There are many articles discussing patient barriers, trying to explain why patients have difficulties improving their self care. There are economic barriers in which patients cannot afford their medications or "special" diabetic foods. Social barriers are discussed in which patients have poor or no support at home, sometimes even being sabotaged by family and friends who entice the patient to participate in unhealthy activities, such as attending "all-you-can-eat buffets." Some articles address literacy barriers or lack of understanding of terminology used by health care professionals or in the literature. A newer barrier is numeracy or the inability to understand and comprehend the numbers of diabetes – either in reference to glucose values, calculating insulin doses or figuring out insulin to carb ratios. There are also articles on "psychological insulin resistance" which can create barriers both on the part of the patient and the healthcare provider.
Last week, we had a new challenge in our busy multi-provider clinic. A young healthcare provider, who has completed college and is now doing her residency (you can do the math) speaks in a very high voice. If you talked to her on the telephone, you would probably judge her to be in her early teens. A patient told her he did not want her as his healthcare provider because she was not "old enough to have the experience needed to know how to take care of him." Needless to say, this really hurt her feelings.
This started us on the conversation of "What types of barriers do patients perceive when interacting with their healthcare providers?" Some staff offered experiences where patients had also commented on their usually young age. I shared that when I first began my CDE career, I would bop into a patients room with my flip-chart and handouts and the elderly men (usually) would pat me on the arm and kindly tell me, "Honey, I've had diabetes since before you were born. What do you think you are going to tell me?" (But no one has said that to me in a LLOONNGG time!)
We discussed not only how youth/age affects patients' perceptions of us, but how some male patients do not want female health providers. Many female patients do not want male healthcare providers. Does it matter to patients if an overweight provider is counseling them on dietary management of diabetes? I have had patients tell me that their healthcare provider "needs to practice what they preach." On the flip side of this, one of our dietitians is very thin – she is a runner and has a very lean runner's body. Patients have mentioned to me that they do not think she can relate to their struggles with weight. And does it matter when counseling patients about medications or foot care or prevention of complications if they are of a different ethnic background?
This is an interesting subject to contemplate, don't you think?
What type of unexpected "barriers" have you experienced in your practice? How did it impact the patient and how did it impact YOUR interactions with that patient?