Ever wonder how diabetes educators are trained to deal with us patients? That's the most intriguing thing for us about covering the American Association of Diabetes Educators annual conference. Out of 15,000 attendees, we could probably count the non-CDE attendees on one hand. Not many actual patients are in attendance, so these CDEs end up talking and learning about "us" in absentia.
One session title that particularly intrigued us was titled "Dealing with Patients Who Just Won't Change." Ack! That didn't sound promising. Was this going to be a rant-session all about how horrible us "noncompliant" patients are? A woe-is-me diatribe about all the ungrateful patients these CDEs have to deal with? I'll admit: I was suspicious. What exactly where these CDEs going to hear about us?
But you know what? I actually liked it. Shocking, right? Keep reading...
Tackling Communication Issues
This session was led by two Michigan-based diabetes educators, the AADE's Educator of the Year, Ann Constance, and her colleague, Cecilia Sauter. The ladies started off with two rather hokey skits to illustrate why patients have such a hard time listening to their CDEs. In the skits, one woman played a "bad" diabetic (high A1c, low activity level, little understanding about their diabetes) and the other woman, a CDE.
"We are the 'experts' in diabetes — so why are they not listening?" Cecilia asked the audience.
The skit was meant to illustrate why patients have difficulty following directions: the PWD character was a recently widowed man who was going out to eat a lot because he wasn't used to cooking. The CDE character asked a barrage of questions and then provided unrealistic recommendations like never going to fast food restaurants. Of course, unrealistic recommendations usually lead to... patients not following through. Which leads to the controversial (and rather derogatory) label "noncompliant." The second skit showed a successful CDE who, of course, actually listened to the patient, taking the person's real lifestyle and concerns into account before suggesting — not ordering — some things to change.
"When our patients feel that we are actually listening, they are more willing in starting to make changes," Cecilia explained. Seems kind of a "duh" statement from my POV, but it was a relief to know that the hundreds of CDEs in the standing-room-only ballroom were hearing it too! "It takes about two minutes for the patient to tell us what concerns them. Otherwise you are just background noise." Uh-huh!
What does that mean for us patients at home? If our CDE (or endo!) isn't listening to us, we have to pipe up! It doesn't do us any good if we feel ignored, belittled or pushed aside. Our educator's job is to help train us to manage our diabetes when they aren't around, so let's make sure that's what they are actually doing.
Goal-Setting and Problem Solving
The presenters here talked about several methods for identifying issues, overcoming challenges and generally helping patients improve their diabetes self-management. Importantly, they noted that identifying how ready a person is to make a change is actually more important than identifying what needs to be changed. In diabetes, there are a ton of tasks to conquer, and any given patient might need help in several areas: testing more often, remembering to take our meds, carb counting, or exercise (or all of the above). All of these are important in diabetes, but not everything can be your immediate priority, right? So CDEs need to help us figure out what will bring us the "bang for our buck" in the short and long-term.
Here's one example recounted: an overweight patient who's told by her endo to lose weight. Her CDE then plans to concentrate on weight loss, but when the patient comes in to see the CDE, she says, "I'd really like to quit smoking." Although this wasn't what the endo recommended, it was a priority for the patient — and also a great health goal. Over the course of a few months, this patient successfully quit smoking, the presenters said. Moral of the story: even if our CDE or endo recommends one thing, we need to speak up for ourselves and realize the areas of our health that we are most committed to and passionate about fixing.
Once a problem is identified, there were several options presented for goal-setting and empowering the patient. One method I particularly liked was the 5 Step Model for Empowerment:
- Explore the problem
- Clarify Feelings
- Develop a plan
- Commit to action
- Experience and evaluate the plan
It's fairly intuitive, but what I liked was that Cecilia steered away from using the term "goal" when working on changes. She says to call them "experiments." You try something, and if doesn't work, you move on. Sound familiar?
"When an experiment doesn't work, does it mean I'm a bad scientist?" she says. That statement gave me a special kind of hope, not just for the CDEs' sake, but for my own ability to cope with this confounding and frustrating disease. Who says I'm a bad diabetic because I went low during exercise? Or because I went high after trying a new restaurant? Who says I'm a bad diabetic because I have trouble committing to going to the gym? Diabetes is complicated and behavior change is a struggle — not because of us, but because of the disease. Just because something doesn't work does not mean we are failures — it means that what we tried just isn't for us! And — surprise, surprise — everybody is different.
When evaluating a diabetes "experiment," the ladies suggested asking patients the following questions, which I think, in turn, we can simply ask ourselves:
- How do you feel about what you accomplished?
- What barriers did you learn about?
- What support did you learn about?
- What did you learn about yourself?
- What would you do the same or different next time?
Beyond the Doctor's Office
It was a repeated mantra throughout the entire conference: CDEs need to help patients take care of themselves when the CDEs aren't around. Go figure. Especially because the current ratio of CDEs to patients is one for every 1,517 patients a year. There's no way CDEs could reasonably provide ongoing support to everyone in this country, even if everyone had access and coverage to visit a CDE!
Ann and Cecilia offered up a few "outside" resources, like Weight Watchers meetings that could help facilitate weight loss in a consistent and community-based way.
The only part of the session that had me cringing was what wasn't said. There was absolutely no mention of the Diabetes Online Community, which I thought was slightly ironic considering that session took place just prior. It would have been a perfect continuation of the theme of diabetes support and education.
On the other hand, I was hardly surprised. The DOC is still very suspicious to most CDEs. At the end of the session, I did speak to Cecilia and thank her, and I asked her point-blank how she felt about blogs and the online community. She told me that she thought certain "vetted ones" were very helpful, but there simply wasn't enough time to cover all the resources. Hmm.
Hopefully by next year, the DOC will no longer be an afterthought in resources for patients! What these educators may not realize is that it may be much easier for us to take advice from and get motivated by each other on things like lifestyle changes.