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When I was a child, my mother always said, "Think before you speak." Have you heard of this before? If not, please digest my words. If you have heard of this simple yet beneficial policy, please reconsider its merit and then implement it into your practice.
You are in a position of extreme power. The title next to your name (MD, RD, RN, etc.) elevates you to a certain status in patients' minds. You are educated. You are powerful. You are specialized. You are respected. Your words can make or break a patient.
Recently I went to a new podiatrist. I'll be honest. I get a little rise out of being the "good diabetic" and going to see my doctors. Each time I enter one of their offices, diabetes is with me, and my visits are almost always focused on my disease. I am determined, adamant, and educated. I come across as a confident patient. And for the most part, I am.
However, when I enter an office like yours, I am reminded of what I don't have: a perfectly healthy, normal body. I am usually in the waiting room surrounded by overweight older men and women sporting walkers, wheelchairs, baggies full of medication bottles, and oxygen tanks. I walk into that waiting room on my own two feet, holding my medical insurance card and toting my 23-pound daughter. You see, I'm one of the young ones, one of the healthy ones. But I'm there, doing my duty, being the good patient.
After I fill out pages upon pages of forms, giving strangers the history of my life, I hand over my co-pay, take a seat, and wait my turn. I might flip through a magazine or play peek-a-boo with my baby. I do not have white coat syndrome; however, I do feel the slightest twinge of butterflies in my stomach, knowing that soon I'll be facing you.
I am called back to a patient room, where a nurse asks me why I am there. I tell her that I just want a general checkup. She leaves, and I read my daughter a book and feed her a snack while we wait for the doctor. The room is pleasant enough (large windows, music over the intercom system), as is the staff (doting on my baby girl). I feel ok about the visit. After all, I am there, the good patient, at attention and ready for lift-off into an even better attitude toward my disease.
Then the doctor comes in. He spends a minute or two reading my chart and then asks why I am visiting him. I tell him that I want a general foot check. He asks me when I was diagnosed with type I diabetes. I say just three-and-a-half years ago.
The conversation goes like this:
Doc: How is your diabetes?
I smile and say: Pretty good.
While writing in my chart, the doctor says: What was your last A1c?
Me: 7.5%. I'm usually in the 7% range.
Doc, looking over his reading glasses and frowning: Why?
The first word out of a doctor's mouth, a doctor whom I just met three minutes ago, is a critical "why?"! And once again, like I am after many medical appointments, I am left feeling discouraged, embarrassed, and depressed. As if diabetes isn't in itself discouraging, embarrassing, and depressing.
Unless you have type I yourself, there is no possible way you can understand how my life works. But let me try to help you see.
Imagine having type I diabetes. In order for your doctors to give you approval and act like you are a worthy and decent human being, you must do all of the following:
If you can manage to do all these things, you will be approved. Well, until your next appointment.
Please listen to me as a person, not just as another one of your hundreds of patients. I am doing a damn good job of managing my disease. I am proud of my 7.5% A1c. I do everything I can to do the "right things"---though I'm not perfect and am always pushing myself to improve.
Relate to me on a human level. What do people REALLY need to hear? Not a snide and judgmental "Why?". Please, take a new approach. Try encouragement instead of criticism, support instead of scrutiny, and education instead of lectures.
Please do not forget this lesson that my mother taught me. Please think before you speak. If you can approach a patient with the right attitude, you will do what you probably set out to accomplish in medical school---make a positive difference in the lives of your patients.
34 comments - Nov 7, 2009
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