Association of Diabetes Care & Education Specialists

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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.

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