Knowledgeable patients encounter problems with ill-informed doctors

Thursday, April 10, 2014 by: David Gutierrez, staff writer
Tags: patient knowledge, doctors, diabetes

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(NaturalNews) Patients who are especially knowledgeable may experience conflict with less-informed health providers, sometimes with dangerous results, according to a study conducted by researchers from King's College London and published in the journal BMJ Open in November 2013.

Advanced patient education has become popular in the United Kingdom, with many hospitals now teaching the Dose Adjustment for Normal Eating (DAFNE) course to help diabetic patients better manage their own health. While prior studies have consistently shown that DAFNE graduates have significantly improved health outcomes, the authors of the new study note that such research has been dominated by a medical perspective and has not asked what the impact of such advanced education is on other aspects of the patients' lives.

In order to study such impacts, the researchers interviewed 21 patients with type 1 diabetes who either had completed a DAFNE course in the past 10 years or were about to begin one. All the courses had been completed at one of three UK teaching hospitals.

Patient (dis)empowerment

The DAFNE course teaches patients to take control of their own diabetes treatments at a very high-level, training them to interpret complex blood glucose results, continually alter insulin regimens for best outcomes and understand the interaction of the many factors that can affect blood sugar, including drug combinations, other health conditions, diet, exercise, hormones, alcohol and travel.

In addition to learning knowledge and skills, patients are encouraged to view themselves as active and expert managers of their own health, rather than passive recipients of care from doctors or other care providers.

While most patients did indeed report that they felt empowered by the course and that their overall quality of life had improved, many found their healthcare decisions repeatedly challenged and even undermined by their care providers -- particularly by generalist practitioners who actually had significantly less diabetes-specific knowledge than the patients themselves.

"When these professionals did not understand what their patients were trying to do and were uncomfortable trusting their expertise, there could be serious consequences for these patients' ability to continue effective self-management," the researchers wrote.

In many cases, ignorant doctors merely tried to "educate" patients with false information. In other cases, they actively sabotaged patients' efforts to manage their own disease. For example, the DAFNE method calls for patients to test blood sugar significantly more often than is typically recommended, so they can make more precise decisions about blood sugar management. Numerous patients interviewed for the study reported cases of general practitioners (GPs) refusing to write them prescriptions for the number of blood glucose test strips that they needed. In other cases, doctors agreed but then wrote prescriptions for a lesser quantity. These decisions -- which occurred even among doctors presented with documentation explaining the DAFNE method -- actively undermined patients' ability to manage their condition, placing their health at risk.

"As [one patient] put it, his doctor did not 'win the battle' because of superior medical knowledge; the GP simply had more power, and chose to exercise it," the researchers wrote.

In another case, a woman was actually hospitalized against her objections when her doctors decided that her blood sugar was dangerously high - even though she knew that the higher levels were due to an unrelated infection and were not dangerous. While at the hospital, her ability to manage her own blood sugar was taken away and she was placed on an automatic glucose drip known to have a high rate of dangerous dosage errors.

"[P]atient education... cannot solve the power imbalance that remains when a generalist healthcare professional, however well meaning, blocks access to medication and supplies needed to manage chronic diseases successfully," the researchers wrote.

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