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Some clinicians seem to have a knack for understanding a patient's psyche and helping him or her take the first steps. And many patients succeed in overcoming the obstacles to a healthier life. If the clinicians who treated them followed a cookbook approach, everybody could do it. But there is no one way that works for all patients. How do those who find success overcome the inertia, obstacles, and barriers that stump others?
DOC News asked:
How do you motivate patients?
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This question betrays a lack of understanding of empowerment as a philosophy of patient care. If a health care professional attempts to change the behavior of adult people with diabetes by trying to "motivate" them, the people tend to resist what they perceive as a manipulation. Those who do change generally do not maintain the new behavior, because the motivation is external.
What does work in helping people to initiate and maintain physical activity is for the health care professional to serve as a facilitator and expert consultant. People who have diabetes have far greater expertise about their own lives than their health care professionals ever will. This expertise is essential for designing a plan that will work for them.
In a clinical practice situation, the health care professional can implement this by asking questions that help a person to identify their own motivation and plan for healthy living. Professionals can also share information about how diabetes affects people and about diabetes treatment choices and research. The plan for behavior change is then designed by the health care professional and person with diabetes working as a team.
Ann S. Williams, PhD, RN, CDE Diabetes Educator Cleveland, Ohio
One of the most difficult things we have in the management of diabetes is to get [patients] to be compliant. One way is to explain the benefits of complying [with] whatever drug or therapy is prescribed. Also, of course, finding out why the patient is not complying. Is it possible they don't understand the consequences; or do they not understand the process? Is it side effects? People are worried about side effects. They don't want to inject themselves or stick their fingers, and to a large extent don't understand when you talk about complications, something that may come in 10 or 15 years.
Asiru Ado Bakare, MD Endocrinologist Thunder Bay, Ontario, Canada
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There is a group of patients with a lot of complications. I try to give them optimal therapy. I try to explain the goals of therapy, and I think a high percentage, maybe 80–85%, are compliant.
In Germany, one of the big problems is that the medications are so expensive. I try to help them find less expensive alternatives. Whatever the problem is, we talk about it.
Irmtraud Hüttl, MD Endocrinologist Berlin, Germany
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I try to be insistent. Not to condemn them or berate them, but to be supportive.
Gabriella Roma, MD Diabetologist Cluj, Romania
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I try to explain everything to them. They choose their best solution. If they have a fear of needles, I show them that it is painless. I'm giving them an option. They must know that if they don't want the treatment they are at risk of developing some complications. People who are young want to live long and healthily. I explain everything to them and let them participate in the decision-making.
Narcia Kozarzewski, MD Endocrinologist Porta Verde, Spain
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Time is a primary issue. I take several consultations. And motivate through confidence. They have to trust that I'm not going to be some bombastic tutor forcing them into something. We have a dialogue, and I give them a variety of books and brochures. And spend time when they come back with questions to work in a lifestyle change. That's the only way to get through. They have to feel that they own the problem, and they have the responsibility.
Erik Buchmann, MD Internist Oslo, Norway
TALK BACK: WHAT'S IN STORE FOR HEALTH CARE
If you haven't seen a retail medical clinic, chances are that you soon will. These freestanding "doc in a box" facilities are springing up in malls, shopping centers, and supermarkets across the country (DOC News, October 2006, page 5).
In the past few years, retail health clinics have evolved from a smattering of pilot projects to chains of outlets with names like Take Care and Minute-Clinic. According to the American Academy of Family Physicians, at least 89 clinics operate in retail pharmacies today. By the end of 2007, there may be hundreds or even thousands of retail medical clinics.
For millions of Americans, retail clinics are a convenient and affordable alternative to handle common minor health issues—an ear infection or sprained ankle. Yet, as they do with emergency rooms, some people use retail clinics as a substitute for primary care.
Some in the medical community suggest that retail medical clinics lack a well-defined scope of practice and continuity of care, which can compromise quality. On the other hand, retail medical clinics are popular with consumers. If this is the direction consumer choice is taking, should primary care go with the flow?
What do you think? Is there a place for retail medical clinics in the care of people with diabetes, obesity, and cardiovascular disease?
Send your comments to docnews{at}diabetes.org.
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| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
