Ever wonder what your doctor considers "a good patient"? Yeah, me too. So I figured I'd ask one of the country's leading endocrinologists. Dr. Anne Peters is Director of the Diabetes Program at the University of Southern California (USC), head of the nation's largest outreach program for community-based diabetes prevention and treatment in Los Angeles, and author of the best-selling book Conquering Diabetes. She's the kind of empathetic doctor who seems to have enough time for everyone who needs her, and I'm thrilled to report that she's with us here today at the 'Mine to share her thoughts on "how to be a good diabetes patient."
A Guest Post by Dr. Anne Peters, MD
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When I arrive in my office each day, and glance down my scheduled list of patients, I have varied reactions to the names on the list. Some I am eager to see; others I feel a sense of dread at having to encounter. This sounds mean, but it is honest.
As a physician my interactions with patients are relationships, and as such some I like better and some I like worse. Part of it is chemistry. Part of it is how patients approach their medical care. Of course, deep down I love all of my patients and when confronted with each individual I focus on their individual needs. Still, some patients make it easier and some make it harder.
The one most important element that makes a doctor/patient interaction work for me is a form of time management.
Patients need to realize how short the time I have to spend with them is. An unprepared patient means I have to spend the 15—20 minute appointment searching for information, rather than integrating the data and coming to a useful conclusion.
A prepared patient makes the appointment flow easily; I am able to address all of the necessary health care concerns and help the patient set goals for the next three months. At the end of the visit the patient leaves feeling satisfied and I feel that I have been an effective physician...the disorganized patient who runs after me down the hall asking "one last question" that I can't adequately answer leaves me unsure if I've accomplished any effective healing.
The key is to remember how short the "real" time is. For a 20-minute appointment there is 5 minutes checking in, 10 minutes of face-to-face time and 5 minutes of charting (which often takes much more time due to insurance battles over treatments). That 10 minutes is a very short time to take care of several month's worth of questions and diabetes-related issues...
To illustrate the best and worst patient encounters, here are two extreme examples:
The "Ideal Patient"
* Arrives 5 minutes early
* Signs in and has ready any information regarding insurance/address changes for the receptionist
* Brings a book to read to avoid boredom
* When called for check in, remembers to hand their meter to the nurse for downloading
* Sits on chair in exam room (not exam table—creates disparity in height between provider/patient)
* Takes off shoes and socks if indicated
* Has prepared the following:
- A list of questions
- A list of all medications that need prescribing (including whether a 30 or 90 day supply is needed)
- A list of all current medications (if not available electronically)
- A copy of laboratory or other reports from other healthcare providers
- Logs of insulin doses, blood sugars, exercise, etc. for the past week or two so I can analyze it (having recent data is extremely helpful)
- For some bringing a download of pump/sensor data from the past two weeks is helpful although I often like to do the downloading myself in the office
* When the health care provider enters the room, is ready to discuss the most important topics first. Doctors are taught to write SOAP notes: Subjective (how are you feeling today Mrs. Smith, what brought you into the office?). Objective (BP is, blood sugars are, temperature is, etc...) Assessment (what we think is going on with one or more conditions) and Plan (what to do next). You say "my foot hurts" (subjective), I look at your foot (objective), figure out what I think is wrong with it (assessment) and then send you for a test (plan)... with diabetes, which doesn't hurt and requires lots of patient self-care, it can be a very different visit, but that is why the quality of the interaction can be directly influenced by the patient.
* After spending the visit reviewing your data, answering your questions, arranging tests and providing prescriptions, you leave with all of the information you need.
Make sure, as you are checking out, that you physically have the pieces of paper for the pharmacy or referral to the ophthalmologist or whatever else you need. Take responsibility for organizing the pieces of your healthcare. No-one else will. Be sure you have written follow-up instructions if there are any changes to your regimen. Before your physician leaves the room make sure you have repeated back to him/her the treatment plan. Be sure to ask when you should return (and come back regularly!). If you feel you need to come back more often than the doctor recommends, that is fine. It is important to get the care you need.
The "Less Than Ideal Patient"
* Arrives 10 minutes late for a 20 minute appointment
* Spends the next 5—10 minutes arguing loudly with the staff about the parking problems or traffic or why it is they got lost
* Does not remember to hand over meter for downloading
* Sits in exam room, bored and still stressed over journey to office
* Has not considered questions, medications or other issues that need addressing—more interested in discussing immediate concerns (e.g. tooth hurts, upset with billing office, doesn't like medication provided by primary care provider for reflux symptoms) rather than speaking with diabetologist about issues related to diabetes and diabetes-management
* No logs, blood sugars or other data available for analysis
* In order to deflect focus from blood sugar management and (likely) an A1C that is elevated, has many excuses, reasons why diabetes management is impossible and is not interested in listening to practical solutions.
* Has many questions, but disorganized and not written down.
* Does not know medications and can not remember which ones need refilling.
* Chases the healthcare provider with one last question after the appointment is over that can't be answered quickly or in the hallway
* Gets to the receptionist to check out and suddenly remembers that they need all of their prescriptions refilled
* Loses the instructions provided for on-going diabetes management
* Doesn't have calendar for scheduling follow-up appointment
* Leaves the office without one new goal or plan in mind for improving their diabetes management
I think all of us have been both of these patients, but the more responsibility we take for our own healthcare, the better life will be. I am a resource, and I have lots of experience, but in a 20-minute appointment I can't fix anything — I can simply provide suggestions for improvement and encouragement for all that is going well.
Obviously there are doctors who are more or less likely to listen and sometimes a visit takes me much longer, if a patient is sick or undergoing a transition. I book longer appointments for patients who are pregnant, newer onset, from out of town, etc., to allow a more intensive analysis. And if the next patient doesn't show up, I will spend more time with the patient I am seeing. I also tend to leave all the charting until later so I maximize patient interaction time.
No matter what, we are all in this together and I see my role as forging a partnership. For all of us there will be good days and bad days — days when we are more or less organized or feeling sicker or healthier. But with treating diabetes, as in any long term relationship, it is the bond forged over time, through all of the ups and downs, that creates the connection and the healing.
Heartfelt thanks for the insight, Dr. Peters! Here's hoping that all endos think in terms of "connection and healing."