Pile ’em high. Sell ’em cheap.

This week, I have mostly been having twitter conversations about inflexibilities built in to diabetes specialist care.  Experiencing this type of problem? To quote Douglas Adams, “We are sorry for the inconvenience.”  When I reflect on this, this is the image I see in my minds eye:

How to reach us



I’ve met many people with diabetes who are passionate about helping dismantle these barriers and obstacles, social media has been invaluable in helping me connect them (you!), whilst at the same time it’s also been really useful in helping me to extend my circle of fellow healthcare professional colleagues, many of whom are doing amazing work to change this.

The subject of this short blog is, why has diabetes care been regarded as ‘crowd control’ by many services & healthcare professionals?  Let me unpack my ideas…

My specific diabetes training began with some wonderful, inspirational bosses in a service which was nationally and internationally regarded.  I learned so much from them.  Yet there were aspects of the service which lacked any kind of compassion, dignity or respect.

Picture the scene, NHS in the 1980s. The clinics were truly enormous. No, I’m remembering it all wrong… they were humongous.  The waiting area resembled an aircraft hanger with rows of people seemingly as far as the eye could see.  The timing for the clinic was… well, a movable feast.  It was a war of attrition – who would crack first? Would people with diabetes get fed up and go home at 7 PM, or would they,  despite disapproving looks from the clinic staff, remain bloody minded and stay to the bitter end?

When it was your turn to be seen consultations were held in an open plan space (designed, perhaps for minor surgery, very stark and clinical) with several desks, simple plastic chairs (just one for the patient, no relatives or friends were allowed) and no privacy at all.  As a very junior doctor I remember finding it surreal when a patient across the room, hard of hearing, was having such a loud consultation with their doctor that my patient and I just had to wait until they had finished.

Talking to an ex-diabetes specialist nurse who worked at one of the U.K.’s first dedicated diabetes centres, our patients ‘didn’t know they were born’… At their institution, the doctor sat at the desk in their white coat; whilst there was a chair for the patient, this was pushed in hard under the desk.

Woe-betides anyone who dared pull the chair out and actually sat down…

last see dad

When I was on-call, one of my first evening jobs was to prescribe insulin for every patient in the hospital who needed it.  Probably 75-90% were on fixed-mixture insulins, names like Protophane (still used in Europe I believe). Looking back on those days, it seems so crazy that the most junior doctor in the hospital was being asked to make prescribing decisions about the most dangerous types of drugs (this was also true for warfarin and for a drug called heparin, gladly safer versions of heparin are now in more widespread use).  On each ward I would be presented with a stack of insulin prescription charts along with glucose test result-charts.  There was no sense of what type of diabetes the person had, nor the context (i.e. what was expected of their diabetes control, glucose would be higher during infection for example).

total wipeout


Here I am, attempting to make it through all my insulin prescription-jobs, before I could go and get something to eat after a long day at work… well, forgive me for using artistic license on that.  Did I ever ‘fall in the water’?  In-hospital hypoglycaemia rates suggest I frequently did…

When I became a consultant, I was determined that this would not continue.  Gladly my colleagues and I had the full support of our organisation in changing things.  That said, there still seems to be a belief the doctors and nurses should be measured by how many patients they can process in a session. That kind of thinking gives me my title for this blog, attributed to Jack Cohen, founder of Tesco’s.  Such an approach “sells people cheap“.

Our aim must be quality diabetes services, but most of the quality is around compassion, dignity and respect.  There is no point in being the sharpest tool in the box if all you do is to cut human relationships into ribbons.

In my opinion, there is only one show in town: patient experience.  Everything else we do leads us back to that.



Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s