Dr Janet Titchener says it is time for the Hawke's Bay District Health Board to realise it is missing an opportunity to "expand" and "upskill" diabetic care in the region after funding was cut for her highly praised service.

After finishing her undergraduate training at the University of Otago, Dr Titchener completed a Masters in Experimental Psychology in the United States. It was in a Philadelphia hospital 15 years ago where she realised to truly be able to help someone overcome their limitations, she needed to understand the whole person not just the medical diagnoses.

"I was doing paediatrics at the time and an emergency room physician admitted a child who was suffering from diabetes. He called me down to help treat her and was very angry at the parents because this was the eighth admission in just two months.

"But I said to him 'maybe it is not the parents' fault maybe it is us who are the problem?


"The family was illiterate and could only speak Spanish, but yet here we were giving them all these pamphlets about how to manage and treat diabetes. It was my first realisation that health care didn't really fit everyone that come through the doors - We were prescribing people a lifestyle that didn't fit her culture."

The family asked Dr Titchener to be their teenage girl's doctor leading her on a journey towards more patient-centred diabetes treatment.

"We shouldn't be telling people with diabetes how to live their life or change their life, eat this don't eat that, go the the gym. We shouldn't be fitting their life into diabetes but rather we should be fitting diabetes into their life."

She said The HBDHB needed to understand this notion and share the expertise and knowledge of doctors with local health providers and patients.

"The DHB has come up with a plan that doesn't have any known outcomes and they have no idea if it will be successful, when we have this treatment here that we know works.

"It has also been proven to close the ethnic gap, and isn't that what the Ministry of Health wants, we should be taking what we know and expand."

She said it was a simple concept [patient centred care] but one, historically, medical practitioners often do not apply, preferring to tell patients what to do.

"It's like having a car that uses up a lot of oil. And the way things are with a lot of medical services you take the car into the garage and the mechanic fills it back up with oil and sends you on your way and you're back again in a couple of months. Instead what if the mechanic lifted the bonnet and showed you how the engine works, how much oil you need, how to check the levels and tell you what will happened to the life of your care if you don't put oil in."

Disappointed in the fact her Special Interest (GPSI) diabetes services has not had its funding renewed, she hoped there was a way her patient-centred care approach for diabetics could continue.

"I have been overwhelmed by the ground-swelling support from patients and even people I know asking 'what can I do to help? How can we keep it going'?

"We provide people with a sense of empowerment and freedom and the DHB and medicine fraternity need to understand that and restructure to provide a service like this together, hopefully they can broaden their vision for patients."