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Why you get more bees with honey

Apr 09, 2013

Special guest blog from Molly McElwee, RN, CDE, Clinical Research Coordinator, Center for Diabetes Technology, University of Virginia

Recently, I conducted an informal poll among a group of persons with diabetes on reasons they liked and disliked seeing their diabetes educators.  Here’s what I gathered, and why I think we really need to look at how we approach intensive management with diabetes. 
 
What people heard and didn’t like:
- “Focusing too much on teaching me HOW to use technology and devices instead of WHY or WHEN to use it.”
- “Stop using the following terms/statements: Non-compliant, brittle, bad numbers, good numbers…
- “Never say, you can't do that - you have diabetes.”
- “…at my first appointment with the "diabetes educator" I was told I could never have popcorn again. There should never be NEVERS involved in diabetes care. There are good choices and not so good choices, not absolutes.”
- “I hate being criticized for how I'm doing things wrong and then not given the tools to do them right.”
- “I think the biggest area that's lacking is emotional support, or even just acknowledgement of the emotional aspect of living with diabetes.”
- “I believe it's imperative that we not let money determine the outcomes of our healthcare…  It would have been far more helpful and supportive if she had let me know that there were different options based on what we could afford (pump/pens/syringes & needles) …as well as the hospitals financial assistance program. THAT would have made me feel empowered.”
- “Belittling, guilt, & shame are not tools to motivate or educate.”
- “Do you WANT to lose your feet your eyes AND kidneys?!!”

What people WANT to hear:
- “You are doing GREAT! You are not your diabetes. Stop judging yourself by your numbers.”
- “Diabetes is not your fault.”
- "it's a moving target" and "take a try" and most important and meaningful after finding out I was 12 weeks pregnant: HOW CAN WE BEST SUPPORT YOU IN THIS”

If we are to be agents of change we need to motivate, inspire and support the patient.  One of the most important lessons I learned in nursing school was “meet the patient where they are.”  It’s unrealistic to expect a patient to meet me where I thought they should be or wanted them to go.

If your patient is having financial difficulties, you know that they are making difficult decisions every day.  Maybe it’s buying test strips instead of milk. Is there a cheaper test strip; is there a free clinic that can help; a company that does discounted prescriptions?  Telling someone they are not testing enough when they are choosing between testing and eating isn’t fair and isn’t helpful.

Another example, a patient comes in after a long hiatus of care and wants to begin education with you.  Do you choose to embrace this patient where they are – looking for help and support after a long hiatus of no care, or do you admonish them for not coming in sooner?  I’ve heard this story too many times from tearful patients who were afraid of what I might say to them after putting off an appointment for months.

Although you may be employed by a big company or hospital, you are still being utilized by the patient.  I regularly tell patients to “fire” healthcare providers that don’t meet their needs.  Remind yourself and your team that you’ll catch more bees with honey.

7 comments

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  1. May 21, 2013

    I whole heartedly agree that starting with patients where they are and allowing them to set their "realistic" goals with some guidance works much better. Encouragement in small positive changes is the best approach. When the group educational opportunities are limited - by insurance etc - I wish there was a good way to assess the impact of these educational programs. Do you have a way to assess how and what they learned and could implement? A Pre and post test that has been designed and could be used for reporting purposes? I am Medical Director of Harmon Diabetes Center in Kansas City.
  2. Apr 15, 2013

    Thanks Molly and I agree with all of it! I am shocked about how many respectable health care folks still use the term compliant/non-compliant. Language is powerful and people with DM already feel judged by their meter every day - they don't need us doing it as well. And I think it is imperative to acknowledge to them that we never take their day to day journey for granted - what a daily burden to bear, and some compassion goes a long way. I also like my patients to know that I expect them to have their ups and downs - I am not "surprised" to see them after a long hiatus. It is all part of the chronicity of the disease. I often remind them they don't give themselves enough credit - for if they come to a visit or call me, that is a big deal. "Showing up" is 90% of most success… I seldom do blogs, but may paste this in for kicks… Thanks for raising the awareness of all!
  3. Apr 12, 2013

    BRAVO!!!! If I have said it once, I've said it 1000 times, ther is not a patient who is non-compliant with daibetes. Can any of us who do not have diabetes live the life as someone who does have diabetes for a day, week, month PERFCTLY!!
  4. Apr 11, 2013

    Oh, Molly, we are on the same page! Thanks for your great post and for including these quotes from people living with diabetes. One of my concerns is that diabetes professionals will read/hear things like this and think, "well I don't do that" or "I use that approach." We've been talking about empowering patients and using approaches like motivational interviewing for YEARS. But why are the patients still having these experiences and hearing these phrases/words? I strongly believe that the language we use with patients and with colleagues outside of the "exam room" sets the stage for how we interact with all people and specifically our patients. By adjusting our language, we can adjust our approach - and remember that it is not about us, it's about them. Thanks again!
  5. Apr 09, 2013

    Thanks for a great post. I really like what you said about meeting patients where they are. We must learn what the patient is able to do and work on helping them from that point. Thanks
  6. Apr 09, 2013

    Great post, Molly! And please allow me to say, Wahoo Wa! (I am a nurse, a grad student at UVA, a person w/ T1, a pumper, and an aspiring Diabetes Educator) I learned, as a pt, from a great CDE many years ago, blood sugar is not good or bad. It is high, low or in-range. It is not a test to pass or fail. Blood sugar results are information. Thanks for all the great tips!
  7. Apr 09, 2013

    Excellent post, thank you. This is something we all need to be reminded of now and again.

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