I just returned from the American Association of Diabetes Educator's national conference. About 2,500 educators attended out of approximately 17,000 in the country. (The 17,000 educators for now more than 26 million people with diabetes is another story!)
I attended as a presenter ("Dancing Together: The Power of a Relationship-Centered Approach"), to hear the latest news and to connect with my fellow educators -- perhaps the most impassioned group of health care providers I know.
But that's not what I want to talk about. I want to share the opposite -- the phenomena that too many health care providers fall victim to -- clinical inertia.
Clinical inertia is when a health care provider gets sluggish with your care. When he or she doesn't initiate or change your treatment when clinically indicated.
The Danger of Clinical Inertia
Clinical inertia is a major contributor to inadequate treatment in chronic illnesses like diabetes, heart disease and depression. It may even account for up to 80 percent of cardiovascular events.
Like medical errors, clinical inertia can put a patient in danger. For instance, your depression goes untreated or your blood sugars are always high because you're not on the right medicine.
Yet unlike medical errors, clinical inertia goes mostly unreported and under the radar. That's why it's up to you to be mindful whether your provider is providing treatment and recommendations in your best interest.
I hear about clinical inertia often in diabetes. Not from physicians, but from patients. While they don't use the term, they describe its effect.
A patient will tell me their blood sugar has been consistently in the 300s mg/dl (above 16.6 mmol/l). When I ask, "For how long?" they say for years. After I recover, they go on to tell me their doctor doesn't seem concerned.
When I first heard this from patients I was surprised. I hear it so often now, I'm not. What does surprise me, however, is many patients' inertia to discuss their continued poor health with their doctor.
Is it the white coat syndrome? The authority we bestow on doctors? It could be because when I suggest switching providers, whomever I say this to typically hesitates. Then a moment later I see the lightbulb go on. Of course I should do that!
I'm not damning doctors. I have some amazing doctors. Nor can I know when a patient tells me they're struggling, whether they're on a poor treatment plan, or it's brilliant and they're not following it.
But I do know clinical inertia is real and it occurs frequently among general practitioners in diabetes. And it's understandable why.
Treating diabetes is complex and time-consuming. Many patients need to be taught how to manage their blood sugar, blood pressure, cholesterol and weight. How to organize taking a plethora of medicines by time and amount and keep their prescriptions constantly filled.
Most patients will need to change lifelong behaviors around eating and exercise -- actions that have been ingrained for decades. They may also need to learn how to use blood sugar monitoring and tracking devices, or learn how to adjust their insulin doses daily on a sliding scale. And much more.
Causes of Clinical Inertia
There are three main reasons cited for clinical inertia: 1) Providers believe they're already giving sufficient care, 2) Providers lack sufficient training and 3) In chronic illnesses that require patients to change behavior, many providers don't believe patients are capable of, or willing, to do so.
The fear of losing patients and the income they provide can also be a cause of clinical inertia. A pharmaceutical rep, who works with doctors in New York City's Chinatown, told me a doctor he knows who has Type 2 diabetes finally put himself on insulin and said it was the best thing he'd ever done.
When the rep asked if he now recommends insulin for more patients, he said, "Absolutely not. They'll only leave me and go around the corner to a doctor who'll happily give them pills."
I hope this is uncommon. I also hope if you are a medical professional and fear patients will leave you because you recommend an injectible as their best treatment, that you help them understand why this is in their best interest and explore with them what they're willing to consider and do to address their own fear of taking shots.
Speak Up For Yourself
If you have a chronic condition and a voice in your head is saying, "I should be doing better, something's not right," you owe it to yourself to say that to your doctor. If you don't get the answer you want, find a doctor who agrees with you.
Dr. David Agus, professor of medicine at the University of Southern California, Keck School of Medicine, says in his book The End of Illness that the knowledge you carry about yourself is as essential to your wellness as your doctor's knowledge. Agus also recommends if you feel you can't talk to your doctor, find another doctor.
We're all prone to inertia from time to time. But when it comes to living with a chronic illness, if you're doing nothing when things are going poorly, you are actually doing something -- getting worse. Trust me, I know. My friend's cousin did just that and he's no longer here to tell you about it.
Riva's new book, Diabetes Do's & How-To's, is available in print and Kindle, along with her other books, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs Of Loving Yourself With Diabetes. Riva speaks to patients and health care providers about flourishing with diabetes. Visit her websites DiabetesStories.com and DiabetesbyDesign.com.
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