Professionals: Educate yourselves, your patients

Responsibility’s equally patients’, providers’

      Diabetes is serious.

This eye-catching message and the slogan "Control your diabetes for life" from the National Diabetes Education Program are echoing across the airwaves and being beamed into physician and clinic waiting rooms as diabetes educators search for ever more effective ways to get the attention of health care professionals and the public.

As the evidence for strict glycemic control expands, diabetes educators are expanding their search for ways to help patients bring their disease under control. And they are looking for ways to help lift the burden from time-pressured primary care physicians.

"Right now we don’t have a health care system that is fully supportive of prevention, since you will hear again and again that physicians only have 10 or 15 minutes with people with diabetes," says Faye Wong, MPH, RD, co-director of the National Diabetes Education Program (NDEP) at the Centers for Disease Control and Prevention in Atlanta.

She says short-shrifting patients in terms of physicians’ time is unfair. "Patients are set up for failure; patients are set up to be victims. They are set up to be blamed for the disease." She adds, "The system is not set up to adequately provide patients with the knowledge they need, the skills they need, or the support to carry them through."

Of course, Wong concedes, there is a tremendous storehouse of knowledge that needs to be transferred to newly diagnosed patients, but she cautions that it shouldn’t happen all at once. Wong says she blames health care professionals for attempting to download "six years of education on a patient in five minutes" and then being puzzled why outcomes are not better.

"In our society, we tend to treat everybody the same," she says. "The health care professional walks in the door and says Here’s the ten things I have to tell you’ and then you tell them those ten things and say goodbye."

Not only do newly diagnosed patients need time to adjust to the distressing news they have a disease that will require intensive management for the remainder of their lives, they need programs tailored to individual needs, Wong explains.

The NDEP says the team approach is the answer. Recent experience backs the concept with measurable results. If a physician moves toward team approach, the patient can benefit from the combined experience of nurses, dietitians, pharmacists, diabetes educators, and other providers who are familiar with diabetes — treating diabetes and educating people with diabetes.

"Oftentimes, there are providers who are more knowledgeable about diabetes than the doctor himself or herself, especially in the case of family practitioners who have to know every disease. It’s overwhelming for them," Wong says.

It’s important to bring the broader community — family members, friends, and the community patients live in — in the team approach to diabetes education, she says, because "these are important support mechanisms for people with diabetes."

Wong and her NDEP colleagues are strong proponents of assessing where patients stand in terms of the disease before thrusting them into programs that might not be suitable for their needs.

"If you take a group of people, you find people at the extremes and in the middle," she says. "You might find one group, the minute they hear about diabetes, they will be doing the right thing immediately because they are very self-motivated people. On the other hand, some people, no matter what you tell them even under a death sentence, they won’t do the right thing."

It’s all about motivation, but tailored to the individual, educators say.

Health educators need to do a better job of staging people and assessing them than they are doing right now, Wong urges.

"Are they at the full denial stage where it is a waste of time telling them anything? Or are they at a stage where they are ready to start reading, but not necessarily take action? Or are they are the stage where they are ready to try one thing?" she asks. (For examples of educational material, see box, p. 83, and principles for physicians, at right.)

"What’s important is to keep them going."

For more information, contact: Faye Wong, MPH, RD, Co-director of the National Diabetes Education Program, Centers for Disease Control and Prevention, Atlanta. Telephone: (770) 488-5037. E-mail: flw2