Who's the boss?
For the first six months of our acquaintance, the boy who lived next door to me in my first home-away-from-home - a university dorm run by sadists with a penchant for 2am fire drills - was a human puzzle I couldn’t solve. I never quite knew what to expect from my neighbour, Rob.
Rob was often friendly, enthusiastic and generous but sometimes, for no particular reason I could see, he would swerve into a mood of intimidating grouchiness, becoming intolerant, withdrawn and irritable. “Why’s he so angry?” I wondered. “Is he depressed? Is he on drugs? Is he unhappy because he’s so mean?”
Later I learnt that, in fact, Rob had Type 1 diabetes, a condition that requires daily insulin shots, self-monitoring of glucose levels in the blood and careful attention to diet. Rob had all the equipment he needed in order to treat his diabetes, and understood the processes he was supposed to follow in order to keep it under control. But in his first year away from home, Rob just wanted to have fun.
Like the rest of us, he would get through the end-of-semester study-fest by pigging out on Tim Tams and Coke. Occasionally (don’t tell mum!) he’d skip meals in favour of drinking beer. And sometimes he’d stay out all night tearing up the dance floor, sleeping for most of the next day to recover.
This kind of behaviour isn’t likely to improve anyone’s health, but for a person with Type 1 diabetes it can have consequences including mood swings and “hypos” (hypoglycaemia or low blood sugar, which causes pallor, sweating and an inability to think clearly, and which can progress to disorientation and unconsciousness). Hence Rob's abrupt shifts between charming Dr Jekyll, and nasty Mr Hyde.
Untreated, Type 1 diabetes can be fatal. But—as I observed through my interactions with Rob—it was possible to treat Type 1 diabetes without managing the condition properly. Rob had access to good health care, but he lacked the skills to be a successful self-manager.
Self-management of an ongoing health condition, according to the Centre for Advancement of Health, “involves engaging in activities that protect and promote health, monitoring and managing the symptoms and signs of illness, managing the impact of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes.”
Thus, as with any management position, learning how to manage an ongoing health condition has two broad components. The first is having the technical skills, know-how and equipment necessary to accomplish the “job” of staying well. Rob had this aspect of diabetes management down pat, although he didn’t always bring his skills to bear on his situation.
This brings us to the second component of managing an ongoing health condition: marshalling resources, including the skills described above, to work towards the goal of health and wellbeing. This is where Rob seemed to come unstuck—and he’s not alone in finding this aspect of health management difficult.
Having an ongoing illness or injury isn’t just a medical problem; it affects every area of life. Rob’s diabetes affected his social life and made it harder for him to do some of the things that his peers could do. When I knew him, Rob hadn’t learnt how to manage this difficulty, or come to terms with the limitations that diabetes imposed on him. Ironically, Rob's health, education outcomes and social life all suffered.
In order to assist people like Rob take better care of themselves, Flinders University has developed a Chronic Condition Self Management Program. According to this program, effective self-managers are individuals who:
- Have knowledge of their condition;
- Follow a care plan agreed with their health professionals;
- Actively share in decision making with health professionals;
- Monitor and manage signs and symptoms of their condition;
- Manage the impact of the condition on their physical, emotional and social life;
- Adopt lifestyles that promote health; and
- Have confidence, access and the ability to use support services.
In relation to RTW, there are a couple of things worth considering. The first is that individuals who struggle to balance an ongoing health condition with expectations at work might benefit from learning self-management skills. Where appropriate, employers could consider providing some workers with training in self-management.
The second thing worth considering is whether your organisation is sticking rigidly to the “medical model” and ignoring the many other factors that influence how well people cope with injury and illness.
As well as providing information about medical matters such as medication and exercise, a successful chronic disease management program offered at Stanford University in the US teaches participants how to deal with problems such as frustration, fatigue and pain, and also how to communicate effectively with family, friends, and health professionals.
Frustration and communication aren’t medical concerns, but by moving beyond the “medical model,” self management programs are able to actually improve medical outcomes.
The benefits of the Stanford program have been shown to last for up to three years, and include “significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations”. Participants are also less likely to require hospitalisation, or to seek other medical treatment. The cost to savings ratio of this program is 1:4.
Does your injury management system take non-medical issues into account? Do you encourage and support people to manage their own health condition? And if not, how many “Robs” do you have mired in the system?