How Can We Engage Doctors to Change Behaviour?

Melinda Seed

Lots of talk of patient engagement around the traps of late and following some discussions on Twitter I’d like to share some  common problems with engaging doctors to change their behaviour.

Just switch the word “patient” in this definition of patient engagement to “doctor” in each case and we’ve got a handy way of thinking about doctor engagement.

Patient<Doctor> engagement…a concept that combines a patient’s <Doctor’s> knowledge, skills, ability and willingness to manage his own health and care with interventions designed to increase activation and promote positive patient<doctor> behavior.

My concern here is with engaging doctors to improve care for those, in any way involved with providing medical services to people with type 1 diabetes. The scale of the problem with inpatient care of people with diabetes and its consequences are well known and documented. The UK diabetes inpatient audit showed:

40% of inpatients on insulin experienced one or more insulin errors.

1 in 4 people with type 1 had a severe hypo

1 in 25 patients with type 1 developed DKA during their hospital stay.

One of the most common problems is doctors’ lack of education, or is it poor behaviour that makes then deny people with type 1 insulin when they’re not eating?

Whilst we’re at it, anyone asserting that there are lots of reasons why people with type 1 develop DKA whilst in hospital needs some activation towards further education.  There aren’t lots of reasons, the only reason somebody with pre-existing diabetes develops** DKA whilst in hospital is severe shortage of insulin. This is an example of not holding people accountable, ‘lots of reasons’ lets HCPs off the hook. THIS behaviour of excusing inadequate medical care needs to stop too if we’re ever to change the behaviour of those providing medical services.  As page 8 of the summary report correctly states:

“DKA and HHS are serious conditions which can have very serious consequences for the patient. They are preventable and should not occur during a hospital admission.”

Let’s get behaviour change happening in hospitals. How about some motivational interviewing of staff when we’re admitted? I think I’ll start asking a few questions to assess their knowledge and then take the opportunity to provide a learning experience for them, perhaps refer to some structured education? Maybe scare tactics? What about some cool tech that sends them an SMS every time a patient’s sugar goes out of range?

I don’t know about you but I’m still needing more strategies to deal with these non-compliant avoiders    Do you have any ideas, maybe we could write a paper or run a course or something?

*Quote from,

**The one in 25 stat refers to those who enter hospital without DKA but develop it whilst in the ‘care’ of the hospital, not to those who may enter hospital with DKA.

2 thoughts on “How Can We Engage Doctors to Change Behaviour?

  1. I’d say, “Bring somebody who knows something about type 1 diabetes and your specific protocols with you when you get admitted to hospital. I’ve seen the idiots in action many times, but I’m still surprised at the number of patients who go into DKA in hospital nevertheless. I know last time my type 1 diabetic husband was an inpatient, one resident finally capitulated when my husband pointed out to him man to man that the resident had no clue about type 1 diabetes and my husband should just call for the nurse to do a blood glucose reading and he would adjust the insulin delivery from the pump as necessary. People take a doula in when they are about to go into labour so why not have a confederate with you if at all possible until the hospital staff learns more or understands the power of an insulin pump and cgms. After reading this, I have no intention of leaving my dh without me there ever again. I’ll bring my own air mattress if necessary.

    1. I agree Dianna, I think you need to have somebody with you and to be as prepared as possible. It’s exhausting! I like the doula comparison, maybe that’s a new career path for me-dunno what to call it -hospital diabetic lifeguard maybe.

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