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Silver Spring, Md.
How interesting that so many of the medical personnel queried failed to acknowledge that bias could be an issue for them (DOC News, April 2007, page 13).
As a lifelong obese woman who works in the health field, I have personally experienced the bias present in many medical professionals. In my case, the bias displayed has ranged from insensitivity to what—in hindsight—bordered on malpractice. Few have taken the trouble to check my medical records, to see that careful food choices have produced excellent cholesterol levels or that frequent physical activity has resulted in strong muscles and a very good heart rate.
But then, medical professionals are just college students who went on to get medical degrees. Their attitudes reflect the perception among the general public that it is OK to "bash" people with this particular health issue, much like cancer patients were once shunned lest their disease be contagious.
The truly bizarre thing is that these scientifically trained people don't apply basic logic to the situation. Demonstrating a lack of sensitivity— or outright hostility—greatly impacts the exact quality most medical professionals desire: patient compliance. Has it truly been their experience that communicating with patients in a hostile or critical manner results in improved compliance? I think not. Do they also treat their minority patients or patients who come from a different ethnic or religious background this way? Again, I think not.
Humane reasons aside, less biased behavior certainly results in better outcomes, starting with a willingness to see a doctor earlier. Isn't that worth keeping one's bias to oneself?
TALK BACK: A FAMILY AFFAIR
Clinicians facing difficulties in getting patients to achieve treatment goals could have an unlikely ally: patients' families.
A pilot program for adolescents and young adults with diabetes incorporated a Web-based component in a care plan, but compliance was attributed to reminders and encouragement from a diabetes educator and immediate family members.1
The Institute for Family-Centered Care in Bethesda, Md., describes the core concepts of patient- and family-centered care:
What do you think? How do you get family members involved in patients' plan of care?
Send your comments to docnews{at}diabetes.org.
References
2. Institute for Family-Centered Care: Frequently asked questions. Available online at www.familycenteredcare.org/faq.html. Accessed April 5, 2007.
Pomona, Calif.
I am responding to your article by Dr. Irl B. Hirsch on Diabetic Care in Nursing Homes (DOC News, April 2007, page 3). I would like to clear up some misconceptions presented in the editorial. I attend patients in over 20 nursing homes and several board and care facilities. The case described in the article appears to be a resident of a board and care (otherwise known as assisted living or residential care) facility. In these settings, the staff are not allowed to administer injections, usually due to state or municipal laws.
Therefore, we have home health personnel come to the facility to give the insulin injections in patients who need them. Medicare only allows twice-daily visits in someone needing insulin injections. A true type 2 patient with diabetes cannot even get fingerstick glucose testing done, unless insulin is being given on a regular basis. This explains why most home health [care] nurses want tight sliding scales, so they have a justification for administering an injection.
Patients of mine who are residents in nursing homes are cared for by licensed nurses 24 hours a day. The nurses can and do check blood glucose as often as I request (usually four times daily) and can administer insulin injections anytime.
I hope this helps to clarify the status of diabetes care in nursing homes
and assisted living facilities. 
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