It has been nearly four months since I joined this incredible project. It has been an exhilarating roller coaster ride from the very beginning. I don't think I have ever experienced working on such a dynamic team so intensively toward a common vision.
The Joslin Diabetic Center sent Richard Jackson and Bill Polonski to Bellingham a few weeks ago. They have actively integrated "patient-centered care" into their practices as physician and diabetic educator. They shared their expertise vividly and dramatically. I learned a great deal from their presentations to us as healthcare providers. However, it was watching these gentlemen in action with an audience of over one hundred patient and family members that most powerfully communicated what patient-centered is really all about!
In their presentations to staff, the Joslin team gave us these important things to provide to patients:
Confidence in their ability to manage their diabetes.
Hope, that they can live long and generally healthy lives with their symptoms under control.
Effective treatment available; Evidence-based medicine.
Clarity in exactly what they need to do to manage their illness.
Knowledge of how to monitor their progress.
I had always considered myself to be very patient-centered but I was profoundly moved as I watched these gentlemen work with the large group of patients and their families. At one point in the discussion, they asked how many diabetics there expected to develop blindness as a result of their diabetes. A great many hands went up. Dr. Jackson then reviewed the evidence, the facts we know now, about retinal fibroplasia and diabetes. He said that people who control their diabetes, keep their hemoglobin A1C at normal levels, and have regular eye exams have a less than 2% chance of developing eye complications in their lifetime. There was a sense of shock and relief that went through the audience. Nothing could have been more powerful.
So I learned that evening how important hope is to our patients. I also learned that sometimes we as medical providers hesitate to have the patient start on insulin when clearly their A1Cs can return to normal sooner if they would use insulin.
I changed my practice approach the very next day. One of my patients has been extremely frustrated and terrified that he would die as his father did, in a diabetic coma. He has been frightened as he watched his hemoglobin A1C start to climb past 7.0. He was eager to start insulin and had already experienced giving his own injections when he was post-op from a cardiac by-pass. Both his provider and I had attended the Joslin inservice so she elected to not wait another few weeks to see how the larger dose of oral agents would work. She started him on Lantis that evening. When I called to see how he was the next day, he said: “A miracle has happened! My fasting glucose was 127 this morning! I feel great and I am so happy I cannot believe it!”
Thank you, Joslin! You’re right on!!
