A qualitative study of perceived responsibility and self-blame in type 2 diabetes: reflections of physicians and patients

Elizabeth A Beverly, Marilyn D Ritholz, Kelly M Brooks, Brittney A Hultgren, Yishan Lee, Martin J Abrahamson, Katie Weinger
Journal of General Internal Medicine 2012, 27 (9): 1180-7

BACKGROUND: Despite new treatment therapies and the emphasis on patient activation, nearly 50 % of diabetes patients have hemoglobin A(1c) levels above target. Understanding the impact of unmet treatment goals on the physician-patient relationship is important for maintaining quality care in clinical practice.

OBJECTIVE: To explore physicians' and type 2 diabetes patients' views of patients' difficulty achieving diabetes treatment goals.

DESIGN: Qualitative study using in-depth interviews with a semi-structured interview guide.

PARTICIPANTS: Nineteen endocrinologists and primary care physicians and 34 patients diagnosed with type 2 diabetes at least two years prior.

MAIN MEASURES: In-depth interviews with physicians and patients. A multidisciplinary research team performed content and thematic analyses.

KEY RESULTS: Qualitative analysis revealed two main findings, organized by physician and patient perspectives. Physician Perspective: Physicians' Perceived Responsibility for Patients' Difficulty Achieving Treatment Goals: Physicians assumed responsibility for their patients not achieving goals and expressed concern that they may not be doing enough to help their patients achieve treatment goals. Physicians' Perceptions of Patients' Reactions: Most speculated that their patients may feel guilt, frustration, or disappointment when not reaching goals. Physicians also felt that many patients did not fully understand the consequences of diabetes. Patient Perspective: Patients' Self-Blame for Difficulty Achieving Treatment Goals: Patients attributed unmet treatment goals to their inability to carry out self-care recommendations. Most patients blamed themselves for their lack of progress and directed their frustration and disappointment inwardly through self-depreciating comments. Patients' Perceptions of Physicians' Reactions: Several patients did not know how their physician felt, while others speculated that their physicians might feel disappointed or frustrated.

CONCLUSIONS: Physicians' perceived responsibility and patients' self-blame for difficulty achieving treatment goals may serve as barriers to an effective relationship. Physicians and patients may benefit from a greater understanding of each other's frustrations and challenges in diabetes management.

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