Using Analogies in Endocrinology to Better Care for Patients

An endocrinologist discusses the value of using everyday analogies to explain diabetes management issues to his patients.
An endocrinologist discusses the value of using everyday analogies to explain diabetes management issues to his patients.

I have a confession to make: I love analogies. They're an enjoyable, creative way to help me to see and form new connections, consider new perspectives, and thus learn and grapple with concepts. I've also found them to be immensely useful tools to teach — to explain concepts to patients, as well as to the medical students and residents I have the privilege to work with. With diabetes, for instance, I've found that using the example of driving a car can be versatile on multiple levels.

1. Are you moving in a positive direction?

Patients living with diabetes may have veered off in the wrong direction, sometimes just for a brief interlude, other times for a prolonged period. I discuss with my patients that we can all get knocked off-course, and there are times when someone may abandon or take their foot off the pedal on their healthier meals, exercise, or medications. They might ignore or turn off their GPS altogether (or ignore their map or tune out their significant other, who's the chief navigator). The physician may be making every rational, sound argument for getting back on track, but the patient, for various reasons, is just not ready or willing to hear this message.

 

I counsel patients, "We can't tell you what to do, or not do. We can only make recommendations, and answer any questions you have, so that you can make the best decision for yourself. My team and I will be there for you when you're ready to change, without judgment or having you feel badly."

2. Are you willing to make short-term investments for long-term gains?

The check engine light comes on. "The car's fine. I don't have to worry about this for another few hundred miles easily, at least." Complications may similarly not appear immediately, but when they do, they may be irrevocable, and they may be much more costly than doing a bit more work every day upstream.

 

We similarly ask patients who have diabetes to perform more self-management compared with many other chronic conditions, whether it's testing self-monitoring of blood glucose, checking their feet, adjusting insulin dosages, or obtaining yearly eye exams. Yet making these regular, small investments of time and energy may very well prevent or delay a potentially catastrophic, devastating complication down the road that may compromise quality of life.

3. What do you do to fine-tune?

I liken self-monitoring of blood glucose to the speedometer on your car (or if you'd like to take a break from this analogy, the aircraft's many instruments). If we don't receive feedback, we can't take corrective action if we need to. We're essentially driving (or flying) blindly. We don't have any inkling whether we our actions are moving us closer to our goals. If a patient is doing well and doesn't need to make changes to their medications, diet, or exercise patterns, I say to that individual, "Give yourself a pat on the back, continue checking, and keep challenging yourself to seek ways to improve. If your readings are not where we'd like them to be, try not to feel discouraged or upset. Look at this as information as guidance to start making adjustments."

We all can relate to this, and you may use something like it when speaking with your patients.

But here's something else even more interesting (and I would argue that the above is already significantly intriguing): This car analogy applies to us, as well.

If we're not paying attention to where we're going, if we ignore or disregard the signs, the GPS, and the navigators of our professional and personal lives, we run the risk of getting stuck in a rut. Or we may find ourselves in the fast lane to burnout.

If we don't do the daily tasks to tend our engines, we can feel imbalanced. This may mean making time to think, or exercise, or pursue an idea that might just become an innovation. If we don't take the time to pause from our overscheduled lives and reflect, both on what's going well, and what we can improve, we may be checking things off our to-do lists, but at the expense of addressing our most important, yet not as urgent, items.

Now, we wouldn't be curious scientists if we didn't put these concepts to the test! Thus, I'd like to offer you a challenge: See whether this or another analogy that you create might work for your patients — and for yourself. Observe the reactions from your patients, and if the analogy works for them, ask for feedback and explore what outcomes may follow.

Do the same for your own analogies in your professional and/or personal life. Then, if needed, tweak the analogy or the process or the outcomes. Much like we ask patients to titrate their insulin dosages (there's another analogy), experiment persistently, keep adjusting, and enjoy this process!

I invite you to share your observations and insights, and would love to see your comments.

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