Do you think your patients understand the difference in the medical care of an acute illness versus the medical care of a chronic illness?
I often begin my patient visit with these questions -- What made you decide to come to this visit? What do you hope to learn?
Too often, I will get a response such as "My doctor told me to come." , "I want you to tell me what I can eat."
To me, these responses indicate that the patient is still in an 'acute healthcare model'. These patients believe that if they are 'compliant' with directions, they will be well again. "Just tell me what to do"
So my first challenge is to help them understand that to live well with a chronic illness, the patient must become the expert. Diabetes is not black and white -- it will be a little different for each patient and even a little different on a day to day basis for any patient. I believe the patient must see himself as the owner and star player of the team -- the healthcare professionals are the coaching team that he hires and fires to help him develop the skills needed to be a successful player. In the end, the successful player will be the one who knows the rules of the game, the intricacies of the good game and practices the needed skills every day.
This is the message Jana and I are putting together for the presentation for the August/Sept patient support groups.
If you have additional analogies or ways you move your patients into the SELF management concept, I'd love to hear from you.
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Brenda:
ReplyDeleteI hope you don't mind me commenting. My name is David Hueben and I am a 60 year old well-controlled Type II diabetic here in Overland Park. Diagnosed in June of 2005. By the way, I may be at the KCRADE session on April 18th as a representative of the Kansas Diabetes Advisory Council.
To your question as to whether Type II diabetics understand the difference between managing an acute illness and a chronic illness like diabetes, my answer in an emphatic no.
First of all, most people are used to seeing a physician when they have an acute problem like the flu, an infection, or an injury. The physician makes the diagnosis, many times prescribes a medication, and schedules a follow-up. A few days later, the problem is fixed. There is little need for the patient to understand the physiology of the problem, why a particular medication was prescribed, or what might have happened if the problem were not treated.
Obviously diabetes is a whole different situation. In my experience of running a diabetes blog and being a regular contributor to the WebMD Type II Board, most newly diagnosed Type II diabetics get very little information from their PCP. Usually, they are told their FBG and A1C results, are handed an ADA "Food Pyramid", and are often told to lose some weight, eat better, and get some exercise. They have no idea what the FBG and A1C mean, no idea how to count carbs, what a carb is, how many carbs to consume, no concept of how the liver and pancreas are involved in the whole blood glucose control process, and on and on. Many do not get a referral to a CDE and/or dietitian.
To most of these people, the "cause" of their diabetes was poor nutrition and excessive weight. So, it almost seems intuitive that the "fix" is to lose weight and eat properly. That should make "the problem" go away, right? To aggravate matters, when eating better and losing a little weight doesn't yield the anticipated outcome, the frustration increases and non-compliance is often the result. This is a classic example of looking at the problem as an acute medical condition.
In my personal situation, the most important thing I ever did after my diagnosis was to buy a meter. However, I was unsure how to use it and I called Catherine Parkhurst and asked if she could spare 15 minutes to show me how. She agreed and I stopped by St. Joseph's one morning. She showed me how to properly use the meter, but more importantly, she gave me some web sites to read. Since I have some educational background in physiology (albeit it a million years ago), I devoured everything I read. I wanted to know all about diabetes, what "caused" it, the underlying physiology, the meaning of and relationship of all the lab tests (A1C, FBG, lipids, kidneys, liver, etc), and the pharmacological action of all the possible medications.
Perhaps one of the best web sites I found was on "How Stuff Works". There is a section on diabetes and it explains in fairly simple language (and good diagrams) the relationship of the liver and pancreas in maintaing a stable blood glucose level and what happens when one develops diabetes. It explains the functions of natural insulin and glucagon, how the liver stores and releases stored glucose, and how insulin functions to facilitate the uptake of glucose by the cells.
Personally, understanding this physiology and how the processes are disrupted when you develop diabetes was a critical step in understanding I had a chronic condition that had to be dealt with on a long-term basis, not just fixed like other medical issues.
I would be happy to offer my time to you as you prepare for your patient support group meetings in August, as I have many other thoughts on the subject of patient self-management.
David Hueben
Overland Park, KS
dhueben@aol.com