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I’ve been reliably informed that in some areas of the country before patients are allowed a pump some healthcare providers make them sign a contract which says they will cooperate with health practitioners and turn up to appointments, etc.
Ignoring the legalities for the minute, what views do you have on patient contracts like these?
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They are a bad thing. It implies that the healthcare provider is doing the patient a favour by letting them have a pump, and in return the patient has to do as they are told. Which is often a bad thing, as many (not all) healthcare providers dont know as much about diabtes, in particular the patient’s diabetes, as they think they do…I think it is treating the patient as a child or a criminal – ‘do this and we’ll let you have a new toy’ or ‘do this or we’ll punish you’ (by not letting you have a new toy).
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They are a bad thing. It implies that the healthcare provider is doing the patient a favour by letting them have a pump, and in return the patient has to do as they are told. Which is often a bad thing, as many (not all) healthcare providers dont know as much about diabtes, in particular the patient’s diabetes, as they think they do…I think it is treating the patient as a child or a criminal – ‘do this and we’ll let you have a new toy’ or ‘do this or we’ll punish you’ (by not letting you have a new toy).
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I’ve also seen heartbreaking posts by people who have been threatened with (or have experienced) having their pumps taken off them for not achieving what are deemed to be satisfactory results. In some cases within as little as 6 months!
Given the ferociously steep learning curve that some people will face in transition from (poorly supported/educated) MDI to pumping this seems nothing like long enough to me.
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I’ve also seen heartbreaking posts by people who have been threatened with (or have experienced) having their pumps taken off them for not achieving what are deemed to be satisfactory results. In some cases within as little as 6 months!
Given the ferociously steep learning curve that some people will face in transition from (poorly supported/educated) MDI to pumping this seems nothing like long enough to me.
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The original conversation I had was taken in the context of Did Not Attends (DNAs). Subjectively* it seems that at my local hospital pump users are not turning up for their regular clinics. The “contract” is a proposal being mooted to force patients to turn up.
* the stats seem to be vague, so it’s probably difficult to get an objective measure of whether pump users are actually worse than other patients when other factors – such as age – are taken into consideration.
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The original conversation I had was taken in the context of Did Not Attends (DNAs). Subjectively* it seems that at my local hospital pump users are not turning up for their regular clinics. The “contract” is a proposal being mooted to force patients to turn up.
* the stats seem to be vague, so it’s probably difficult to get an objective measure of whether pump users are actually worse than other patients when other factors – such as age – are taken into consideration.
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@mike – if one looks at my A1C *alone* my control is worse on a pump than on MDI. So by that measure alone you could argue for having my pump taken from me.
However, what the A1C doesn’t show is that my day to day BG is far, far, far better than before. I used to have very high swings leading to a great average BG. Now I have fewer swings but a higher average BG.
I guess this shows that A1C is a crap measure when used alone, something that’s been discussed many times before on these hallowed pages.
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@mike – if one looks at my A1C *alone* my control is worse on a pump than on MDI. So by that measure alone you could argue for having my pump taken from me.
However, what the A1C doesn’t show is that my day to day BG is far, far, far better than before. I used to have very high swings leading to a great average BG. Now I have fewer swings but a higher average BG.
I guess this shows that A1C is a crap measure when used alone, something that’s been discussed many times before on these hallowed pages.
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@seasiderdave – I think it would be better called a “memorandum of understanding” rather than a “contract”; it’s technically more correct and scores a potential 120 points at Scrabble.
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@seasiderdave – I think it would be better called a “memorandum of understanding” rather than a “contract”; it’s technically more correct and scores a potential 120 points at Scrabble.
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I don’t see it as good or bad.
if they’re the rules a provider comes up with to supply a pump abide by them, If you don’t like it buy your own pump & supplies.
Admittedly applying rules to the level of control achieved would be somewhat more complicated and likely to be unfair in some cases.
It’s not limited to diabetics, the same arguments & contracts are made about smokers/drinkers & organ donners.
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I don’t see it as good or bad.
if they’re the rules a provider comes up with to supply a pump abide by them, If you don’t like it buy your own pump & supplies.
Admittedly applying rules to the level of control achieved would be somewhat more complicated and likely to be unfair in some cases.
It’s not limited to diabetics, the same arguments & contracts are made about smokers/drinkers & organ donners.
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Can you have a 3 word phrase in Scrabble?
I think it’s fair to set out what’s expected of a patient – what that is depends on the actual patient. eg if you asked me to commit to doing as I’m told, I’d tell you that I commit to listening to what you have to say, doing independent research on the subject and making my own decisions. But at least I’m demonstrating that I see I have an important part to play in my own care. Other people might demonstrate that by turning up to appointments, attending education classes etc.
HbA1c improvement is a very clumsy measure to track pump success by, it’s one factor to look at, but little more that that.
I’d like to see a similar list of what I can expect from my diabetes team too. That way, we all know what’s expected of each other.
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Can you have a 3 word phrase in Scrabble?
I think it’s fair to set out what’s expected of a patient – what that is depends on the actual patient. eg if you asked me to commit to doing as I’m told, I’d tell you that I commit to listening to what you have to say, doing independent research on the subject and making my own decisions. But at least I’m demonstrating that I see I have an important part to play in my own care. Other people might demonstrate that by turning up to appointments, attending education classes etc.
HbA1c improvement is a very clumsy measure to track pump success by, it’s one factor to look at, but little more that that.
I’d like to see a similar list of what I can expect from my diabetes team too. That way, we all know what’s expected of each other.
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I work in healthcare and have come across similar things although they are generally referred to as patient agreements, chronic pain clinics is the one example that springs to mind. Also they may be put into place if there is a “difficult to manage” patient, ie one that is violent, disruptive, repeatedly drunk or on illegal drugs. Also often seen within mental health areas
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I work in healthcare and have come across similar things although they are generally referred to as patient agreements, chronic pain clinics is the one example that springs to mind. Also they may be put into place if there is a “difficult to manage” patient, ie one that is violent, disruptive, repeatedly drunk or on illegal drugs. Also often seen within mental health areas
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@tim Just because they are “violent, disruptive, repeatedly drunk or on illegal drugs” doesn’t mean they are not diabetics!
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@nigho – ha ha ha, very good point. I should have thought of most Shoot Up meet ups – I’m not sure about the illegal drugs and violence, but there’s always plenty of disruption and repeated drunkenness
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Is the onus just on the patients to turn up and co-operate or do the health practitioners have to do the same?
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