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Working with Physicians to Improve Patient Care

Dec 26, 2012

Special Guest Blog from Kathaleen Briggs Early, PhD, RD, CDE, Assistant Professor of Nutrition and Biochemistry, Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima WA

As we approach the coming New Year, I would like to reflect on how we function as diabetes educators within the larger health care team.  The “captain” of this team is hopefully your patient – as is promoted in the patient-centered medical home (also known as collaborative diabetes care) so rapidly sweeping the nation.  Most healthcare teams strive to gain mutual trust and work together to achieve health-related goals, and hopefully make life with diabetes a little less difficult.  In the ideal setting, all members of the healthcare team are on the same page and are eager to work with the patient from where they are at right now – not where they should be, or where they were ten years ago (e.g., “non-compliant”).  Most of us, however, have stories about physicians or other healthcare providers who have actually been an unintentional barrier to optimal patient care.  How do we work through these provider-related barriers to care, and can they be reduced or overcome?  I think most of the time, the answer is certainly yes!

Limited time is a common reason why providers may inadvertently be a barrier to optimal diabetes care.  I’m sure most of us would agree that there are very few providers who don’t want to talk about prevention and how to improve success in living with a chronic condition, but they simply feel extremely pressed for time.  When many physicians and mid-level practitioners see roughly 25 or more patients per day, it is easier to see why they stretched for time and often don’t completely read chart notes from diabetes educators.  This is why I strongly encourage dietitians and diabetes educators of all stripes to keep chart notes concise and to the point.  Document only the essential pieces that are needed for the provider.  Keep extraneous details about food intake to a minimum.  For example, rather than reporting, “Patient states he eats a big mac, large fry and 32 oz. diet coke at least 3 days a week; only vegetables consumed are peas and corn; and is unable to exercise except for walking to/from the grocery store parking lot,” try a shorter description such as “Patient reports a diet high in processed/fast foods and limited in fruits/vegetables with minimal physical activity.”  Or, rather than documenting all blood glucose numbers, it is often acceptable in many situations to make some overall conclusions about your interpretation of the blood glucose data such as “Patient typically has waking blood glucose levels >200 mg/dl.”
 
Another barrier that some providers cause is lack of understanding of the referral process.  They may simply not know where to send patients for diabetes education or how diabetes educators can be beneficial to their practice and patients.  Help out your providers by ensuring their office/nursing staff and medical assistants know how to refer patients to your program; include a brief bullet list of your services with a clear description of how many/what types of classes are available.  Moreover, sometimes providers are never clearly informed if and when their patient attended a diabetes class, or met with an educator.  Just like with chart notes, be sure your letters to providers are clear and concise – easy for them to quickly scan and figure out who was seen, what they likely learned, and how you expect the patient to do.  Lastly, if you have suggested changes in the diabetes regimen that are important, give the provider a call!  Most of them are more than willing to hear your input and take necessary action for the betterment of their patients.

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  1. Dec 28, 2012

    Thank you Dr. Early for your insightful comments. It is often too easy to put the blame on our physician colleagues when we hear patients say things like "he told me to just walk" or "just watch what I eat". When in fact there was probably more to the conversation that what we are hearing. We are all partners on this journey with the patient and it would serve us all well to remember there are always two (or maybe even three) sides to the story.

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