Journal of General Internal Medicine

, Volume 27, Issue 9, pp 1180–1187 | Cite as

A Qualitative Study of Perceived Responsibility and Self-Blame in Type 2 Diabetes: Reflections of Physicians and Patients

  • Elizabeth A. Beverly
  • Marilyn D. Ritholz
  • Kelly M. Brooks
  • Brittney A. Hultgren
  • Yishan Lee
  • Martin J. Abrahamson
  • Katie WeingerEmail author
Original Research



Despite new treatment therapies and the emphasis on patient activation, nearly 50 % of diabetes patients have hemoglobin A1c levels above target. Understanding the impact of unmet treatment goals on the physician-patient relationship is important for maintaining quality care in clinical practice.


To explore physicians’ and type 2 diabetes patients’ views of patients’ difficulty achieving diabetes treatment goals.


Qualitative study using in-depth interviews with a semi-structured interview guide.


Nineteen endocrinologists and primary care physicians and 34 patients diagnosed with type 2 diabetes at least two years prior.


In-depth interviews with physicians and patients. A multidisciplinary research team performed content and thematic analyses.


Qualitative analysis revealed two main findings, organized by physician and patient perspectives. Physician Perspective: Physicians’ Perceived Responsibility for Patients’ Difficulty Achieving Treatment Goals: Physicians assumed responsibility for their patients not achieving goals and expressed concern that they may not be doing enough to help their patients achieve treatment goals. Physicians’ Perceptions of Patients’ Reactions: Most speculated that their patients may feel guilt, frustration, or disappointment when not reaching goals. Physicians also felt that many patients did not fully understand the consequences of diabetes. Patient Perspective: Patients’ Self-Blame for Difficulty Achieving Treatment Goals: Patients attributed unmet treatment goals to their inability to carry out self-care recommendations. Most patients blamed themselves for their lack of progress and directed their frustration and disappointment inwardly through self-deprecating comments. Patients’ Perceptions of Physicians’ Reactions: Several patients did not know how their physician felt, while others speculated that their physicians might feel disappointed or frustrated.


Physicians’ perceived responsibility and patients’ self-blame for difficulty achieving treatment goals may serve as barriers to an effective relationship. Physicians and patients may benefit from a greater understanding of each other’s frustrations and challenges in diabetes management.


physician-patient relationship type 2 diabetes self-care behavior qualitative methodology 



This work was supported by the Kathleen P. Welsh Fund, NIDDK RO1-060115, the Diabetes and Endocrinology Research Core NIH P30 DK36836, and the NIH Training Grant No. T32 DK007260. We thank the physicians and patients who shared their experiences and perceptions with us. We also thank Dr. Nadine Palermo, Nicholas Hebert, and Ross Markello for their useful comments on the manuscript.

Conflict of Interest

No author received other support for this grant other than funding from the Kathleen P. Welsh Fund. However, Martin J. Abrahamson, MD has provided consulting services to Novo Nordisk, Halozyme, and Boehringer Ingelheim. No other author has anything to declare.

Author Contributions

E.A.B. conducted interviews; read, coded, and thematically analyzed the transcripts; and wrote the manuscript. M.D.R. conducted interviews; read, coded, and thematically analyzed the transcripts; and reviewed and edited the manuscript. B.A.H. and K.M.B. read, coded, and thematically analyzed the transcripts and reviewed and edited the manuscript. Y.L. analyzed the quantitative data and reviewed and edited the manuscript. M.J.A. reviewed and edited the manuscript. K.W. had the initial idea for this study and wrote the research proposal; read, coded, and thematically analyzed the transcripts; and reviewed and edited the manuscript. All contributors had access to the data and can take responsibility for the integrity of the data and the accuracy of the data analysis.


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Elizabeth A. Beverly
    • 1
    • 2
  • Marilyn D. Ritholz
    • 1
    • 2
    • 3
  • Kelly M. Brooks
    • 1
  • Brittney A. Hultgren
    • 1
  • Yishan Lee
    • 1
  • Martin J. Abrahamson
    • 2
    • 4
  • Katie Weinger
    • 1
    • 2
    Email author
  1. 1.Clinical, Behavioral, and Outcomes ResearchJoslin Diabetes CenterBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Children’s HospitalBostonUSA
  4. 4.Joslin ClinicJoslin Diabetes CenterBostonUSA

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