As noted in our Editor’s Letter, David Joffe discusses the importance of how we talk with patients. And to that I’ll add…how or if we listen to our patients.
David’s letter made me think about what we say to patients when they are at risk, when they are diagnosed, and during the treatment phase. If we keep current with our knowledge of diseases — in this case, diabetes — and share what we know today but be clear that we may learn more and differently in the future, the patient may be more open to accept changes and work toward their health goals while at the same time taking into consideration what is known and currently available.
For example, when someone is diagnosed with prediabetes, do discuss that making lifestyle changes can prevent or delay the onset of type 2 diabetes. Many people say “prevent” but leave off the word “delay.” Then, if and when someone makes the changes but still develops type 2 diabetes, he or she may think, “Well, there’s nothing I can do, so why try?” That person may stop trying and not manage their diabetes.
When someone is diagnosed with what we think is type 2 diabetes and we talk negatively about insulin, then, if and when we find out they actually have LADA or type 1 diabetes, or need insulin to manage whatever type of diabetes they have, they may never accept the fact they need insulin nor realize that insulin can be a benefit, a lifesaver for them. These people may not take their insulin or take it the way they actually need to.
Today, someone came into our office. Our patient is in his late 80’s. His A1C is now elevated higher than we would like someone’s A1C at his age to be. He looked at me, and asked me what he should eat. He started telling me what he eats and said, “I’m hungry all the time.” I started thinking, this is because he must have fast gastric emptying as many of our patients who have type 2 diabetes have. Then he said to me, “I know why I’m hungry all the time. I was in World War II when I was a child. They starved me. Since then, I’m hungry all the time, whether I eat or not. I always think about food. I did then and I do now.” Wow, were my eyes opened!
We decided to utilize a professional CGM for him. I asked him not to change anything he normally does or eats, but to keep record of it and also document if and when he felt hungry. I informed him that wearing this tool will tell him how the foods he eats, and will allow us to see, how they affect his glucose levels. In my mind I’m thinking, I don’t want to deprive this patient. He’s been deprived enough in his life. If in fact certain foods, or certain amounts of foods, cause problems, we can further discuss his eating patterns, keeping in mind we do not want this patient to feel deprived.
He will return in 2 weeks. At least at this time, I’m hoping the way I listened and spoke with him has already avoided a disaster — a psychological disorder.
- How we speak with our patients makes a difference, not only in their numbers, but their quality of life.
- Keep current with present science, knowing that it may change. Share with patients what you know today and let them know what you’re sharing now may change in the future.
- Don’t make promises for the future nor use scare tactics.
- Listen. Take time and listen to your patients. Everyone has their own story.
Joy Pape, FNP-CDE
Medical Editor, DiabetesInControl
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