I would like to tell you a story about two women whom I shall call Tara and Sara. I met them recently in Florida and they are originally from New York, just as I am. They are very interesting, bright articulate women and represent two of the types of people with diabetes that I have taught most of my career.
Both are retired, professional women in their late sixties and were college educated. Both are still married to very pleasant, caring men and have children and grandchildren. They happen to be Sisters-in-law. Both have a comfortable life that they have earned and deserve. Both are charming and lots of fun. Both have type 2 diabetes.
Tara is very concerned with her diabetes and is determined to be in the best condition and heath status for the rest of her life. I met her at the swimming pool exercising. She walks two to five miles every day, takes her insulin faithfully and checks her blood four times a day. She gets upset with peaks and valley and tries to keep her glucose levels as close to normal as possible. She is a partner with her endocrinologist, two and a half hours drive away, and asks and reads about everything. She will attend any class or support group available. Least you think that she is a “ Professional Diabetic” she has a very rich full life. She and her husband are wonderful dancers. Least you think her a Saint she likes to eat rich desserts at dances. She thinks I don’t notice. Now that we are friends she has included me in her team. It is my pleasure.
Sara introduced herself to me as the “other type of diabetic.” She is rather overweight and does not exercise at all. She tests her blood, “sometimes when I remember” and is somewhat embarrassed to say that to me. I never asked her. She tells me that she is not a “real diabetic” because she does not take insulin. She says that she is not prepared to be a diabetic and has no real problems or complications with it. Yet. At this point she has gotten to me. I asked if she has ever been to a class or course on diabetes or been under the care of a Diabetes Educator? She took a class once a long time ago. It was not very interesting, she really couldn’t get into it and she couldn’t remember the name of the educator. Her doctor made her go and it really did not matter to her, after all she is the other kind of Diabetic.
Sound familiar? It made me sad to think of this really nice woman walking around in “diabetes limbo”. I am concerned that we, diabetes educators and health care providers, somehow missed the boat with this lady. Somehow we never had, or created, a teachable moment where we “gotchya.” We did not turn her on to her own responsibilities and abilities or motivate her to want to care for herself. It is going to be much harder now.
Before we beat ourselves up completely there is the other side of the coin. For many years I believed that if a patient did not learn then I had not taught correctly. I had failed and was a poor excuse for an educator. It took a long time for me to understand that education is a partnership and not just my job.
Our job or purpose, if you will, is to motivate the person to want to learn. I define patient education as, Giving the person all the information they need to make decisions about what they are willing to do. We cannot give anyone information until we motivate them to want to learn. If we can turn them on they half the battle is won.
Sara is in denial. She does not want to be a “diabetic” or have to deal with it. She is a grown woman and has to make her own decisions and perhaps live with the ramifications. She is not ready to learn and it may take a very long time for her to reach the stage where she needs to learn and wants some help. I may not see her again and she was not at all interested in seeing the educator that I mentioned. When Bob Anderson and Marti Funnel talk about Empowerment they don’t suggest you do it with a club or hold hostages. People do need to control their own lives and destinies.
I have stuck Tara and her husband on the case and hope they will wear her down or finally get to her. It was the best that I could do.
Ginger Kanzer Lewis has been teaching people with Diabetes for almost thirty years. She is a Registered Nurse with a Masters Degree in Education from Harvard University and Certification in both Diabetes and Continuing Education and Staff Development. Ginger has spent over twenty years teaching educational methodology to health care professionals while working as Director of Staff Development or Education in Hospitals through out the North East. Ginger is the immediate Past President of AADE and is a well known national and international speaker.