Transcript No Slide Title

Management of chronic diseases
Nature
Treatment
Patients
Doctors
1.
Incurable
1.
Important
1.
1.
2.
Mostly silent
2.
3.
Persisting
pain if at all
Variable
effects
Prescribe but not
control fully
2.
Need to share
knowledge and
foster attitudes
3.
Intervene in
emergency
4.
Detect
complications
early
5.
Should work in a
team
4.
5.
6.
No correlation
between
complaints
and lab data.
Uncertain
progress
Lifestyle
related
3.
4.
Patients
need self
discipline
Costs are
mental,
profession
al, social
and
financial
2.
3.
4.
Need to control
it even though
incurable
Juggle between
treatment and
life
As vigilance
lessens
problems
increase
Has to be
trained to handle
acute crisis.
Two types of responses to initial
shock of chronic illness*
Integration Process
o Disbelief
o Revolt (accusation)
Distancing Process
• Anguish (medical
team could cause it)
o Depression (sadness
for health lost)
• Denial of emotions
(sense of shame/ suffer
in silence)
o Confronting reality
• Passive resignation
o Consenting (coping)
with serenity
• Meloncholia (may
need psychiatric help)
*Lacroix A., Therapeutic Education 2003
Doctor’s role of patient’s health belief model
Patient should be convinced that he is ill.
He must believe there could be serious consequences
because of this illness
He must believe treatment will be beneficial
He must believe that the benefits will be more than
psycho-social and financial side effects of the treatment.
These can be discovered only by “semi directive
interviews” which convince the patient that interest being
shown in him is not merely biological.
This shifts the locus of control to the patient.
Empathy is the key to success
Empathy is not sympathy
Empathy is adult to adult
Empathy demands sincerity
Empathy demands dedication
Empathy creates trust and loyalty
Th. Arrivaali (the knowlegeble)
Age: 55-60 years
• Likes to be independent
Diagnosed since at least
8 -9 yrs.
• Knows the severity of the ailment
Gender:
• Mostly males/some
females in south
• Also seen in diabetic
couples
• Believes prevention is better than cure
• Well-informed: collects printed articles on
diabetes & attends seminars
• Positive about life despite diabetes. Follows diet and
leads a disciplined life
• Motivated enough to exercise regularly, believes
in timely medication, does not add sugar to food
Region:
• Mainly South India
• Practices self monitoring and self injection, visits
doctor less often, family involvement is very high,
calm and collected during hypos - knows what to
do.
Th. Bhayanthavar (the Scared)
Age:40-45 years
• Constantly curses his fate ‘Why me??’
Recently diagnosed
• Dependence on others …lack of faith in self
Gender:
•Equal proportion
of males & females
• Apathy in gaining knowledge about diabetes
• Looks upon diabetes as a demon controlling his life
• Resents the rigid lifestyle. Claims that he feels
dead from within.
Region:
Northern & Western
India but a rare case
in the south
• Visits the doctor every 7 - 15 days and hoping to
achieve better sugar control thereby
• Cannot overcome the craving for sugar and sweets,
family involvement in managing diabetes in low
•Dependence on others for taking insulin
injections
Th. Parkalaam (the casual)
Age: 40 +years
Living with the
disease for long
Gender:
• higher proportion
amongst housewives
than males
• Feels defeated. Dislikes rigid and disciplined
lifestyle
• Relaxed attitude towards self care, health and
diabetes…no drive to seek knowledge
• Considers self as least important member of the
family. Family too attaches low importance to her
health.
• Believes, “God gives so he will manage it…”
• Ignores diabetes until complications set in
Region:
Northern & Western
India but a rare case
in the south
• No exercise, poor compliance to dosage
schedule and no diet control
• Visits doctor only for emergencies
Th. Kurukku vazhi (the myopic)
Age: 50 - 60 years
Diagnosed since at least
8 -9 yrs.
Gender:
• Equal proportion
amongst Males and
Females
• Wants maximum results with minimum effort.
Thinks only of short term
• Convenience very important,
excuses to postpone treatment
looks
for
• Low awareness and lacks interest to increase
it. Looks for ways to end the treatment. Keeps
asking how long treatment will go on
• Convinces the doctor to postpone insulin
treatment, continues on orals even when they
have failed
Region:
Spread across regions,
fewer in south
• Maintains good diet control. Avoids oil and
sugar completely.
• Does not find even 10 minutes for regular
exercise, cites paucity of time as main reason
Th. Yavum Arivom ( I Know it all)
Age: 40 - 45 years
Recently diagnosed
Gender:
•Mainly Males
• Low awareness, but claims knowledge
• Experiments with different medications
without the doctor’s consent
• Gets information from diabetic friends &
relatives rather than professionals
• Takes risk. Will try all the possible remedies
including unproven and herbal
Region:
Not very region
specific, but none found
in South
• Avoids visiting the doctor to labs; feels it is a
waste of money
Positive attitude to treatment
Patient segments
Negative attitude to treatment