I say to all my patients that my job is to give them all the information they need to make decisions about what they will and will not do. I have to convince them that this will make a difference. Fortunately, we now have the data to support this. We can say, “We know that if you keep your blood glucose under tight control, you can decrease the risk of complications like retinopathy, neuropathy, and nephropathy.” But, emotionally, I have to show patients that taking care of themselves is going to
improve their quality of life.
For instance, if the patient is an 80- year-old woman who can’t see well enough to crochet sweaters for her grandchildren, I may say to her, “If you keep your blood sugar stable, your vision will be better, and you will be able to crochet. Do you want to eat anything that you want, or do you want to be able to crochet sweaters for your grandchildren?”
People have to be able to make informed decisions, and so we can’t withhold information from them. We need to let them know what the truth is and help them make the best decisions by putting it in terms that make sense to them.
As another example, when counseling a stockbroker who refused to learn to test his blood glucose with a meter, I asked him, “Would you buy stock on 3- month old data?” When he said “no” I explained, “when you go to the doctor, he tells you what your blood sugar is today, not what it will be tomorrow or 2 weeks from now. So if you eat something in 2 weeks, you’ll have no idea what your blood sugar is that morning.”
That helped him understand the importance of monitoring his blood glucose, and he asked me to get him a meter.
When we talk to patients, we have to talk about what is important to them today, at this point in their lives. In many cases, there is no single right approach. We have finally convinced even the government of this; the Health Care Financing Administration has just ruled that they will pay for an hour of individual assessment for Medicare patients as part of a comprehensive diabetes education program.