Barriers to communication about diabetes mellitus. Patients' and physicians' different view of the disease.

BACKGROUND: Management of diabetes mellitus is difficult for both the patient and the clinician, and poor communication resulting from different conceptions of the disease and different treatment goals can exacerbate the problem.
METHODS: We used qualitative methods, including semistructured interviews with patients and clinicians and direct observation of clinical precepting sessions by trained observers at an inner-city family practice training site. Transcripts from these sessions were analyzed for content (with the help of Nud.ist software) to identify themes that highlight problem areas in clinician-patient communication.
RESULTS: The most important themes revolved around the concept of control, which was used in at least 3 different ways, and the concept of frustration. Frustration resulted from different understandings of the biology, physiology, and natural history of the disease, and approaches to treatment. In the interviews, clinicians often spontaneously acknowledged the multiple physical, psychological, and social obstacles to treatment confronted by their patients, but in observed practice they almost always focused entirely on managing blood sugar numbers.
CONCLUSIONS: Different conceptions of the term "control" affect the ability of patients and clinicians to communicate effectively. The tendencies of clinicians to view their own management strategy as scientific truth, and their focus on managing numbers rather than attempting to understand their patient's conception of disease and their treatment goals, lead to frustration and are serious obstacles to effective collaboration.