Cowboys and Horse Whisperers: Changing Paradigms of Diabetes Education and Care

Editor’s note: This article is adapted from the address Dr. Anderson delivered as the recipient of the American Diabetes Association Outstanding Educator in Diabetes Award for 2003. She delivered the address in June 2003 at the Association’s 63rd Annual Meeting and Scientific Sessions in New Orleans, La.

I grew up in Texas, so I learned that a cowboy’s job was to break horses, that is to use tactics such as fear and domination to control or “break” a horse so that the horse would submit to a saddle, bridle, and rider. Later on, as an adult, I discovered horse whisperers, who used tactics such as observing and learning a horse’s natural language and understanding and respecting the innate nature of the horse as a flight animal. In this way, a horse whisperer could “join up” with a horse, rather than “break” the horse, in order to saddle, bridle, and ride it.

These two strikingly different strategies for achieving the same goal of horse compliance to human authority hold lessons for us all as clinicians dedicated to the education and care of people living with diabetes. In this article, I will trace the story of how the cowboy paradigm of diabetes education and care has, over the decades, gradually transformed into more of a horse whisperer’s paradigm. And because this article grew from a celebration of outstanding education, I will also discuss my two primary clinical mentors about the patient-provider relationship: Dr. Julio V. Santiago and Dr. Sarah A. Anderson.