I think all of us can agree that health care providers work under a great deal of pressure. There are endless interruptions and decisions to make daily. Patients arrive late, and although there are policies, they beg to not have to reschedule because this is a rescheduled appointment due to a clinic “glitch.” Staff call in sick – requiring appointments to get canceled, or those patients get absorbed and worked in. The computers act up and create delays. Financial folks send messages saying the clinic needs to “step up” production (which I think sounds so industrial – we are not producing widgets). Pharma reps are clamoring to see providers – although there are set times to learn about the latest and greatest medications or technologies, someone always stops by because they were “in the neighborhood” and thought they would see if we need anything. Periodically the sink is clogged, the paper towels are out, the hand sanitizer gets bumped and leaks on the floor.
Finally we get to the patient visit. Despite repeated reminders, the person forgot their log book and/or their meter. They were started on a new medication by another specialist but cannot remember the name. Although this is an appointment with the endocrinologist, today their back is really bothering them and they feel the need to explain in great detail what they think the problem with their back might be. They have not started the medication prescribed last visit because they saw a negative ad on TV about that drug, or someone in their church group told them it was dangerous.
Once all the above gets sorted out and the person is once again redirected to their diabetes management, a decision has to be made to re-explain the action and purpose of the drug prescribed at the last visit or switch to another drug. Do you believe the person's recall of their glucose values from home that all fasting are running “about 120” when today's point of contact A1C is still 8.7%? If the decision is made to add a third or fourth agent, which one will their insurance cover? For the patient with Medicare, how long will it be until they are in their “doughnut hole” and the drug which is working great and can afford the co-pay of $30, suddenly costs the elderly person $800.
That is our specialty – to connect with our patients. To educate, enthuse, empower and engage.
During all the above, the provider is focusing on getting to know their patient and build a provider-patient relationship. Providers are trying daily to encourage and engage their patients in positive self-care behaviors. The late Dr. Charlie Reasner told me many times that to be successful in diabetes management, patients have to like you. You have to get to know who they are, what their struggles are and what motivates them.
Often this is very difficult given all the distractions that occur. Day to day glycemic control is impacted by so many factors and often requires more engagement on the part of the patient than most other disease processes. That is where the CDE shines. That is our specialty – to connect with our patients. To educate, enthuse, empower and engage. It'a big job, but because of our passion as CDEs, we are up to it.
Remember to register for AADE18. You also need to get recharged. See you in August!
About the Author
Barbara Walz is an RN, BSN and has been a certified diabetes educator since 1986. Since 2000, Barbara has coordinated a multi-site diabetes study examining the macro-vascular effects of diabetes at the South Texas Veterans’ Healthcare System under the supervision of Dr. Ralph DeFronzo.