised Care Planning Workshops
*You can download the ‘take home messages’ of workshop participants from this page
Monday, 13 January 2014
Action on 'Action for Diabetes'?
It’s great news that a document full of vision for diabetes has been published at the start of the new year, a time brimming with motivation and good intention. ‘Action for Diabetes’ is NHS England’s manifesto for making inroads into the challenges and complexities of this massively important condition. What does it say and will it be effective? are the questions on everyone’s lips – or should be!
The document is an easy read, well-formatted and simply presented. It talks about the importance of diabetes in the modern world. Its huge and growing prevalence, its disastrous consequences and need for ongoing, lifelong, quality care. So much we know – that has all been said before. Often in these documents it’s just the numbers that change and usually upwards. So what is new (or at least new-ish?) A commitment to developing personalised care planning – with systems and processes and tools to document it all specified. That’s good, much needed. There’s a commitment to produce another service specification – for young people transitioning from children’s to adult services. Also good, also much needed, having foxed the life out of many practitioners over many years. Maybe this time? Mention is made also of enabling people with diabetes to access structured education within 9 months of diagnosis. Extremely good. Making this a quality indicator (ie must do) would really show commitment and it looks like this iteration of diabetes policy might, just might, do that.
Action on diabetes also tells us what’s recently been put in place to support action. A toolkit for clinical commissioning groups to ‘transform participation in health and care’. That is excellent. But for those with a condition like diabetes, participation isn’t just a ‘no-brainer’, it’s mandatory. They already participate by virtue of having the condition and it doesn’t go away, just because someone isn’t paying it any attention. So I’d say, remember that the idea of participation is more that health and care services also participate with people with diabetes, rather than just the other way round. For example, that their view comes first in a consultation, their personal priorities are respected and that they are treated holistically rather than 'an HbA1c on legs'. That isn’t mentioned and should be, perhaps?
There’s a model behind the vision – the model is of a house, whose walls and roof will not stand up unless all the elements are in place, including firm foundations of good commissioning. This house model has been used over recent years to illustrate the importance of all elements working together, for example in Year of Care work on diabetes. It’s great that an old model is being used in new ways, showing how national, local and individual priorities can be represented in it. And we can all relate to a house, so in this way it makes the words even more accessible.
Will the contents of the document come to pass? I hope so – action is a great word to use, and even greater when it jumps off the page into our clinics and services. NHS England, you’ve made a great start. Keep up the good work, we are watching…
Action for Diabetes
Transforming participation in Health and Care
The document is an easy read, well-formatted and simply presented. It talks about the importance of diabetes in the modern world. Its huge and growing prevalence, its disastrous consequences and need for ongoing, lifelong, quality care. So much we know – that has all been said before. Often in these documents it’s just the numbers that change and usually upwards. So what is new (or at least new-ish?) A commitment to developing personalised care planning – with systems and processes and tools to document it all specified. That’s good, much needed. There’s a commitment to produce another service specification – for young people transitioning from children’s to adult services. Also good, also much needed, having foxed the life out of many practitioners over many years. Maybe this time? Mention is made also of enabling people with diabetes to access structured education within 9 months of diagnosis. Extremely good. Making this a quality indicator (ie must do) would really show commitment and it looks like this iteration of diabetes policy might, just might, do that.
Action on diabetes also tells us what’s recently been put in place to support action. A toolkit for clinical commissioning groups to ‘transform participation in health and care’. That is excellent. But for those with a condition like diabetes, participation isn’t just a ‘no-brainer’, it’s mandatory. They already participate by virtue of having the condition and it doesn’t go away, just because someone isn’t paying it any attention. So I’d say, remember that the idea of participation is more that health and care services also participate with people with diabetes, rather than just the other way round. For example, that their view comes first in a consultation, their personal priorities are respected and that they are treated holistically rather than 'an HbA1c on legs'. That isn’t mentioned and should be, perhaps?
There’s a model behind the vision – the model is of a house, whose walls and roof will not stand up unless all the elements are in place, including firm foundations of good commissioning. This house model has been used over recent years to illustrate the importance of all elements working together, for example in Year of Care work on diabetes. It’s great that an old model is being used in new ways, showing how national, local and individual priorities can be represented in it. And we can all relate to a house, so in this way it makes the words even more accessible.
Will the contents of the document come to pass? I hope so – action is a great word to use, and even greater when it jumps off the page into our clinics and services. NHS England, you’ve made a great start. Keep up the good work, we are watching…
Action for Diabetes
Transforming participation in Health and Care
Monday, 9 December 2013
'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
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
Tuesday, 3 September 2013
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'
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'
Sunday, 28 July 2013
Letter to the Home Secretary: On Developing Diabetes
Dear Mrs May
'What a b***y pain.' You may have said to yourself. 'Just when I am so busy helping to run the country, I have to get diabetes. And not the pill-taking kind, that some of my parliamentary colleagues seem to have, it's the serious sort that needs injections every day'.
You may equally, or also, have thought 'Phew. I was just beginning to wonder if all those symptoms were something really serious, like cancer. I've seen that happen to people, too. What a relief'.
If you did think either, or both of these things, you have a lot in common with the many thousands of other people with Type 1 diabetes. In my experience, everyone remembers their diagnosis and how they felt, whether it was annoyance or even anger at its unannounced and unwelcome arrival, just when they were busy doing something else much more important, or because it gave a more positive name to their worst fears.
Either way, you know it's here and here to stay. We wish you success in living with it and making use of the vast array of treatments, information and fantastic support that is available to you. It's not always easy. There will be some days - known to many as 'bad diabetes days' - when it simply doesn't behave whatever you do and even gets the better of you. You can't avoid this, however strong, clever and powerful you are - and there are many other such people, like you, out there.
Above all, take advantage of what your government offers to people with long term conditions: Rigorous medical care; The chance for personalised discussions about what care and treatment is right for you; Structured education to learn more about these, meet others (learning from many others, as well as the famous, like Steve, can be inspiring and practical) and get to know how to self manage it successfully. For example, it's unlikely that 2 injections will do the trick for you with your busy lifestyle. If it does, please tell everyone how so, as it would be welcome news for many.
Please allow yourself to feel the emotions that go with such a momentous diagnosis and life with diabetes - anger, relief, disappointment, even stigma and shame. Your feelings will affect how you deal with it practically and there is nothing wrong with acknowledging them. You won't want to tell the whole country (who would?), but do tell yourself and your loved ones, who live with it too and they will want to do their bit to help you.
There's a big society with diabetes in this country, Mrs May. People who've been there and know some 'tricks of the trade'. Please take advantage of what they offer and experience the benefits for yourself - for example, one thing people will be delighted to tell you is how you can still eat bread, cake and sticky toffee pudding!
It's unwelcome news to get diabetes, but you're very welcome here.
Yours Sincerely
Successful Diabetes
Here are just a few of the many online places you might like to visit
Successful Diabetes: Getting started: a short guide
Diabetes UK
Blog: Shoot Up or Put Up: The lighter side of insulin dependency
Carbs and Cals
'What a b***y pain.' You may have said to yourself. 'Just when I am so busy helping to run the country, I have to get diabetes. And not the pill-taking kind, that some of my parliamentary colleagues seem to have, it's the serious sort that needs injections every day'.
You may equally, or also, have thought 'Phew. I was just beginning to wonder if all those symptoms were something really serious, like cancer. I've seen that happen to people, too. What a relief'.
If you did think either, or both of these things, you have a lot in common with the many thousands of other people with Type 1 diabetes. In my experience, everyone remembers their diagnosis and how they felt, whether it was annoyance or even anger at its unannounced and unwelcome arrival, just when they were busy doing something else much more important, or because it gave a more positive name to their worst fears.
Either way, you know it's here and here to stay. We wish you success in living with it and making use of the vast array of treatments, information and fantastic support that is available to you. It's not always easy. There will be some days - known to many as 'bad diabetes days' - when it simply doesn't behave whatever you do and even gets the better of you. You can't avoid this, however strong, clever and powerful you are - and there are many other such people, like you, out there.
Above all, take advantage of what your government offers to people with long term conditions: Rigorous medical care; The chance for personalised discussions about what care and treatment is right for you; Structured education to learn more about these, meet others (learning from many others, as well as the famous, like Steve, can be inspiring and practical) and get to know how to self manage it successfully. For example, it's unlikely that 2 injections will do the trick for you with your busy lifestyle. If it does, please tell everyone how so, as it would be welcome news for many.
Please allow yourself to feel the emotions that go with such a momentous diagnosis and life with diabetes - anger, relief, disappointment, even stigma and shame. Your feelings will affect how you deal with it practically and there is nothing wrong with acknowledging them. You won't want to tell the whole country (who would?), but do tell yourself and your loved ones, who live with it too and they will want to do their bit to help you.
There's a big society with diabetes in this country, Mrs May. People who've been there and know some 'tricks of the trade'. Please take advantage of what they offer and experience the benefits for yourself - for example, one thing people will be delighted to tell you is how you can still eat bread, cake and sticky toffee pudding!
It's unwelcome news to get diabetes, but you're very welcome here.
Yours Sincerely
Successful Diabetes
Here are just a few of the many online places you might like to visit
Successful Diabetes: Getting started: a short guide
Diabetes UK
Blog: Shoot Up or Put Up: The lighter side of insulin dependency
Carbs and Cals
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