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#10
Attitudes of Internal Medicine
Physicians Toward Type 2 Diabetes
Internists
have certain negative attitudes toward diabetes.
This study was designed to identify differences among internists
in their attitudes about diabetes and how those attitudes
influence practice behavior. Routine care for patients with type
2 diabetes is provided mainly by primary care physicians such as
internists and family physicians.[7] However, data from
several studies indicate that the quality of diabetes care in
primary care settings is less than optimal.[8,9]
Suggested reasons include deficiencies in physician knowledge,
lack of belief in the value of aggressive treatment of diabetes,
and problems with patient compliance, including the lack of
fostering patient autonomy.[10] Other suggested factors
include the complicated nature of diabetes care and the
substantial time requirements of high-quality diabetes care.
Negative attitudes toward diabetes among primary care physicians
is thought to be a more significant barrier to improving outcomes
than a deficit in diabetes-specific knowledge.[13,14]
Data suggest that negative beliefs and attitudes impede guideline
adherence[15,16] and aggressive treatment of type 2
diabetes.
A cross-sectional study of 55 internists in an academic medical
center was done using the Diabetes Attitude Scale (DAS-3), a valid
and reliable measure of attitudes toward diabetes.
Results. Most respondents were white (89%), male (65%), and
</=40 years old (85%). On the need for special training,
internists were significantly different from the standardized norm
for the DAS-3. Similar differences were observed on the
seriousness of type 2 diabetes, the value attached to "tight
control," and patient autonomy. Differences by age, sex, and level
of training were not significant.
Conclusion. Internal medicine physicians appeared to have
certain negative attitudes toward diabetes. These negative
attitudes were consistent across age, sex, and level of training
of physicians. However, older physicians were more likely to
appreciate the need for special training in teaching, counseling,
and behavior change techniques for health care professionals who
care for patients with diabetes.
According to the results of this study, there is a need for a
change in the attitudes of internal medicine physicians toward
diabetes. Of particular importance is the need for physicians to
acknowledge patient autonomy in diabetes self-management.
Consistent with the principles of chronic disease management,
decision-making in diabetes care is likely to be more effective
when patients are in partnership with their physicians. In
addition, negative attitudes toward patient autonomy can impede
patient-physician collaboration, which is particularly essential
in the management of type 2 diabetes.
Type 2 diabetes is a serious disease, and tight glucose control
reduces morbidity and mortality associated with diabetes.
Consequently, the negative attitudes toward the seriousness of
type 2 diabetes and the low value attached to tight glucose
control by internal medicine physicians in this study are
important findings. Such negative attitudes may affect
implementation of current American Diabetes Association guidelines
for diabetes management and outcomes for diabetic patients.
The fact that physicians in training and attending physicians
shared similar negative attitudes suggests that such attitudes may
develop early in the careers of internal medicine physicians. In
addition, it raises questions on when and how these attitudes
develop and whether such negative attitudes are directed toward
other chronic diseases in primary care settings.
The major implication of this study is that greater attention on
physician attitudes is needed, particularly in the case of
diabetes, where physician attitudes have been shown to affect
practice behavior. In addition, educational interventions at the
residency level may be beneficial to promote the right attitudes
toward the management of chronic diseases such as diabetes.
Regardless of age, sex, or level of training, internal medicine
physicians have negative attitudes toward type 2 diabetes that
require future educational interventions. Source: Southern
Medical Journal Volume 95 Number 2
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Did you know?
It is estimated that there are 150 million people in the world
with diabetes now. This figure is expected to double over the
next 25 year.
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