I would agree that most of the folks that I see identified by many of my colleagues as difficult are just folks that are frightened at the loss of the control they feel.  It's an opportunity to use Dr. Phil's line: "Is what you are doing working for you?" to help glean from the patient what could be done differently.  It does though take patience on the part of the educator, to be able to hear the patient without taking it persoanlly.  Do they have classes in that?  I think I've learned it on the job...but what a great topic idea for continuing education, if it hasn't been done already!

Dr Phil's is a great question :Is what you are doing working for you?"  Thanks for sharing that, Joan. I swill surely use it.

Hi All,

When I do my presentations on the use of motivational interviewing (MI) in DSME and MNT (group or individual), or any other pt counseling for changing pt behavior, I make sure to cover the topic of this particular blog in detail, as it's SO "real world diabetes" (my new favorite term...or "RWD"!)  

A patient's resistance/anger/angst is the patient's way of saying one or more of his/her own 5 feelings and/or needs: 

1) "I don't see the importance of this at all."  (i.e., low knowledge of why
      to do it*)

2) "I have no confidence at all in being able to do this." (i.e., low 
     skill in how to do it*)

3) "I'm not ready to do this." (i.e., stage of readiness is pre-contemplation
     or contemplation in Transtheoretical Model of Change**)
 
4) "I won't like to do this as it will decrease the quality of my life." (In 
     many cases, the pt would be right!  How many of us would like to stick
     our finger with a needle multiple times a day?)

5) "I need help, but am ashamed or embarassed to admit it."      


* If anyone would like the pt worksheet I developed that incorporates the "Importance x Confidence = Readiness to Change" ruler (a measuring scale for the pt's self-assessment of knowledge of why and skill in how over time) let me know on this blog forum.


** If anyone would like the "6 Question Tool" that can be used by the pt to easily identify his/her stage of readiness for EACH self-care diabetes behavior, please let me now on this blog forum. 

Mary Ann Hodorowicz, RD, CDE, MBA, Certified Endocrinology Coder
PresentDiabetes Author of MNT and DSMT Reimbursement Audio Lectures

Eat Well, Laugh Often, Love Much

I feel that as long as the person realizes the gravity of the situation and still chooses to make those decisions that have labeled them 'non-compliant' then it is their choice.  

What I mean is...

When I see a patient who is not doing what I feel they ought to be doing to control or manage their diabetes in some way first I make sure that they realize the gravity of the out of control diabetes.  Do they know the risks they are at with uncontrolled diabetes?  Do they realize that if they get the diabetes under better control it may decrease those risks? 

If they do and choose to not try to do what I have suggested then that is their decision.  It is unfortunate but it is still their decision.  I can continue to try and work them toward a healthier lifestyle or action but if I am unsucessful I don't take it personally.  

They are making an informed decision.   

I agree with you completely Micki. In fact, I tell my clients that my goal is that they have all the knowledge and tools they need to make informed choices. Each of us makes choices all day long, and PWD have even more opportunities to make choices. As long as they're making an informed choice based on solid science, I'm happy - even if that choice isn't what I would recommend. How many of us 'follow the rules' 100% of the time? I know I don't!