Doctor versus Patient

April 22nd, 2010 by Amy Gonsalves Leave a reply »

I went to a talk last night given by a type 1 psychologist (you may have read my earlier post stealing from an article about her).  She gave me some things to think about in an interesting new light.

I liked hearing from her “therapist” point of view, as opposed to my “attorney” point of view.  We very much agreed, but my spin is a bit different than hers.  We agree that there are too many factors outside of anyone’s control that affect blood glucose levels to give patients the blanket instruction of “control your diabetes.”  (Dr. Bernstein calls the various factors and how they can affect blood glucose “inevitable imbalances”.  I’m planning to use that term; I like it!)

Given these inevitable imbalances of factors affecting blood glucose, Dr. Bernstein wants doctors to assure their patients they are not at fault when their blood glucose levels do not fit in range all the time. 

Knowing that “success” in this endeavor must be re-defined as something much much looser than 100% of my time in range, I want doctors to help me figure out what factors do what, when, so that I can plan accordingly and try, essentially, to outsmart the factors as often as possible. 

For her, a visit to a doctor is a chance for a virtual hug.  For me, it’s a chance to learn more about the game and to modify my strategy.

Interestingly, Dr. Bernstein asserted that people in Western culture fundamentally do not deal with mortality or suffering, and western medicine is designed to fix physical ailments and eliminate suffering.   

Living with diabetes involves recognition of our own mortality and daily dealings with our body means tricking it into staying alive with insulin injections.  This leads a person living with diabetes to a different psychological place than where a doctor usually meets her patient.

A doctor went to medical school I expect because they wanted to heal or fix patients with physical ailments.  But you can’t heal or fix diabetes.  You can’t even control blood glucose levels!  So in order for a doctor to approach a patient with diabetes with compassion, she must first acknowledge that diabetes can never be about achieving control or fixing or alleviating suffering.  Type 1 diabetes is most basically about an effort to stay alive with the use of insulin, precisely timed and precisely planned in an incredibly imprecise environment.

Whatever support a patient needs as they struggle with the inevitable imbalances and imprecision, I believe a doctor thinking that success with diabetes just takes the patient doing something differently will always fail

Diabetes is about doing your best, knowing as much as you can, thinking as much as you can about what you do, doing it intelligently, letting the rest happen, and always making sure the person with diabetes knows that they are not alone with their struggles and that there is no blame involved in a glucose reading.  We have enough going on to inflict any blame on ourselves–we have a body to take care of!

Here’s to the work you do every moment of every day.  Here’s to you.

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  1. MaiaJane says:

    This is precisely why I would not rest until I found an Endocrinologist who has Type 1.
    Nobody understood quite like she did when I came in, flustered and frustrated that she was out of my insurance network and my A1c wasn’t doing what I wanted it to.
    We talked about what she would have been doing at my age, and figured out how to move forward, make improvements, eliminate some variables.
    I’ll have to start working on feeling less “out of control”

    Can I say it again, or am I starting to get annoying? I love you!

  2. Joby Cleary says:

    This is so good. I plan on showing it to my family and doctor. Not that they don’t understand but it’s nice to see others in agreement. We are not “bad” because we struggle even when you overdose with fast acting rather than slow acting like I did recently. Mistakes happen. Hopefully, not often!

  3. Jayne Hom says:

    By the way Jessica Bernstein will be givng a talk in Palo Alto.
    WHEN: Wednesday September 15th at 7:00pm – 9:00pm
    PLACE: Congregation Etz Chayim; 4161 Alma Street, Palo Alto, CA

    In a controversial talk, Psychologist Jessica Bernstein sparks debate about our current method of approaching diabetes care with the goal of controlling the condition. Dr. Bernstein, who has had type 1 diabetes since age one, will discuss two key questions:
    • Is it possible to control diabetes?
    • Is it healthy to approach diabetes care with the mindset of trying to control the condition?
    She will also show clips from the movie she is producing to share her message.

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