Physicians must understand that many of the decisions made in diabetes are those that the patients make on their own. They have to be clear about what information they have given the patient, what form it is in, and what the patient’s level of understanding is. If, for instance, the patient’s memory is poor, you can’t rely on that patient’s memory alone. You need to find someone in the family constellation to provide backup. Too often, excellent physicians provide good information to someone who can’t retain it.
We work with diabetes educators to provide both individual and group diabetes education on a regular basis. We believe that education should be intertwined with care because it needs to be repeated over and over again. People don’t learn things in just one sitting. To think that people will change their lifestyle and learn about fairly complex topics in one sitting is fallacious. In our practice, we give patients written information about insulin or other medications, and, because of the EMR, it is very easy to print whatever other information the patient wants, such as dietary instructions and general information about diabetes.
But to me, the most important thing is to work with someone who is going to be able to make sure that the patient understands and can do the things that need to be done. That’s why I’m so much in favor of thinking of diabetes care as a team effort that should be patient-centered. What we’re trying to do is to get large groups, such as family practitioners, internists, endocrinologists, cardiologists, and other members of the team, thinking in terms of how they can work together cooperatively. This is a point that I really want to emphasize: We are taking care of the same patients. We should cooperate. It is in the patient’s best interest.