A Youth Spent in "Dead World" Leads to a Career of Empowering Patients

As a child, Robert M. Anderson, EdD, hated school.

He hated the uniforms. The lectures. The domineering nuns of his parish school in Boston, in an Irish enclave with a 10:1 “pub to church” ratio.

He hated algebra, but was told to “pay attention because it’s important.”

“I’m 70, and it still isn’t important,” Anderson said.

Getting to the heart of what’s important—and discarding what’s not—has been the theme of Anderson’s career, one spent upending conventional wisdom on how the “experts” should teach persons with diabetes to managed their disease. It’s a message that’s as timely as ever, with CDC publishing data on obesity that some see as a “tipping point” and CMS finally moving this spring to pay for diabetes prevention in Medicare.

In a session with plenty of music (and no math), Anderson shared his journey in a session titled, “How My Hatred of School Led to a Passionate Commitment to Patient Empowerment.” Anderson had been scheduled to give the talk at the 2015 Scientific Sessions of the American Diabetes Association (ADA) as last year’s winner of the Richard R. Rubin Award, but he was unable to due to illness.

Friday’s lecture at the 76^th Scientific Sessions in New Orleans began with the best-known music and scenes from the film, “Pink Floyd: The Wall,” with a column of expressionless schoolchildren forming a line into the meat grinder, while a professor screams nearby. Anderson used this to set the tone of what education felt like to him as a child.

“School was ‘Dead World,’ where curiosity came to die,” he said. Changing into his street clothes every afternoon was a glorious transition, “from the ‘Dead World’ into the ‘Living World.’ ”

He initially declined to attend college, but changed his mind to avoid going to Vietnam, because he opposed the war. There, he discovered psychology, philosophy, and sociology, and got a degree in the latter. Through an interest in counseling high school students, he took classes in “experiential learning,” which was nothing like he had experienced in his own primary education.

“We talked about it if it became a problem,” he said. “The Dead World could be brought back to life.”

When he got his EdD, Anderson got a job in Maine with the CDC, and was given the task of improving the quality of diabetes education. So he took a diabetes education class.

The first day, he thought, “Oh my God, I have been here before.” Dead World was back.

The complex scientific information was overwhelming, with an off-putting message, “You will comply!”

He ended up at the University of Michigan, where today he is professor emeritus of Learning Health Sciences and associate director of the Intervention and Technology Research Core of the Michigan Diabetes Research and Training Center.

There, Anderson formed a key professional partnership with Martha M. Funnell, MS, RN, CDE, FAADE, and together they designed a whole new way to teach people with diabetes to managed their disease. It started with a simple principle: their role was to empower people.

“There were no lectures,” Anderson said. He and Funnell discovered a simple fact: “People don’t care about diabetes. They care about their diabetes.”

Instead of asking patients to learn difficult scientific information that they’d never use, they focused on helping them learn to make good decisions. They saw immediate results, but patients hit a familiar wall after about 2 months. So, they developed support programs, all evidence-based.

He published seminal papers starting in 1985 with, “Is the problem of noncompliance all in our heads?”¹ and several provocative papers addressing issues of race in diabetes education, including, “Into the heart of darkness: reflections on racism and diabetes care,”² evoking the famous work by Joseph Conrad.

His methods start with the idea that empowering patients requires listening to them first, to understand their goals, limits, and concerns. This is especially true in the support phase after an initial intervention.

“It must be based on what patients want and need to know, instead of what we think they need to know,” Anderson said. “It reawakens their desire to control their diabetes better.”

In a nod to the host city, he concluded his tale of “the boy who hated school but devoted his life to education,” with music from Louis Armstrong: What a Wonderful World.

References

1. Anderson RM. Is the problem with noncompliance all in our heads? The Diabetes Educator. 1985;11(1)31-34.

2. Anderson RM. Into the heart of darkness: reflections on racism and diabetes care. The Diabetes Educator. 1998;24(6):689-692.