We are all patients…..


Ruth Miller
Diabetes Nurse Consultant for the North West London Diabetes Transformation programme


Diabetes is mostly a self-managed condition and in fact, according to a study done by Diabetes UK, people with diabetes spend only three hours a year with a healthcare professional on average and for the remaining 8,757 hours, they manage their diabetes themselves.

Many people living with diabetes who have successfully accessed information and training about the condition will have learnt skills to independently and confidently take control of their diabetes. 

Although we know that people often feel overwhelmed by their diabetes, many people still enjoy a good quality of life. Given the right support, people can and do live well and live healthy lives for many decades.

Closely linked to the term patient is the concept of patient compliance.

The good patient is compliant and does what they are advised but the bad patient doesn’t follow advice.

Interestingly, the term non-adherence started to replace non-compliance in the belief that it sounded less judgemental but in actual fact, both words mean the same thing: disobedient, a word most people (myself included) don’t respond to well.

I believe that another problem is that diabetes reporting in the national media and press is frequently misinformed and inaccurate and this contributes to the perpetuating of punitive diabetes stereotypes.

We should not underestimate the negative impact that this can have on the emotional wellbeing of people living with diabetes. 

It is worth reading the NHS England publication “Language Matters” which focuses on how language can stigmatise and impact people living with diabetes, and those who care for them.

My experience working in diabetes clinics is that people more often than not, expect to be told off because they feel that they are somehow to blame if they didn't ‘get it right’.

Some years ago I went to a crowded diabetes lecture, the lecturer said:

“Stand up all of you who broke the speed limit in the past month….

All of you who failed to eat 5 portions of fruit or vegetables daily in the last month…

All those who went over the daily recommended alcohol limit in the last month”….

You get the picture, practically the entire lecture theatre of healthcare professionals was on its feet, demonstrating that compliance is probably not natural to the human condition!

Through the years the relationship between the patient and health care professionals has evolved and changed.  With access to more information and knowledge on the internet, the general public is better informed than ever before and health care professionals have had to adopt a more ‘patient-centred’ or ‘person-centred’ approach.

So what is patient-centred care?

According to the Royal College of Nursing person-centred care is about the focusing of care on the needs of the person rather than the needs of the service - (the word patient is changed to person).

Most people who need health care these days aren’t happy just to sit back and let health care staff do what they think is best.

They have their own views on what’s best for them and their own priorities in life.

People with diabetes are more empowered now than in previous decades, especially given the self-care nature of the condition.

So as health care workers, we have to be more sensitive and flexible to meet the varying needs of all people – we have to make our system suit them, rather than the other way round.


See the Know Diabetes website for information about different diabetes courses:

See the Know Diabetes pages on taking care of your mental health:



Ruth Miller

Diabetes Nurse Consultant for the North West London Diabetes Transformation programme

Ruth is a Diabetes Nurse Consultant working for the NWL Diabetes Transformation programme and has developed the 'Diabetes 10 Point Training' programme. 

She is passionate about diabetes education for all health care staff to ensure the best care for people with diabetes and self-empowerment through knowledge for all people with diabetes.