“Diabetes has ruined my life.”

“Diabetes has ruined my life,” said the patient.


I felt sad for him. It’s a chronic illness. His life is ruined. Yet he was sitting there, robust and articulate. Why was he feeling so helpless and hopeless?

The best way to respond to a statement like this is assessment. Find out what the patient feels, believes, and understands. Listen until you fully understand the patient’s point of view. Gently ask questions for clarification. Understand where the patient is coming from before you intervene, so you don’t unintentionally harm the therapeutic relationship.

Then the health coaching can begin.

Yes, patient education takes some time. But done well, it can move mountains. It can change health outcomes.

2 Responses to ““Diabetes has ruined my life.””

  1. Oscar says:

    “Then the health coaching can begin”?! What a colossally idiotic thing to say! This presupposes that health education can somehow make a difference in what the patient already knows about his fate? What are you going to tell him? The real statistics on his likelihood of going blind, suffering end-stage renal disease, sexual impotence, neurological disease, gastroparesis, cardiovascular disease, early death, etc.? How is that going to change his mind about diabetes having ruined his life? Or are you going to impose some strict control regimen on him that will require him to live his life on the knife-edge of hypoglycemic seizures and a perpetual risk of death? You utter and absolute idiot, don’t you realize that the patient knows a trillion times better than you will ever be able to understand that his life is ruined? Or do you somehow believe that strict control will make everything all better, understanding nothing about how the continuing autoimmunity of the disease and genetics also cause complications?

  2. I’m so sorry I wasn’t clear. I really meant the best way to respond to “diabetes has ruined my life” is assessment. Listening. Understanding the patient’s point of view. Finding out what the patient is most concerned about, and what the patient wants. Because actually being heard can change a lot.

    I realize the patient knows his life is ruined. The key is to find out specifics. What was the patient hoping for that can no longer be? What dream is lost?

    But also, what dream can still be pursued with possibility for success?

    Health coaching is a process by which the health care professional individualizes care to optimize health outcomes. Optimization takes into account the patient’s wishes, resources, capacity, limitations, and available supports. Health coaching views the situation realistically and supports healthy, productive ways to cope.

    It may be that until one or several of those complications of diabetes occurs, the patient’s life is not yet ruined. Health coaching can help the patient live as fully as possible in the present, within the knowledge of limiting parameters. Focusing on the past and what is lost forever can lead to feelings of hopelessness. Focusing on the future can create anxiety. Either can mean losing the potential of today, because there is still opportunity to live now, and set goals that can be achievable. Health coaching can provide the support and balance that could actually optimize health outcomes.

    The goal is not to impose controls or to raise false hopes (which are confident feelings about something that might not be true.) The goal is to find and strive for the most favorable patient-identified outcome based on what you have to work with.

    Optimization is about making the most of today.

Leave a Reply