Stay positive, attend to emotional issues, and dig in for the long term: success at engaging patients with diabetes depends on these three key strategies. That was the message delivered by Rose Iserhoff, CHR from Chiasasibi, to doctors gathered in Montreal on February 12. Iserhoff’s presentation “Communicating with our Patients” began a day-long event on diabetes sponsored by Cree Health Board and McGill University. Working with Dr. David Dannenbaum, she presented five case histories to the roomful of physicians, in addition to other in northern communities who connected online.
“The first visit to the clinic is our first and best chance to show we are there to help,” Dannenbaum told the audience. “So we need a hook to get them to come back.” One possible hook, advised Iserhoff, was to deliver a positive message. “You can start by congratulating new patients on coming in for treatment in the first place,” she said. The same applies to patients already in treatment. “If someone has been managing their glucose levels well, you can get them to identify what they have done that was so successful.” Indeed, for patients with a treatment history, physicians can use tools like the Cree Diabetes Information System (CDIS) to track their progress. “Changes in glucose levels or weight are graphed on the CDIS,” said Dannenbaum. “And we can use these graphs to encourage people by giving them this visual representation of their progress.”
But diabetes patients often have other concerns that will take priority. Concerns with relationships or work may seem more pressing to an otherwise healthy twenty-year-old, and mothers dealing with children may feel they lack the time and energy to focus on their own health. In such cases, physicians must help patients address these concerns, as they will otherwise influence the success of diabetes treatment.
In addition, perceptions associated with diabetes can upset patients. “There are a lot of negative messages out there, and sometimes people feel ashamed,” Iserhoff points out. “Diabetes can seem like a death sentence to them, and they focus on that.” Alternatively, notes Dannenbaum, “Some people don’t want to believe they have diabetes, even if they have been in treatment for years. Denial is a big problem.”
Getting the right message out
In some cases, physicians are responsible for negative attitudes towards diabetes treatment. “Sometimes we threaten patients with insulin, saying things like, ‘If you don’t eat well, you will need insulin,’ so resistance is our own fault,” Dannanbaum pointed out. “We need to get the right message out.” Sometimes, the best educators are experience. “I had two patients, a husband and a wife,” Iserhoff recounted. “The husband noticed that his wife, who was on insulin, was feeling better than he was. So he asked to have insulin also.” In addition, Iserhoff and Dannenbaum agreed, clinicians should be prepared to show patients how to use an insulin pen to help the squeamish overcome their fears about the process. A show of hands revealed that only Iserhoff and Dannenbaum had insulin pens in their offices for such purposes. “You should all get yourselves an insulin pen!,” Dannenbaum exhorted the audience.
Ultimately, diabetes is a lifelong condition that demands an ongoing education. “It takes many years of learning and experience to become a skilful hunter,” said Iserhoff. “We need to tell patients that it’s the same with diabetes – it takes a long time to learn about it.” The message for patients and physicians alike is that there is little point in trying to do everything right away. Instead, the goal is to develop a trusting relationship and to educate and support patients with tools like the CDIS and the Cree Public Health DVD Sweet Blood. “Patients don’t have to learn all about diabetes on their first visit to the clinic. And often helping them find someone else in the community to talk with can help them deal with their own approach to diabetes,” says Dannenbaum. “Our goal is for them to keep coming back, to keep learning, and to stay engaged in their treatment.”