A fictional 46-year-old attends after two diagnostic-range HbA1c results. They work rotating shifts, care for a parent and fear that medication means they have ‘failed’.
What they need from today.
- Understand whether the diagnosis is certain
- Know whether complications are inevitable
- Avoid a plan that is impossible during night shifts
What you should practise.
- Elicit ideas, concerns and expectations before giving advice
- Explain type 2 diabetes in plain, non-stigmatising language
- Agree individual goals, treatment and review rather than prescribe at the patient
Listen before you explain.
Before I explain the results, what have you been told about diabetes, and what worries you most about this?
Open the patient agenda before delivering information.I think I caused it. My father lost his sight, and I cannot manage a strict diet while working nights.
This is not a personal failure. Several factors contribute. We can reduce future risk, but the plan needs to work in your actual week. Would it help if we take the results, options and next steps one at a time?
Acknowledge emotion, remove blame and chunk information.Yes. I mainly need to know what I can change without giving up my shifts.
Let us choose one achievable change, discuss medicine in the context of your health and preferences, and agree when we will review it. Could you tell me how you understand the plan so far?
Co-produce the plan and use teach-back.Choose before the senior view.
The question behind the question.
How will you know that this was shared decision-making rather than a polite prescription?
The record should show the patient’s priorities, options discussed, agreed first steps, individual target, review point and their understanding.
CONSULTANT FEEDBACKGood. Also make uncertainty explicit: treatment reduces risk; it does not promise a complication-free future.
Recommended phrases
- “This is not a personal failure.”
- “What matters most to you as we plan the next step?”
- “Could you tell me how you understand the plan?”
Phrases to avoid
- “You brought this on yourself.”
- “You must completely change your lifestyle.”
- “If you do this, you will not get complications.”
Make the next action explicit.
- Explain how and when results and treatment will be reviewed.
- Give clear routes for help if medicines cause significant adverse effects or symptoms worsen.
- Address cardiovascular, renal, eye and foot risk through the appropriate planned pathways.
Where consultations fail.
- Leading with blame or a lecture
- Setting a target without discussing quality of life
- Offering too many changes without prioritisation
Which assumption about this patient’s priorities did you have to discard?