6 Tips for a Better Endo Visit
In her new book, diabetes educator Ginger Vieira provides ideas to improve communication between people with diabetes and doctors.
Throughout July, we’re featuring excerpts from Ginger Vieira’s new book, Dealing with Diabetes Burnout. In this third of four edited excerpts from the book, the longtime life coach and diabetes advocate suggests simple fixes to get more from your next doctor’s appointment.
We need doctors (or nurse practitioners or certified diabetes educators) who are able to treat us like human beings rather than just patients with diabetes. They’ll listen to our concerns, our questions, our fears. They’ll look us in the eye and speak thoughtfully when addressing the fact that maybe we need to lose weight or maybe our A1C has increased significantly since our last appointment. They won’t scold or blame or boo and hiss at our imperfections. And they won’t let us settle for less than our best—they’ll challenge us, motivate us, encourage us to keep trying.
But we need to show up, too, and I don’t just mean, like, check in at the front desk and sit down in the doctor’s office. I mean totally show up, 100%. There is no health care professional in the world who can help us if we ourselves don’t listen, ask questions, tell the truth — make an effort.
In my experience as a diabetes coach, sometimes the biggest source of diabetes burnout is just frustration with blood sugars that don’t seem to budge despite your best efforts … and quite often the solution is a few simple tweaks in your insulin doses! But if you don’t explain what’s going on to your doctor, and don’t let him help you with your insulin doses, then diabetes will continue to be that much harder.
Sometimes, what needs the most attention is merely how you communicate with your doctor or certified diabetes educator (CDE). Here are a few tips for you, as the patient, and then, a few tips for your doctor or CDE.
3 Things to Remember When Visiting Your Doctor
1. Try Asking the Question, “If I Could Focus on Improving One Habit in My Life, Which Part of My Life Would You Suggest I Focus On: Exercise, Nutrition, or Diabetes Management?”
Sometimes, especially if you’ve been struggling with your health and diabetes overall, your doctor may give you a very vague form of advice simply because she doesn’t have enough time to break apart every aspect of your health that needs to be improved. And, naturally, your doctor may realize that telling you to make improvements in all three areas could simply be overwhelming. Show your doctor that you’re interested by asking for the suggestions yourself, and give her permission to help you focus on just one area rather than all three.
2. Stand Up for Yourself
If it feels as if your doctor has suddenly forgotten just how challenging diabetes is, speak up. Remind her that balancing your blood sugar around life isn’t easy. That knowing the carbohydrates in everything you eat all the time isn’t really possible. That you get zero days off from the demands of diabetes. That you’re doing the best you can. Some doctors may be so overwhelmed by a day full of patients, all of whom may have diabetes, that you may be getting mixed up in the mash of people they are trying to help attain better blood sugars. And I’m not excusing them, but … stand up for yourself if you feel that your own doctor is not treating you like an individual.
3. Always Ask More Questions
These days, health care professionals of all kinds are under a major time-crunch, so if you don’t stop and ask them for more details, they may just graze right by you. At the start of each appointment, a nurse probably checks your blood pressure and your weight. If the nurse doesn’t volunteer the information — and they usually don’t — ask what those numbers are!
(You could even ask to have all the numbers written down so you can take them home with you — it’s easy to forget all those test results by the time you’re back to your busy life.)
If your doctor makes changes in your insulin doses or your oral medications that you don’t understand, ask why she or he made those changes. The more effort you put into learning about your diabetes and your health during those appointments, the more you’ll get out of them.
3 Questions Every Doctor Should Ask You
The following three questions are something you should consider printing out and handing to your doctor. Sometimes, the most important questions our doctors could ask us are the most basic, and yet, with a day full of patients to see, these questions can be the first thing for which your doctor doesn’t make time.
1. What Have Been Some of the Biggest Challenges for You Concerning Your Health Lately?
This question is purposefully open-ended. Doctors might look at our blood sugars and think they can pinpoint exactly what’s wrong, but the numbers are only half the story. It may look as if I need more basal insulin during the night because I’m waking up with high blood sugars when what’s really causing the highs may be binge-eating before bed because I’m going through a divorce or struggling with depression or really stressed-out at work.
Whatever it is, the number doesn’t tell the whole story. Asking this open-ended question gives the patient room to say exactly what’s been the hardest, and that will often directly explain why blood sugars may be out of whack during a particular part of the day.
2. How Can I Help You Today?
This open-ended question addresses the same issue of assuming what we, the patient, need rather than letting us tell the doctor. Using the same example of high blood sugars in the morning, I may know exactly why they’re high (because of overeating late at night or forgetting to take my insulin, etc.), but what I really want to talk to my doctor about might be something completely different, which is possibly much more important!
3. Do You Know You’re Doing a Really Great Job?
This question should be asked of everybody…even the patients whose blood sugars may not look so stellar. Too often, we feel judged and guilty when we’re with our doctor. The focus is always on what we aren’t doing well, which numbers aren’t in range, how we’re not exercising enough or how we gained too much weight, etc.
But before all those details is this disease. And this disease is hard, hard, hard work! To hear from our doctors that they understand we’re doing the best we can (even when our best doesn’t look all that great) and that they understand how immensely challenging diabetes and health care can be, easily changes how open and eager we as patients are to opening up and talking to our doctors. It doesn’t matter what our A1C is, we deserve a pat on the back just for showing up every day.
If you’re not too fond of your current doctor and overall health care team, and they don’t seem to be listening to you as an individual, or asking you at least one of these questions during your appointments, it may be time to start finding a new doctor!
To order Dealing with Diabetes Burnout got to Amazon.com or http://www.demoshealth.com/store/new-titles/dealing-with-diabetes-burnout.html. You can also visit Ginger’s site at http://living-in-progress.com/.
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