Female, 67 years of age, type 2 diabetes, class 2 diabetes, depression, hyperlipidemia, vitamin D deficiency plus more. Her A1C is 6.8% and her lipids are within goal. Her random glucose 2 hours after eating cookies was 118 today. Her glucose lowering meds are Trulicity, metformin, and Jardiance. She takes them as prescribed. Her endocrinologist recommended she meet with me. She refused until he recommended she see me the same day she was coming in to see another health care provider for her monthly infusion for another disease process to make getting here easier. Remembering who she is, I was extra careful with my words and actions. Rather than weigh her “automatically,” I asked her permission to weigh her today. She said she’d rather not. We then sat down in my office for her assessment. Within the first few moments, I had the thought to forget the computer, just let her talk with me unless I needed to make a quick note about something to make sure I would not forget to document it later. Early on, although she would answer my questions, she did not make eye contact with me. She also told me she doesn’t do anything to take care of her diabetes and her weight.
Without me typing, or taking notes, we just talked. I was very aware of my body language. I wanted to make sure my arms were not crossed, I wanted to be open and show her that. Slowly she started looking at me. She opened up and she cried. She told me about her father and sister who died of complications of diabetes. He was 58 years of age, her sister 54. She was the one who found her sister dead at home.
The time seemed to go fast. I was told my next patient was here and ready. She was crying. Her “time” was up. I did not abruptly end the visit, let her settle down some. Then I reflected on our visit. I told her that the fact that she takes her medications and she came to see me were 2 steps in the direction of her caring for herself and caring for her diabetes. I gave her credit for that. I asked her if she wanted to meet again when she is again in the vicinity for her monthly appointment. She said she would. Turned out, my schedule was full that day other than the lunch hour. I asked my office staff to please schedule her during my lunch hour. She left with a shared decision–she will consider one more thing she will do to help her manage her diabetes and we’ll discuss that next visit.
- Make room for your patients. Although each an individual, there will be some you need to go out of your way for to act and be different with. Be aware of your body language.
- For some, success breeds success. Zero into the positives, not the negatives.
- For a patient health care relationship to work, it takes a trusting relationship.
Joy Pape, FNP-C, CDE
Medical Editor, Diabetes In Control
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