Shifting the Focus: The Medical Model of Disability and Beyond
Some 106+ years of experience should not be ignored
In the new book I’m currently writing, I discuss 3 models: the moral/religious, medical and social models of disability.
I won’t go into them in too much detail here, but it’s enough to say that the medical model of disability sees patients in need of a cure. It is one dominant way of looking at disability in our society. This poses a problem for people with a chronic condition such as diabetes, and leads to stigmatization.
Suzanne Johnson, in The Pediatric Psychology Handbook, suggests there should be a shift in focus from patient to medical practitioner. She writes that “in contrast to the wealth of information available on patients’ behaviour, there is remarkably little on health care providers’ behaviour.” 1 This is not surprising, and health care providers’ behaviour has been found to directly affect patient outcomes.
Somewhere over the rainbow we can find a more empowering way for people with T1D.
Johnson further points out that:
“studies suggest that inappropriate treatment recommendations and inaccurate diabetes knowledge imported by ignorant providers may be responsible for some patients’ poor glycemic control.” 2
Ouch. Yes, it’s true dear reader. And it’s seldom mentioned.
Often, it is a family physician, having to be knowledgeable in myriad areas of medicine, who is the primary information resource for those with diabetes. Telling a person with diabetes that they should try to stay within a “normal” blood sugar range is not enough (and technically impossible). It is much more than insulin, meal plans and exercise. Medical professionals need to be more informed, and people with diabetes need to demand sufficient treatment. Much of what I learned about diabetes was from others who had diabetes and through a lot of trial and error.
Deb Butterfield writes of her experience with a doctor, illustrating that the person with diabetes often has more experience with it than the medical professionals:
I had been living in my diabetic body for 24 hours a day, 365 days a year, for 24 years. That was 210,240 hours. If I had worked that many hours in a 40-hour-per-week job, I would have 106 years of experience. Yet, as was often the case, the doctor dismissed me as a layperson and assumed power of attorney over my decisions. It was a typical example of a chronic illness being cared for in a medical system designed to take care of short-term illness and trauma. 3
We see the doctor to understand the biomedical reality of diabetes. Listening to the perspective of the people who have it, rather than relying on a medical system that considers chronic conditions problematic is a way forward.
Reframing means looking beyond the medical model (and the moral/religious model for that matter) to show the social model offers a way to empower people living with the condition, despite the stigma and challenges posed by the first two models.
We have a long way to go.
Every day I write the book. See you next week.
Johnson, S. (1995) “Insulin-Dependent Diabetes Mellitus in Childhood” in Michael C. Roberts (ed.) (1995) Handbook of Pediatric Psychology, 2nd ed.The Guildford Press, p. 266.
Johnson, S. (1995) “Insulin-Dependent Diabetes Mellitus in Childhood” in Michael C. Roberts (ed.) (1995) Handbook of Pediatric Psychology, 2nd ed.The Guildford Press, p. 276.
Butterfield, D. (1999) Showdown With Diabetes, W.W. Norton, p.126