QUEBEC CITY — Diabetes patients and their physicians are at high risk for burnout, but they can sidestep some of that risk by ruling out depression, William Polonsky, Ph.D., said at the joint annual meeting of the Canadian Diabetes Association and the Canadian Society of Endocrinology and Metabolism.
“Depression is much more common in these patients—they are 11/2 times more likely than average to have a major depressive disorder, and 37% of them have depressive symptoms,” Dr. Polonsky said, citing his own study on the topic (Pract. Diabetol. 2001:20;20–9).
Such mood disorders make it harder for patients to initiate healthy behavior change and are a powerful predictor of hospitalizations for diabetic complications, said Dr. Polonsky, a certified diabetes educator in San Diego and author of a book called “Diabetes Burnout: What to Do When You Can't Take It Anymore” (Alexandria, Va.: American Diabetes Association, 1992).
Dr. Polonsky's research has shown that fewer than 50% of diabetes patients follow physicians' guidelines on healthy meals, exercise, and blood glucose monitoring.
In a soon-to-be-published study of 700 patients, he found that 24% felt hopeless about avoiding the long-term complications of diabetes; 17% felt that diabetes controlled their life; 15% felt unmotivated to maintain healthy habits; 14% felt angry, scared, and depressed; and 13% felt overwhelmed.
These attitudes and behaviors from patients can put their physicians at risk for burnout. “You may get discouraged and depressed, and you may stop helping,” Dr. Polonsky said.
Patients may appear to lack motivation, but the problem is typically one of personal obstacles to good medical care. And mood disorders top the list of obstacles.
“Stay alert for undiagnosed depressive disorders and screen regularly. I am a big believer in once-a-year depression screening questionnaires,” Dr. Polonsky said.
If a yearly questionnaire does not fit well into a physician's routine, “tell patients they are at risk for depression and ask them two simple questions”:
▸ During the past month, have you felt down, depressed, or hopeless?
▸ During the past month, have you had little interest or pleasure in things that you used to enjoy, such as food, reading, or sex?
Once depression is ruled out or treated, other obstacles can be tackled.
A common problem is that of unrealistic patient goals. To lose weight, many patients will set such challenging weight-loss goals that they become discouraged and abandon their efforts.
There is a surprising level of miscommunication between health care professionals and patients when it comes to giving and receiving instructions. “Many of our patients don't speak our language,” he said. In one study that polled diabetes patients as they left their health care professionals' offices, patients and professionals disagreed on what issues were discussed almost 20% of the time, on decisions that were made almost 21% of the time, and on goals that were set 44% of the time (Diabet. Med. 2003;20:909–14).
Miscommunication may be partly due to patients' lack of “health literacy” and needs to be addressed. One study of 38 physicians and 74 diabetes patients found that physicians assessed patients' recall and comprehension in only 20% of 61 visits and for only 12% of 124 new concepts covered in the visits. But when an interactive educational approach was used, patients were 15 times more likely to have achieved glycemic control (Arch. Intern. Med. 2003;163:83–90).
Tackling a patient's diabetes burnout with such techniques is an effective strategy to avoid physician burnout as well, Dr. Polonsky said.