I don’t believe in the term “non-compliant” when it comes to type 1 diabetes. I understand it, and I know what it means, but I have a hard time reconciling it with the sheer demands of this disease.
The term “non-compliant” can seem like a scarlet letter on a patient’s electronic health record. To so many people living with diabetes, “non-compliant” is seen as a negative word, and has the ability to perpetuate defeatist thoughts and make the daily struggles of life with a chronic illness even more challenging than they are on their own. Finding success with type 1 diabetes requires a balancing act of blood sugars, carbohydrate intake, measured and monitored activity, and knowing your body and its myriad of potential malfunctions extremely well. As demanding as this disease is, it’s a wonder, frankly, that anyone is ever deemed “compliant” with diabetes.
The worst part about being labeled “non-compliant” is the emotional impact of the term. Not only does it haunt the patient personally, but when seen in a patient record, it often conjures unconscious bias against patients by the healthcare professionals that we trust to help us get and stay well. In turn, these areas of non-compliance become the focus of our healthcare, instead of focusing on all of the many things that we do right in our daily decisions with our disease.
Word choice matters, and the words we use to describe people and patients living with diabetes holds great power over both patient and healthcare professional. We and our healthcare teams need words that convey meaning with more empathy and compassion, and better acknowledge what the individual patient is going through.
A better set of words to appreciate the challenges of living with diabetes, and the desire to constantly improve, are “struggle” and “thrive.”
A struggle, put simply, is a conflict of any kind, or a task or goal requiring much effort to accomplish or achieve. People can relate to a struggle, because we have all experienced some form of one in our lives. The struggle demands hard work and focus to overcome it, and maybe even inspire others along the way.
Example: Patient is struggling to lose weight due to 8-10 hours of office work per day.
Given many of the stumbling blocks that people with diabetes face, a struggle is more forgiving when that person needs to ask for help. Struggle has the capability to shift the focus to the problem, not the person. When a healthcare professional hears of a patient’s struggle, it can prompt a more meaningful conversation about the details of the struggle, and shift the focus to those things that the patient is distinctly struggling with.
Example: Thank you for sharing that you’re struggling to lose weight, and mentioning that you spend most of your day in the office. Let’s talk about how we might be able to incorporate more exercise in your day, and give you an opportunity to thrive outside of the office.
Struggle also yields a “can do” feeling, and is empowered by progress. To overcome a struggle, we must find a way to thrive. A person may be struggling with their diabetes, but they always have the potential to thrive. As we thrive, we learn from our struggles, and we increase the likelihood of repeating those behaviors that yield positive results.
Example: After struggling to lose weight due to a sedentary office environment, patient is now thriving after incorporating early morning 30-minute workouts at the gym, and has lost five pounds since his last visit. Well done! Keep up the great work.
The most important aspect of the shift from struggle to thrive is positive and constructive feedback. When we label things compliant and non-compliant, it’s as if the judge has already ruled on our situation, and we missed the opportunity to present our case and discuss the evidence. With struggle and thrive, talking through challenges is imperative to define the struggle, and ultimately ensure that we eventually find success.
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