Management of chronic diseases

Nature1. Incurable

2. Mostly silent

3. Persisting pain if at all

4. No correlation between complaints and lab data.

5. Uncertain progress

6. Lifestyle related

Treatment1. Important

2. Variable effects

3. Patients need self discipline

4. Costs are mental, professional, social and financial

Patients1. Need to control

it even though incurable

2. Juggle between treatment and life

3. As vigilance lessens problems increase

4. Has to be trained to handle acute crisis.

Doctors1. 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

Two types of responses to initial shock of chronic illness*

Integration Process

o Disbelief

o Revolt (accusation)

o Depression (sadness for health lost)

o Confronting reality

o Consenting (coping) with serenity

*Lacroix A., Therapeutic Education 2003

Distancing Process

• Anguish (medical team could cause it)

• Denial of emotions (sense of shame/ suffer in silence)

• Passive resignation

• Meloncholia (may need psychiatric help)

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

Diagnosed since at least 8 -9 yrs.

Gender:• Mostly males/some females in south• Also seen in diabetic couples

Region:• Mainly South India

• Believes prevention is better than cure

• Likes to be independent

• Positive about life despite diabetes. Follows diet and leads a disciplined life

• Well-informed: collects printed articles on diabetes & attends seminars

• Motivated enough to exercise regularly, believes in timely medication, does not add sugar to food

• Practices self monitoring and self injection, visits doctor less often, family involvement is very high, calm and collected during hypos - knows what to do.

• Knows the severity of the ailment

Th. Bhayanthavar (the Scared)

Recently diagnosed

Gender:•Equal proportion of males & females

Age:40-45 years

Region:Northern & Western India but a rare casein the south

• Constantly curses his fate ‘Why me??’

• Apathy in gaining knowledge about diabetes

• Dependence on others …lack of faith in self

• Looks upon diabetes as a demon controlling his life

• Resents the rigid lifestyle. Claims that he feels dead from within.

• 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)

Living with the disease for long

Gender:• higher proportion amongst housewives than males

Age: 40 +years

Region:Northern & Western India but a rare casein the south

• Relaxed attitude towards self care, health and diabetes…no drive to seek knowledge

• Feels defeated. Dislikes rigid and disciplined lifestyle

• 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

• No exercise, poor compliance to dosage schedule and no diet control

• Visits doctor only for emergencies

Th. Kurukku vazhi (the myopic)

Gender:• Equal proportion amongst Males and Females

Age: 50 - 60 years

Region:Spread across regions, fewer in south

Diagnosed since at least 8 -9 yrs.

• Convenience very important, looks for excuses to postpone treatment

• Low awareness and lacks interest to increase it. Looks for ways to end the treatment. Keeps asking how long treatment will go on

• Wants maximum results with minimum effort. Thinks only of short term

• Convinces the doctor to postpone insulin treatment, continues on orals even when they have failed

• Does not find even 10 minutes for regular exercise, cites paucity of time as main reason

• Maintains good diet control. Avoids oil and sugar completely.

Th. Yavum Arivom ( I Know it all)

Recently diagnosed

Gender:•Mainly Males

Age: 40 - 45 years

Region:Not very region specific, but none found in South

• 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

• Avoids visiting the doctor to labs; feels it is a waste of money

Patient segments

Posi

tive a

ttit

ude t

o

treatm

ent

Scared

Negativ

e a

ttitude to

tre

atm

ent

Knowled

geab

le

Low levels of awareness

Myo

picI K

now

it a

ll

Cas

ual

High levels of awareness