There are times when writing this retirement blog that I have the first sentence in mind but not the rest of the blog. At other, less frequent times, I have the blog in my head but not the first sentence. This latter was the situation with this blog which is why I’ve started with the above. The reason I had the ‘body’ of the blog somewhat ready to go in this case was because, after the event, I wrote down in my diary as much as I could remember about what had taken place. Just let it be said that I needed to write it down, or as much as I had remembered, because it upset me so much. So, taking my own advice, I wrote it out, it’s that writing as therapy business once more.
The event is simple enough to describe, it was my six monthly diabetes review. After this I’m finding it quite difficult to set down, so be patient. The first difficulty is deciding what the theme of this blog about the review should be. At this point I’m going to suggest to myself that the underpinning theme is the importance of positive feedback (and the lack of it in this case) in those medical situations where the person’s psychology plays a big part in determining how successful their ‘treatment’ is. The problem, in my opinion, is that the professionals involved, in this case two of them – a diabetic nurse and a dietician – are trained to describe problems, to help the client, patient, victim understand the seriousness of their condition. Then they are programmed to give advice.
All well and good you think but, again in my opinion (and this is the first challenge), this advice is based on ‘pseudo science’. Why do I say that? Because each time you meet a new professional they give you their own pet version of what diabetes is about and how to go about ‘curing’ it. This differs from the last person you met. It is unfortunate that this was the case with the two professionals involved with my last review. Without any word of information or explanation I was wheeled in to meet them. Was it alright as they were short of time if I met them both at the same time as opposed to one after the other as on previous occasions. What I am going to say? I don’t care that you screwed up your schedule, do it properly. Don’t think so.
The dietician immediately whips out her book full of photos of meals. Quite brisk but then they were short of time. Which of these three pictures are most like your beans on toast; baked potato; bowl of cereal etc? Despite the knife and fork at the side of each dish it was difficult to choose the ‘right’ one. I started to get increasingly cross. What I felt this person was doing was hiding behind her photos, her ‘pseudo science’. I did not feel treated as an individual with his own emotions or psychology if you like, I was simply an appointment to be assessed, criticised and moved on. I did not like this. I started to resist which is what clients do when the therapist in a counselling situation try to push them too fast or too far. After 30 plus years as a psychologist this much I know.
So far the session had been impersonal and too fast, a couple of problems for me but the main irritation and one common to this setting is the lack of positive feedback about my lifestyle. As a psychologist I was a big believer in finding something positive about the child and working with the adult involved to find a way to build on the positive in a small way. Small steps as the cliché has it. I gave them the opportunity when I told them about walking the dogs twice a day. ‘Brilliant’ the dietician said and then with no further comment, back to the photos. I think I’m right in saying that two key aspects of treating diabetes are diet and exercise. Here I was doing well on the exercise front, what I like to think I would have done with a reluctant-to-change diet person would be to ask more about the exercise – did I find it easy? How did I keep going with it? How did I feel after I’d done my two hours? And so on then tried to find a pathway to tackling my diet.
I wasn’t completely surprised by the lack of pick up on the dog-walking front. I remember when I told my then diabetic nurse about getting the pups, I was so proud, she would be so pleased and, sad though it sounds, I want somebody to be pleased. She wasn’t pleased instead she said, ah, but do you stroll? I mean bloody hell, would it kill you to say something positive? Last time I visited my GP he asked me how much alcohol I drank, I said two pints a week and two glasses of wine, say 4 or 5 days a week. About 14 units a week. Pretty good I thought. You could lose a glass of wine each day, he replied. This medical lark feels like an unending round of rugs being pulled out from under feet. Witness the baked potato as above. How big is your baked potato? I indicated the middle picture (as above). No questions about fillings, toppings, just, they’re very high in carbohydrate (in fact this woman seemed to have a little hobby horse about carbo bleedin’ hydrates, no questions about sugar, butter or any of the bad things according to some people). I mean if you can’t put your trust in a bleedin’ baked potato without any topping what is a chap to do? I felt this woman had developed her hypothesis and now let’s make the facts fit it.
I felt moved to tell these two about my visit to my dentist. He looks at my teeth and says, good brushing, Peter. I feel ten feet tall and you know what I make sure I continue with the good brushing. It’s called positive reinforcement and, with a few qualifications (which I don’t have space for here), I reckon it’s a good thing when it comes to shaping human behaviour, man or boy, healthy or with a condition.
If, by now, you think I’m blaming the wrong person, i.e. them not myself, that this is all a bit one sided, you know them bad, me good, just let me say that I told them as well as being very disappointed with the professionals, now them included, the person I was most disappointed with was myself, for getting diabetes and for being dependent on an increasing amount of medication. This approach didn’t seem to help either, maybe it’s just me. I don’t know whether as I get older I become more sensitive (and I can hear friends saying, nah, you were always sensitive) more needy and that diabetes now means something more psychologically to me than when I was younger, but I tell you this, I need some psychology as part of my treatment plan and I’m not seeing any. So there we have another aspect of my retirement, this time to do with my health. Like so much of my retirement life I realise it’s far from perfect but what the heck, we carry on regardless.