I was recently sent an article from Medscape that was written by Svetlana Katsnelson MD, endocrinology fellow at Stony Brook University Medical Center in New York.
The gist of the piece is that for a week as part of her endocrine fellowship training, Dr Katsnelson wore an insulin pump and checked her BGLs, and now believes she knows about living with diabetes. She also considers herself non-compliant because she didn’t bolus for an apple.
This may be oversimplifying the article a little and I honestly do believe that the intention here is good. But a little perspective is needed, I think. It was this comment that really upset me:
‘The experience provided me with a better understanding of how to use the devices that many of our patients use every day, but it gave me much more than that. I truly began to understand how difficult it is to live with diabetes.’
No, Dr Katsnelson, no. You do not truly understand how difficult it is to live with diabetes.
What you have is an idea of what it is like to walk around with a device delivering non-life saving saline into your system. You also have an idea of how it sometimes hurts when a sharp object pierces the skin on your finger. You probably could have deduced that anyway because, you know, sharp object, skin, nerve endings etc. You know how the buttons of these devices feel under your fingers and the weight of the devices in your hands.
You may have an idea of how tricky it can be to accommodate a pager-like device if you are wearing a pretty, flowing dress to work (if that is your want). You may now understand how annoying it is to have to stop what you are doing because it’s time to do a BGL check.
But what you don’t understand is that diabetes is about so very much more than that.
Here is what you don’t have any idea about.
You don’t understand the feeling of ‘this is forever’ or ‘I never get a holiday from this crap’. I know that this was acknowledged in the article, but really, you don’t know how it feels to never be able to escape diabetes.
You have no concept of the boredom of living with a chronic health condition, or the monotony of doing the same tasks each and every day over and over and over again!
You don’t understand the fear that overtakes your whole being as you imagine all the terrible complications that have been threatened and promised as result of diabetes.
You have no notion of the frustration of living with a condition that doesn’t have a rule book – and in fact changes the rules all the time!
You haven’t any perception of the fear I sometimes feel that I’ve passed my faulty genetic matter onto my beautiful daughter; or that I am a burden to my family and friends.
You will never feel the judgement from healthcare professionals because numbers are too high or too low – or that there are not enough of them.
You will never be called non-compliant by a doctor or made to feel guilty because you are eating a cupcake – all because your beta cells decided to go AWOL.
While I really do commend the notion of HCPs trying the ‘day in the life’ (or ‘week in the life’) idea, I think that being realistic about what this experience provides is important. It does not give any insight into the emotional aspects of living with a chronic health condition. It doesn’t explain the dark place we sometimes go when we are feeling particularly vulnerable or ‘over it’.
I have to say that all in all, this article left a sour taste in my mouth and I don’t like to feel that way because it sounds like I am being Grouchy McGrouch. I’m not. And as I said, I think that the intention here is good.
I just don’t want Dr Katsnelson to think that she now knows what is going on in my head when I wake up at 4am and every terrible scenario plays out leaves me feeling a pressure on my chest and a blackness in my mind that threatens to overtake me.
But I also want Dr Katsnelson to know that I really don’t expect healthcare professionals to know and understand all of these things. I expect them to treat me with respect and dignity. If this exercise has helped that, then great, but please, call it for what it is.
The article discussed in this post (Svetlana Katsnelson. Becoming the Patient: Not as Easy as It Looks. Medscape. May 12, 2014.) can be accessed here by first creating a free login.







14 comments
Comments feed for this article
May 29, 2014 at 2:26 pm
Jeann
I thoroughly agree with your comments, Renza. It is a 24hr, 7 days a week forever thing to deal with. My feelings and attitude towards diabetes can change from hour to hour.
LikeLike
May 29, 2014 at 7:11 pm
RenzaS
Thanks for your comment, Jeann. I’m so inconsistent about how I feel about diabetes too! Hour to hour/minute to minute!! Thank you for reading!
LikeLike
May 29, 2014 at 2:38 pm
Victoria
She said “began to understand”. She never said that she fully understood or ever would. She is not claiming to know or feel the total emotional pain. But isn’t this a start? Isn’t a start that as part of training she did this? This is much more than any doctors (at least that I know) do. It’s a start to perhaps a more understanding and empathetic medical community that understands and see’s people’s struggle as PEOPLE not as medical specimens who are to be judged for being non compliant. Yes it was only a week and yes it was not simulating real life diabetes but I am so impressed. I understand your anger at diabetes hell yes, but I feel you have reacted to harshly to someone who was trying to do a decent thing and never claimed to have full understanding just the beginning, just the top of an iceberg of what her future patients experience.
LikeLike
May 29, 2014 at 7:20 pm
RenzaS
Thanks for reading and for your comment, Victoria.
I agree that exercises such as this are a start. But my real issue is that in this instance the doctor’s claims that she (or anyone) has an understanding (small or otherwise) of life with diabetes because she wore a device for a few days.
It overemphasises that diabetes is all about the annoying management tasks. We all know that is just one part of it.
Once again – thank you for reading!
LikeLike
May 29, 2014 at 3:45 pm
Glen
Hmmm, so she thinks that she has an idea…. me thinks she has no idea!
Give it a go for a week or a lifetime, I know which I’d choose. I bet I would even be able to smile knowing the end. of the week was coming. I am sure it had novelty value for her and is a good thing to bring up in conversation at conferences. how insulting
LikeLike
May 29, 2014 at 7:13 pm
RenzaS
Thanks for your comment Glen. While I really do think that these diets of exercises have merit, I don’t think that they provide any greater insight other than the practical factors. My real issue was with the doctor believing that her experience gives her an idea about ‘real life with diabetes’.
LikeLike
May 29, 2014 at 7:36 pm
Glen
Exactly.
LikeLike
May 29, 2014 at 4:00 pm
Mike Hoskins (@MHoskins2179)
Exactly – well written. Completely agree on all of it, from the good intentions aspect to the criticisms. What bothers me the most, like you: She calls herself non-compliant because she missed a bolus for an apple. If that’s what it takes to hit “non-compliant” level for the patients this doctor sees, and she justifies using that term on patients because she now has some deep understanding of what it’s like to live with D, then I fear for those patients…
LikeLike
May 29, 2014 at 7:46 pm
RenzaS
Thanks for reading, Mike. Language is so powerful, isn’t it? And the word noncompliant is horrid. I’d be happy to never hear the word again!
LikeLike
May 29, 2014 at 5:07 pm
Patty
Did you read her entire article? Last paragraph: “I found myself eagerly waiting for the week to be over so the pump could be removed. But I also felt guilty as I realized that it is never over for my patients. They do not get to take time off from diabetes; they live with it every day. The experience provided me with a better understanding of how to use the devices that many of our patients use every day, but it gave me much more than that. I truly began to understand how difficult it is to live with diabetes. From struggling to find moments of privacy during the day to check my fingerstick, to keeping track of every morsel I was eating to get my insulin coverage, this was an unwelcome change in my life. I realized that although we have the best intentions as healthcare providers for our patients with diabetes, we are often distanced from their experience. I have spent so much time counseling and teaching my patients that I forgot to learn from them.”
LikeLike
May 29, 2014 at 7:50 pm
RenzaS
Hi Patty. Thank you for reading.
Yes, I did read the last paragraph. I read the whole article several times over. And it is in that very paragraph that Dr Katsnelson made the comment I disagreed with. I really don’t think that wearing a device for a few days provides her with understanding of how difficult it is to live with diabetes. I just don’t.
Thanks for your comment!
LikeLike
May 30, 2014 at 12:09 am
Kirsten
Renza, your post couldn’t have been more well-timed as I was complaining to my (non-D) partner tonight about my frustration that no-one can ever truly understand how I feel except those with Type 1 diabetes. (My partner agreed with me). I have’t read it, but a HP with a functioning pancreas also isn’t going to experience how absolutely shit one feels when really high or really low, the absolute terror of waking up at night to a reading of 26, the feelings of failure when one’s sugars aren’t coming down (or up), the constant thoughts in mind about doctors appointments, medications, site changes, carbs etc. Great that she got some insight, but she can never really know, which is why we need each other both online and offline so we know there *are* other people out there who *do* get it.
LikeLike
May 30, 2014 at 12:23 am
SarahK
True, wearing the device for the week and mimicking the standards we have to live by shouldn’t be seen as fully understanding what it’s like to live with diabetes, but I do give her credit for at least somewhat understanding, even just a smidge, that it’s a struggle. We can’t expect people who don’t live with our disease to fully understand because they never will, but anyone who wants to give any credit they can toward our struggle is welcomed to do so in my book. She never said she understood what it was like to actually be a diabetic, just that she understood the some of the pressure to be “perfect”. I’d rather have this than a doctor or endo tell me that “diabetes is easy, I don’t see why patient’s are not compliant…”
And that whole “non-compliant” word? I don’t’ let it bother me. It’s just a fancy legal term they can use to get them out of trouble in my opinion. I don’t know a single patient living with a chronic disease that has as many restrictions as we do that could be labeled 100% compliant every single day. It’s just too much pressure. (and I think that was what she was alluding do)
LikeLike
May 30, 2014 at 1:33 am
Catherine
I wore a pump for two weeks. I thought it would help me understand a little of what my daughter goes through. What it taught me is that I have absolutely NO idea what it must be like. I could “choose” to test or not, bolus or not. My levels were perfect so I have no idea what highs and lows must feel like. And, at the end of the day, I could take it off anytime I wanted to because my life didn’t depend on it. It did teach me something – but not what I expected. It taught me that I can never even begin to really understand. I can empathise but that’s it.
LikeLike