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The words we use

Leading diabetes organisations have teamed up with NHS England and thrown their weight behind a new guide to help healthcare professionals and reinforce the simple values and the importance of language in diabetes care. As Diabetes Week kicks off, Dr Partha Kar, associate national clinical director at NHS England explains why he’s so proud to have worked on Language Matters.

The launch of Language Matters coincides with Diabetes Week (11-17 June) and this year’s theme tackles the issue of difficult conversations – aiming to make it easier for people to have tricky or awkward discussions with medical professionals, friends or family. It provides a timely opportunity for us to raise the issue of language used in the treatment and care of patients.

Healthcare in the modern world continues to evolve – and diabetes care is no different. New medications, dietary changes, slicker insulins all make their position felt as we deal with diabetes – whatever the background type. In the midst of all this, the explosion of digital technology is laced with possibilities – and the healthcare community perhaps tends to look at the latest “new thing” – and pin their hope on this being the intervention that will make the maximum difference.

Perhaps along the way, we sometimes forget the most basic of all things – the essence of the healthcare professional (HCP) – patient relationship – the simple art of communication, the simple art of asking “How are you?” rather than a quick, brusque “How is your diabetes?”

In the majority of cases, HCPs rarely live the lives of those living with diabetes – and in the fleeting moments we have in the lives of those we look after, perhaps the crunch of time, the pressure of ticking yet another box has moved us to interactions being more about process rather than the simple basics of human communication.

The language used by healthcare professionals can have a profound impact on people living with the disease, and those who care for them – both good and bad. How we interact with those living with diabetes is fundamental to the management of their condition – the tone and words used – all have a bearing on how they look after their diabetes.

A personal belief has always been that the key to improving care is perhaps not the technology – but the ability to support self-management, the ability to encourage peer support – and seeing us as HCPs as guides along the journey – rather than being the enforcer of rules or dictating terms and conditions as to how diabetes care should be improved.

Perhaps to many this may seem like the very basics of being a healthcare professional, something that doesn’t need to be repeated to us and should come naturally to all of us.

However, feedback from those living with diabetes has shown repeatedly this not to be the case. There is lots of evidence from around the world as to how the words used can affect those with diabetes and the guide sets out a number of practical examples, based on research and supported by a simple set of principles.

Work already done in Australia, as led by Professor Jane Speight and Renza Scibilia, as well as the USA, led by Jane Dickinson, has shown its value and by and large, healthcare professionals have welcomed it. Perhaps more importantly, those living with diabetes have seen this as an important advancement of their care.

NHS England Diabetes team have worked over the last few months with multiple stakeholders such as Diabetes UK, Juvenile Diabetes Research Foundation (JDRF), Association of British Clinical Diabetologists (ABCD) – along with those living with diabetes (agnostic of type).

It has taken time to do the background research behind this – as led by Cathy Lloyd and her team – post which the work has been complete and signed off by multiple stakeholders. NHS England have been delighted to have been able to host this work – and hopefully it will help reinforce the simple values of diabetes care, perhaps make some of us pause for a moment and think about the language we use – and the potential impact a negative comment – made in the rush of time – can have on someone who lives with diabetes day in and day out.

Language Matters provides useful advice on things such as alternatives to commonly used phrases which may cause offence to some – it is a practical handbook for healthcare professionals, designed to be used and referred to in a clinical setting, rather than sit on a shelf.

As healthcare professionals, our words have huge impact – and over the course of time, it’s the relations we build, the mutual trust we create with our patients that can help to improve their care.

Partha Kar

Professor Partha Kar is National Specialty Advisor, Diabetes with NHS England and co-lead of Diabetes GIRFT with NHS Improvement.

He has led and delivered so far on (April 2016- till date):

  • Freestyle Libre being available on NHS -across country
  • NHS Right Care Diabetes pathway
  • Diabetes “Language Matters” document
  • Type 1 diabetes NHS England web-resource – on NHS choices
  • Introduction of Frailty into QoF treatment targets for diabetes care in NHS
  • Availability of CGM to all T1D pregnant patients
  • Diabetes Technology pathway development with multiple stakeholders
  • Setting up pilot projects for diabulimia treatment in London & Wessex
  • Introduction of Low Carbohydrate App into NHS Apps Library

Other work has involved input in updating of driving guidelines in relation to use of technology in those living with diabetes, helping to develop a virtual reality programme to improve hospital safety and starting work on increased mental health access for diabetes patients across the NHS

Dr Partha Kar has been a Consultant in Diabetes & Endocrinology at Portsmouth Hospitals NHS Trust since 2008. He has been the Clinical Director of Diabetes from 2009-2015, being part of a multiple national award-winning department (HSJ Awards / BMJ Awards) due to its services and care provided.

He is the pioneer of the Super Six Diabetes Model which aims to deliver diabetes care differently and is recognised as one of the good examples of integrated care.

An avid user of social media such as twitter (@parthaskar) to engage with patients – and been recognised as a “Social media Pioneer” by HSJ in 2014.

He also writes a monthly blog for the BMJ, has a personal blog (“Sugar and Spice: Wish all things were nice”) and a podcast (“Sweet Talking”)

He has also been:

  • Co-creator of TAD (Talking About Diabetes) – TED talks from those with T1Diabetes
  • Co- creator of Type 1 Diabetes comic (Volume 1 and 2)
  • Setting up Type 1 Diabetes: Rise of the Machines – event on Closed Loops/DIY tech

Follow Partha on Twitter: @parthaskar

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3 comments

  1. tony nethersole says:

    come and live with me for a week if you want to no about diabetes. ive had over 10.000 hypos in my lifetime.

  2. christina irving says:

    Your desire to redesign diabetes care is admirable and the NHS report/suggestion document has some good ideas. However, as a diabetic who has been made to feel guilty for 44 years because my blood sugars are erratic and don’t conform to the required standard, I think you fail to give enough clear emphasis to the point that blood sugar control is not an exact science. Human life changes from minute to minute as does the human body. And if the human body was in control of its own insulin then it would be reacting automatically.
    You say that your ideas are almost more important than improved technology. However, almost everyone working in diabetes seems to be missing the point. WE NEED A CURE FOR TYPE 1 DIABETES NOW!.
    How much of the money spent on diabetes is being concentrated on that goal?

  3. Bhadri says:

    I really believe language matters. Instead of reminding about diabetes straightaway it woul d be better to start the the conversation with something interesting like did you walk today?. How many steps did you walk today ? Do you have an app in your phone to count step? About box of salad..talk about fruits .