Outside of writing these blogs, I have a day job which involves the implementation of software to help organizations manage their customers and processes more effectively. I have been doing this job for around 20 years and worked at a couple of the “Big 4” Consulting companies along the way. It is fair to say I understand a thing or two about professional consulting.
Yet, when I go to conferences and hear medical professionals speak, or when I visit diabetes forums and hear of diabetics’ experiences with medical professionals, it is clear there is a problem. For my own medical team I could not be happier. Our conversations do not focus on ‘adherence’ and ‘non-compliance’ but on working together to find the right solution. For other diabetics this is not the case causing mental stress for individuals who, for the most part, are doing everything within their power to stay healthy.
A great example highlighting the problem was this image recently posted by Renza Scibilia.
While not every software implementation project is a success, I would never dream of giving a ‘report card’ to my clients. They are paying me and the company I work for to give them the best possible advice and give them the best possible chance of success. To give my client a rating would be the height of arrogance and conceit and shows a profound misunderstanding of the relationship between us. If my client fails, I have failed and a rating is as much an indictment, if not more so, of my consulting than it is of the client who paid me to deliver success.
The fact is, the relationship between a patient and a doctor, especially a medical specialist, is no different to the relationship between a client and a professional services consultant. The stakes may be higher in the medical field but the dynamic between the consultant and the client should be the same. So what can we apply from professional consulting to modern medicine? As usual, if you want to get to the destination without going on the journey, you can always skip to tl;dr.
People, Process, and Technology
It is well known in IT consulting that the success of a project goes beyond the technology. A common framework for considering the various factors of a project is to consider the People, Process, and Technology.
In this model we have:
- Process: Something we are trying to manage, essential to the ‘health’ of the business
- People: Those affected by the process
- Technology: The tools used to manage the process
Only when these are considered together is the project likely to be a success.
The parallel model for a patient is not a huge stretch:
- Process: The disease i.e. diabetes
- People: The patient
- Technology: The medications and technology used to manage it
Implementing technology with no consideration of the other two factors is almost always a disaster. In the same way, throwing drugs at a patient with no consideration of who they are or how the disease affects them in their day-to-day life is an incomplete solution.
Just as every workplace has similar processes but each has their unique aspects so too with patients and their diabetes. Is it practical for the patient to inject multiple times per day given their job/circumstances? Can they afford the drug/pump/CGM/test strips you are recommending/prescribing? Does the patient have the necessary training/knowledge to manage their medication/technologies effectively? If the answer to one of these is “no”, is it really the patient’s fault when they fail to meet the doctor’s expectations? Is it a case of adherence/non-compliance or a consultant failing to do their job?
As Sir William Osler famously said:
The Trusted Advisor
The ideal situation for a consultant is to be considered a trusted advisor. If the client sees you this way it means they trust you to do the right thing by them and they are more likely to follow your suggestions and, as importantly, confide in you when they feel your ideas may not work.
In my opinion, there is little room for ego when it comes to being a trusted advisor. While you are the expert, humility goes a very long way. It should be very clearly understood who is paying for a service and who is providing that service. The consultant is there at the pleasure and to serve the client, not the other way around.
Being a trusted advisor maximizes the chance of a long term relationship. I have clients who I have been working with for over 15 years, despite working for multiple companies in that time. My clients come to me because they know I will give them the best possible advice I can to help them and not make them feel stupid in asking.
The Client Knows More Than The Consultant
This sounds counter-intuitive given the consultant is being paid for their expertise. However, from a disease perspective, someone who has had diabetes for 20 years will likely know more than a general practice/primary case doctor and are probably more up to date on the latest literature. Why is this the case? Because a doctor gets, at most, an hour or two on diabetes in their entire multi-year training to become a doctor. Whereas someone with diabetes has a strong motivation to understand the latest information on their disease. This will not be as applicable to diabetologists/endocrinologists but it is still completely true for the other aspects of the patients’ life.
In fact, this is probably the hardest lesson for a professional consultant to learn: sometimes the client will ignore your advice and they are completely right in doing so, no matter how insistent you are that it is a mistake.
In professional services, the client knows their business better than the consultant ever will. Therefore, if a consultant provides two options: a good one and an ok one, sometimes the client will still go with the ok solution because they know it has more chance of success despite the consultant’s insistence that the other solution is better. Even if the consultant is not considering the People and Process, the client will be.
What Can Patients Do?
The most productive relationships and best outcomes I have had with my clients is when they invest the time to learn all they can about the technology being implemented. Getting educated gives them the power to ask the right questions and get better solutions; they understand the strengths and weaknesses of different approaches and can challenge the consultant’s assumptions.
If, as a diabetic, you are keen to learn more about your disease and how it is treated, here is a blog article where I provide references to a raft of educational resources. It was using resources like this that allowed me to propose medications to my endocrinologist, based on the latest research, which seemed to lead to a better outcome. She considered my proposal, did her own research and, together we found a solution. This is how we continue to work today.
As a professional consultant with over 20 years experience, I understand the intricacies of working with clients to give them advice and steer them towards success. There are many great medical professionals out there but, based on what I see in diabetic forums and the language used in conferences, it is clear that some professionals could employ a consulting approach towards their patients.
While I could probably write enough to fill a book on professional consulting techniques and their application to medical professionals, I have limited this article to three key concepts:
- Treating a disease goes beyond medication. The phenotype of the disease for that individual, as well as their personal circumstances are crucial elements to consider
- Humility goes a long way in building a trust and rapport. Understanding that the doctor is simply someone being hired for their knowledge and skills is a good start to fostering such a relationship
- Despite the consultant believing they know all the answers, sometimes the patient will ignore the consultant’s advice and it is completely the right thing to do. The patient will always know more about their disease and their personal circumstances than the doctor will
Finally, as a patient, it is in your best interest to understand, as well as possible, your disease and the medication options. This will not only mean you can ask the right questions but also improves the prospect of working with your health case team for the best possible solutions.