Avoiding the language of control with diabetes

"Your diabetes control is really not terribly good and if you carry on like this year after year your risk of getting long term complications from your diabetes is really quite high."

It's a line I have to say all too frequently - though as gently as possible - to patients.

But it strikes me that 'control' is rather an emotive word. I wonder what the patient hears when we say this sort of thing? Perhaps something along the lines of "I'm finding it very difficult to control you and you are a very naughty patient," or "Just as your school teachers of yesteryear said, you aren't doing very well and must try harder."

Maybe some do hear the message as it was intended. However, I remain concerned that 'control' is a bad choice of word for describing the end result of the daily wrestle with one's blood sugars.

There are subtle insinuations that arise from the word. Perhaps 'control' implies that one factor or one person is dominant over another (the doctor over the patient maybe?). Perhaps it implies something regimented, predictable or inflexible, precisely the attributes that one wouldn't normally associate with a biological variable such as blood glucose levels. Perhaps, worst of all, there are connotations that the diabetes might be controlling the patient - a sadly common occurrence.

The 'C' word is not a desperately good word for describing how optimal or otherwise a patient's glycaemia is. Indeed I go through phases of trying not to use it. I replace it with euphemisms such as the aforementioned 'glycaemia', synonyms such as 'regulation' or the rather obvious and unimaginative 'HbA1c'.

However, whenever I do so, my clinic letters take on a stilted, almost constipated air which must seem very strange to the colleague reading them and thus inevitably, unavoidably, I eventually revert back to 'control'.

In the 21st century, in an era of patient empowerment, can we not find a better word to use when discussing the central issue of long term glycaemic regulation with our patients - a word that carries less hidden emotional power, a word that helps rather than hinders our patients?

Answers on a postcard...

Tags for this article: control

The author - Dr Jeremy Turner

Jeremy Turner A consultant diabetologist and endocrinologist in Norfolk, and author of Diabetes Bible

A bit more about the blog...

My blog expresses my personal views on the rapidly advancing field of diabetes. It is aimed at fellow physicians and is not offering medical advice to readers. I will not respond to requests for clinical advice. If you have health concerns please contact your GP or specialist.

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