... and how should they get paid?
What is the best setting for diabetes education -- hospital settings, physician offices, pharmacies, community settings?
As I nurse, I always wanted a dietitian on my team to help individualize the meal plan -- especially when the patient had concerns about concurrent health issues like severe diverticulitis, irritable bowel, crohn's disease and other GI problems that often made my advice of "you should eat more fresh fruits and vegetables" almost impossible to follow.
I also always advised my patients to take all of their medications to the pharmacist and make sure they were entered in their computer program so the pharmacist could review them at each visit and discuss any concerns.
I tell every patient that their diabetes team should include a podiatrist and ophthalmologist in addition to the doctor, nurse and dietitian. But, I have to confess -- I can't imagine the team without a nurse. (that would be me, of course). As I continue to fine tune my behavior modification efforts in teaching self-management, I can see a wide disparity in my initial didactic approach and my current more interactive, coach/mentor approach. I want every diabetes educator to be a CDE who is keeping up with the standards and practices of our national association. So, while there are many health professionals who can talk to the patient about diabetes, I think there are a select few who actually teach diabetes self management.
And now there is another wrinkle in the fabric of "Who teaches diabetes self-management?" Recently, I have been implementing the Diabetes Conversation Maps and watching how peer to peer education works. The facilitator guide puts "Cautions" on every page -- "Check -- are you talking too much?" When I can remember to be quiet and listen to them teach each other, I wonder how the future diabetes teams will look. The team will no doubt include lay members -- people who are living with diabetes -- engineers, school teachers, janitors, receptionists. Will they start their own business for 'diabetes education'? What's to stop them?
We need to define our "diabetes team" and clarify how we work together. The very best picture makes sure that the "Person with Diabetes" is the head of the team.
What do you think?
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