Introduction
Malaysia is a multi-ethnic country, with a population of 25 million¹. Within Malaysia, the increasing prevalence of diabetes has lead to much concern¹ and it is estimated that 2 million people are diabetic². Instituting preventive measures and promoting greater awareness of self-care among people with diabetes is vital. Concordant consultations between patients and their health care professionals may help to achieve effective self-management and improve outcomes ³. The aim of this qualitative study was to explore health professionals’ perspectives on their relationships with patients with diabetes.

Method
Interviews were conducted in June 2003, with 13 Health Care Professionals (9 doctors, 3 pharmacists and 1 diabetic nurse educator), comprising 10 Malays (2 males and 8 females), 3 Chinese (3 females) at an Endocrinology Unit at a teaching hospital in Malaysia. Interviews were audio taped and transcribed. The transcripts were coded, then analysed for emerging themes and trends and the NVivo 2.0 software was used for data management.

Result
The dominant and most consistent themes that emerged from interviews with the health care professionals were issues around time, patients’ knowledge of diabetes, education levels, patients’ orientation towards participation in the consultation, motivational factors, health care system and management issues that needed to be addressed in order to sustain concordant relationships. All the doctors interviewed, raised the issue of time constraints as a barrier to achieving concordant consultations. Some doctors agreed that to have a concordant relationship, patients’ education level such as tertiary education and knowledge of diabetes (where they know the rational of treatment given by the doctors) would help them to participate in the treatment decision-making and would enhance concordance. However, some health care professionals believed that patients who were motivated to seek information about diabetes could help towards improving their disease better. Some health care professionals cited patients’ beliefs about treatment such as a belief that disease was a result of fate, alongside rituals and festivities which hindered concordant relationship with their patients since they showed less interest in their disease. Besides these factors, issues of health system (e.g. where patients did not see the same doctor) and management (e.g. lacked of co-ordination in diabetic education) were also raised as areas to be addressed to enhance concordance and ultimately improve diabetic care among patients.

Conclusion
Consistent themes emerged from the 13 interviews. There are clearly a number of socio-cultural issues, time, motivation, health and management system which need to be addressed in order for the health care professionals to have a concordant relationship with their patients. They agreed that if these issues were addressed, these might have a significant impact on diabetic self-management and would enhance concordance.

References

1. Ismail, IS; Nazaimoon, W; Mohamad, W; Letchuman, R; Singaraveloo, M; Hew, FL; Shuguna, C; and Khalid, BAK. (2001). Ethnicity and glycaemic control are major determinants of diabetic dyslipidaemia in Malaysia. Diabetic Medicine, Vol.18, 501-508.
2. Zaini, A. (2000). Where is Malaysia in the midst of the Asian epidemic of diabetes mellitus? Diabetes Research and Clinical Practice 50 Suppl. 2 S23-S28).
3. Hampson, S.E., and McKay H.G and Glasgow, R.E. (1996). Patients-physician interactions in diabetes management: Consistencies and variation in the structure and content of two consultations. Patient education and Counselling Vol. 29(1): 49-58.