Comments on: Wanted: “Cultural Competence” in Diabetes Care

By: Bek

Bek — Wed, 05 Nov 2008 22:07:35 +0000

Great points…
I would like to also point out that diabetes in and of itself is a culture..
This disease and the management of it are more ingrained in my daily life than any cultural aspects…

I can only imagine how much less frustrating, and more effective, some of my medical experiences would have been had the medical professionals I was dealing with (from pharmaceutical and med technology reps to nutritionists, and even my own doctor) had cultural competence in regards to various medical issues… In my case, cultural competence in regards to diabetes (specifically type 1…most of them seem to have quite a bit of understanding about type 2) and chronic pain management have been proven, time and time again, to be two areas where the “pros” have textbook knowledge and no concept of what life with the disease is like-and that can cause a huge communication problem and lead to compliance issues and patient frustration…

Sure, I’d rather have a doctor that understands my actual cultural heritage and norms (to a degree), but I’d much rather have a doctor who understands that managing this disease goes beyond testing x times/day and shooting up x times/day and that this disease, and the management of this disease, do not exist in a bubble.

Just my 2 cents (ok make that 2.5

By: CALpumper

CALpumper — Fri, 15 Feb 2008 18:01:27 +0000

This is great information and Linda’s post is very scary too.

As a child I had an American Female Pediatric Endo. Good fit. What I found was key to my relationship with her….honesty. She told me how many children hide or lie about their bt’s. I told her, why lie, if I give you the information you need then you can help me.

After her I saw an American Male Endo as an adult. We were not a good fit, he had different agendas and opinions on treatments. After trying his way, getting worse and him being adamant about it working, I left.

Then I moved onto an Indian Female Endo. Although our cultures were very different, important to me was she was a woman. As I was growing and changing with my disease, even in my 20s, she was very helpful. The best thing she did for me was listen, provide information and empower me to guide her.

My latest is a Pakistan Male Endo. I have become very knowledgeable about how my body reacts to certain things and learned some medical jargon. This helped develop a good communication with my Endo as he did not need to explain things to me, he could talk “straight” and I would tell him Yes or No to therapies, drugs, tests etc.

Every Endo I have had is a very different person (where they grew up, what they believe, where/how they got their degree, research concentration). Each has an opinion. So as a patient be vigilant and proactive. Tell your Endo who You are! What you are about! Be honest, upfront. This is Your life and if you do not think something will work, or if you do, tell them. And if you are not comfortable with them, find someone else.

Through the years Endo’s have listened to me, not, tested, tried things, believed it was only one way for all diabetics so it has to be that way for me. I have encountered it all. So you have the choice, listen to your body and find an Endo that fits or just believe what your Endo tells you. (from experience, doctors do not know everything! what they say is not the end all be all, not the only way) I appreciate my current Endo because he can admit that he has no idea why some things work for a time then don’t. That means a lot to me because He is being honest too!

These days with technology, research. Find what works for you and work it!

By: camille johnson

camille johnson — Fri, 15 Feb 2008 17:04:55 +0000

Please tell me who/where to warn potential users.

I need to inform you and potential users of the shortcomings of the Dexcom7 Continuous Glucose Monitor.

I started using this device about four months ago and between failures of one kind and another, I’ve been able to use it, at most, two months. The company and the sales/educator that I worked with were very helpful on the phone and replaced most parts that failed, BUT my patience finally faced reality and that reality is: the Dexcom7 is NOT reliable or dependable and it is NOT ready for mass consumption. Not one of the parts/pieces has worked in a reliable manner and the engineering of the pieces evidently has not been tested in a manner that warrants sale to the public.

It is hard to know exactly what part has failed, but according to the various people I have talked to at customer service, the sensor, the transmitter, the receiver, and the connection cable have all failed. Also [and one of my biggest peeves] the blood test strips rarely work. It is normal that 4-6 (read $4-$6) strips are used before one “works” and displays a glucose level. The management level response to this is that “Dexcom is not responsible for the test strips. Dexcom does not manufacture the test strips.” The OneTouch Ultra Test Strips” are used by other monitors without problems and I don’t believe the test strips are at fault. The Dexcom monitor that “reads” or fails to read the strip, is at fault.

As a Type1 diabetic, I need my monitor to give me reliable information at all times. The Dexcom7 does not succeed. Please help distribute this information to all persons considering this device.

By: Linda B.

Linda B. — Thu, 14 Feb 2008 04:11:19 +0000

I know that understanding other cultures can help in getting good treatment,but, I must point out that sometimes, the doctor treating you who is from the same cultural background can hamper your treatment just like a doctor who may not know your culture. Why do I say this?
My mother in law is Filipino. Her doctor is Filipino. During the past few years this doctor has been what I like to call a pill pusher. They come home with all these drugs and no training. My mother in law is a type 2 diabetic. She has uncontrolled high blood pressure, high cholesterol, and totally out of control diabetes. In the last 6 weeks she has had three strokes. Two on the left and the BIG one on the right side. During this last stroke they went to his office he looked at her and sent her home with a scrip for a CT scan and an aspiration study and told her to call a neuroligist. By the time the time they called me it was 5 hours later and she was stroking out.
because this doctor told them it was not an emergency they sat at home while she worsened, then called us. When we found her she had facial paralysis,nospeech and no swallowing ability left. They would not go to the ER because their doctor told them not to bother it would go away. Well It didn’t. She almost died. This doctor knows the culture and the diet and the foods they eat. He was born in the Phillipines just as they were. he knows. his negligence almost killed her and her husband a year ago. He is also a type 2. Uncontrolled, high blood pressure, etc. etc. They went to see him because he was having some chest discomfort. He said it was probably nothing and sent him home with an unnecessary scrip.Two days later he had a massive heart attack followed by Quintuple bypass. He is still uncontrolled about his diabetes and his diet. He feels because he has new pipes he’s in the clear and the doctor doesn’t tell them he still could have problems. They continue to go to see this doctor because he is Filipino and will talk to them in Tagalog. They both speak perfect english, so language barriers is not an issue. they defend him to the end. The latest defense is he probably didn’t know she was having a stroke because he is just an internist. Ugh! I am banging my head against the wall right now.
I do feel that having a better understanding of the cultures your patients come from can help in the treatment of diseases, but,negligence can happen even if they know the whole culture because they are from the same place as you. In this case their cultural loyalty seems to be killing them.

By: Allison

Allison — Wed, 13 Feb 2008 18:14:09 +0000

Amy-

You haven’t by chance read “The Spirit Catches You and You Fall Down” by Anne Fadiman, have you? We read it in my Health Communication class during my senior year in college and it speaks to the cultural differences patients have with medical professionals very well. It’s an interesting read about the Hmong people, who unlike some populations, are unable to communicate via a translator. Check it out if you can.

By: Rob

Rob — Wed, 13 Feb 2008 17:11:47 +0000

Amy-
You make a very good point here. The cultural differences are sometimes too much to overcome and can lead to what they refer to as “noncompliance.”
But I have seen efforts to combat this. For instance, right in your backyard at the UC San Francisco Diabetes Center, they have a Latino Program that caters specifically to LWD (Latinos with Diabetes), with bilingual AND bi-cultural specialists. This has been a huge success in its short existence and is growing quite rapidly. I work for a foundation that helped provide the start-up money for this program, and am proud to see the differences it is making in people’s lives. Thanks for bringing this to the attention of the diabetic community!