Amy Tenderich: The "Home Depot" method of patient engagement

The following is a reader take by Amy Tenderich.

“You can do it. We can help.”

As one of 21 million Americans living with diabetes, Home Depot’s slogan hits home. Diabetes is largely a self-managed disease. If patients don’t take a “do-it-yourself” approach to their blood glucose control, things tend to spiral downhill.

Home Depot’s motto, with its combined empowering and coaching slant, is the approach that health care providers should be applying to their interaction with diabetes patients around the country.

Instead, diabetes is escalating into a public health crisis, causing nearly 300,000 deaths in the US every year.

Physicians tend to blame the problem of poor disease management on patient “non-compliance”. Patients don’t follow instructions, they say. Often true. But why? Pure apathy or some innate self-destructive tendencies? Doubtful.

Keep in mind that most every human being is motivated to live well and long. Quite often patients just don’t understand what doctors are asking of them and why, they feel utterly overwhelmed, or both.

There ought to be a protocol for every health professional treating diabetes to first explore exactly what’s standing in a patient’s way. Next, the mandate should be to refer the person to the appropriate help – a certified diabetes educator, nutritionist, exercise physiologist, support group or seminar, depression counselor, etc.

But the inefficacy of diabetes management actually goes both ways. Clinical inertia is as rampant as patient non-compliance. In diabetes care, this means “when it takes too long for a healthcare professional to take action to improve glucose control in a patient who is not at goal.” A study conducted a few years ago showed that it took up to two years to either change or add a diabetes medication once the A1c was documented as above 8%. That’s two years of marching in the wrong direction – towards diabetic complications.

As a patient advocate myself, I got together with a prominent endocrinologist last year to write a book about what patients need to do to get a handle on their own health. In a nutshell: get a copy of your lab results and understand what they mean.

Of course this assumes that physicians are proactive about ordering the five key lab tests that everyone with diabetes needs on a regular basis: A1c, blood pressure, lipids, microalbumin, and a diabetic eye exam.

We tell our readers to think of themselves and their diabetes as a small business: you manage it, and your healthcare providers are your consultants, whose job it is to help you succeed.

If your A1c is creeping up, or your cholesterol is above 100 mg/dL, don’t wait until your next appointment. Contact your caregiver/consultant as soon as possible, just like you’d call your accountant if your financial balances were slipping.

But for this model of patient engagement to succeed, physicians have to think of themselves along these lines as well. Be a “health consultant” to your patients with diabetes. Aim not to manage their diabetes, but to help them succeed in doing so.

And what could be a more appropriate motto for “diabetes consulting” than Home Depot’s energizing slogan, “You can do it. We can help”?

Amy Tenderich is the author of Know Your Numbers, Outlive Your Diabetes: 5 Essential Health Factors You Can Master to Enjoy a Long and Healthy Life and blogs at Diabetes Mine.

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