Improving Education 285
Other times, [patients] just get sick of the schedule. . . . Or they’re
feeling sick, so they don’t want to take a pill that makes them
sicker. Trying to ferret it out makes it easier.
The arduousness of sticking to a schedule often startled these doctors,
who then became more sympathetic with patients’ struggles. Steven, the
suburban endocrinologist with HIV who had considered trying a diabetic
diet, but ultimately did not because of the burden, now understood even
better and more clearly patients who had trouble adhering to treatments
other than those he himself took. For example, he had more under-
standing for a diabetic woman who had been checking her glucose too
frequently.
I give patients more slack. This morning was the first time I saw
patients after . . . taking medication myself. I saw a diabetic woman
who had delivered an infant and was still taking six to eight shots of
insulin a day. During pregnancy, that’s ok. After that, it’s unreason-
able. She was checking blood sugar eight to ten times a day. Her
husband checked her blood sugars at night while she was sleeping!
She thought maybe she shouldn’t be on this schedule the rest of
her life. I said, ‘‘For sure you can’t!’’ Some endocrinologists wouldn’t
say that. . . . Previously, I would have said, ‘‘You have to do this.’’
Again, it took one’s own illness to realize how to approach such patients
more effectively. Steven reframed patients’ adherence failures as well.
Now, I acknowledge very small steps—if patients don’t do 100
percent of what they’re supposed to, but just a little bit. In the old
days, instead of saying, ‘‘You’ve really made some improvements,’’
I’d say, ‘‘You need to work a lot harder.’’
These doctors also became less likely to lecture patients about other poor
health behaviors. Steven said, ‘‘I have a better understanding of what
they’re going through. For folks with diabetes to successfully treat their
disease, they have to make major lifestyle changes. I’m seeing how hard
that is for me!’’ These physicians thus became less judgmental, and more
aware of disease management outside the clinician’s office. Previously,
medical training and the functional separation between doctors and pa-
tients had impeded these recognitions.
These physicians also mentioned specific methods of promoting preven-
tive health care. For instance, Sally urged doctors to consider ‘‘well-child