Diabetes and Healthcare Professionals

Hypo in the Diabetes Clinic.

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“Are you still using the Animas?”

“Actually, I have the new YpsoPump.” I replied to the nurse, pulling it out of my pocket.

“Would you like to use your own lancet?”

“Good idea,” I replied, pulling it out of my pencil case and avoiding a bloodbath on my fingers.

“Oh, you’re 3.8,” the nurse said to me after I had applied some blood onto the test strip. “Have you got some hypo treatment on you?”

Before I was even given any time to answer, she had poured me a glass of sugary fluid to drink and handed it to me. Encouragingly, it was an appropriate sized amount that wouldn’t send me rebounding.

“Are you able to feel your hypos?”

“If it’s a steady 3.8, like this one, I feel fine. But if it were a 3.8 and dropping rapidly, I would.” She was lovely, and I didn’t feel that I was being judged.

Another nurse walked in, also wanting to have a look at my new YpsoPump. “Of course, you should treat your hypo first!” She exclaimed to me in a motherly way, after being reminded by nurse one that I was hypo.

“Are you sure I can’t get you some biscuits or anything?” the nurse asked me, as I made my way towards the door.

“No, I’ll be fine. The tea will probably bring me up as well,” I said as I grabbed the Styrofoam cup that I had been given in the hallway earlier.

I made my way back toward the end of the corridor, took a seat and buried my head into my iPhone, grateful for the warm drink on my sore throat. I wasn’t worried.

Some time later, the nurse returned. She hovered for a moment, but I didn’t really notice until she spoke.

“Frank, would you like to check your blood sugar again?”

Knowing it had been sufficiently treated, I had completely forgotten about my hypo. I pulled out my FreeStyle Libre, registering the 3.7. I wasn’t convinced that I needed anything further, and pulled out my meter.

“I’m happy to leave it,” I said, holding up my meter that was displaying a 4.4. “I don’t want to overtreat it, and the tea will probably bring me up a bit more as well.”

“Are you sure I can’t get you any biscuits or something?”

“No, I’m fine. Thank you.”

I get that this comes from a good place. A really good place.

Perhaps if hypos hadn’t interrupted many of my work days, bed times, socialising, housework, walks and errands over the years, I might just treat them with the same response as that nurse.

Hypos are not a scary thing, provided I know how to manage them. They are a part of living with diabetes, just like checking my blood sugar or injecting some insulin. Last year at the Roche Educator’s Day, I made a big point of stating that two hypos per week was an unrealistic expectation from my healthcare professionals. Moreso as my skills in managing blood sugars improved and I was spending more time in range.

I get that hypos are not good for me in the long run. I get that hypos can impair my cognitive function. I also get that hypos can be life threatening – and maybe I’m just lucky that I’ve never had one where I’ve needed help. Believe me, I don’t like having hypos anymore than a healthcare professional likes seeing them appear on a blood glucose meter.

However I feel it’s more important that I’m dosing insulin responsibly, checking my blood sugar often enough, travelling with glucose tabs on hand and am able to sufficiently treat a low.

Some healthcare professionals condemn people with diabetes for having too many lows, and this is where we need to reshape our attitudes toward hypos.

Making me feel any lesser for the number of hypos I have will only make it more difficult for me to share openly in front of a healthcare professional, ultimately jeopardising the provision of any support I may need.

Perspective.

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It was a glorious Friday afternoon. I so badly wished I’d been able to get to the surgery earlier so that I could bask in that golden late afternoon autumn sun. I parked my car on the side of the road adjacent to the building, collected my belongings, locked up and made my way toward my doctor’s surgery.

I stepped inside the green waiting room, announced my name and appointment time to the receptionist before being gestured to take a seat. I made my way towards the corner of the room, taking a seat beside the ottoman stacked with dated magazines. I placed my trusty diabetes case, keys, pocket wifi and pocket tissue pack down beside me, and settled in for the long wait.

I had the flu. I had copped the brunt of it the day prior and was feeling somewhat better, but decided to take advantage of a sick day and pay my doctor a visit for another matter that I’d been putting off for a while.

I buried my head into my phone – something I’ve actually been making a conscious effort to do less of lately – and caught up on some of the news in my feeds.

I did a quick scan of the room. After grouping people together, I figured that there were five or six people waiting to see the doctor late on that Friday. I continuously glanced through the sliding glass door, watching the sunlight disappear from the street corner as the darkness set in.

As I watched the clock slowly move past six and closer to six thirty, the wait wasn’t even particularly bothering me. I wasn’t even thinking about how lousy I felt anymore. I was beginning to feel plagued with sympathy over this hour of day that I was demanding my doctor.

I thought about what I would normally be doing at this time on a Friday. I’d probably be well caffeinated, sweetened, showered and in clean clothes, capping off another working week. I’d probably be sitting down to a nice dinner with my family after grocery shop day. Yet here was my doctor, who had probably started his work day at the same time as me, still shouting out patients names from down the hall before appearing at the reception desk.

My doc could have made his last appointment at 5 instead of 5.30. He could have allocated longer appointment times so that he didn’t fall behind schedule and might get home on time. But he didn’t.

Although he was understandably hurrying things along, my doctor didn’t complain once as he called me in and prepared for me what I had asked for. I was in and out in less than five minutes. 

Our healthcare system is far from perfect. I’m the first person to complain about anything and everything. But this particular visit, at this particular hour of the day, came with a nice little lens that put things into a different perspective.

I’m certainly glad that there are people out there in the world, like my doctor, going above and beyond to help sick people get better.

(Although, as always some more resources to help people like my doc would always be greatly appreciated).

Where Is The Patient Centred Care?

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When are you seeing your doctor? the Pathologist asked me as I followed her into the demountable Caravan that doubled as the ‘D’ block at my local hospital.

It won’t be until he has the results and calls me in for an appointment I replied. I already signed the release form to receive my results when I came in, but with Australia Post and the Easter long weekend I’ll probably be waiting well over a week.

When did you come in to have your bloodwork done?

Yesterday morning.

Seemingly puzzled at why someone would want to know their own test results, she typed my surname followed by my first name into the computer to check the status of my results.

They haven’t all been done yet. They’re about 80% complete.

Is my hba1c there?

There it is. Don’t tell anyone I told you! She half joked, acting as though she had just committed a serious crime in telling someone their own test results.

Fantastic! I exclaimed, my eyes fixed at where the Pathologist had motioned on the computer display that looked like something out of the 1980s.

Five years ago, I wouldn’t have given a stuff about some stupid test results. I certainly wouldn’t have made a detour on my way home from work because I was that eager to know. I probably would have just let my doctor vaguely lecture me in 2 weeks time, rather than making my own evaluations about the condition I live and breathe 24 hours a day.

I feel like the system isn’t even designed with the patient in mind. Why aren’t we making it easier for patients to engage in their own health matters? Why aren’t we encouraging, and praising self management efforts? Why is lived experience not more highly regarded?

Where is the patient centred care here?

Now you can go home and enjoy your Easter long weekend! the Pathologist replied as I thanked her for her time.

But don’t eat too much chocolate! She exclaimed as I stepped outside into the crisp afternoon, the door slamming shut behind me.

Putting Patient Centred Care Into Practice at #ADSADEA2017

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There are still a few more sessions from this year’s ADS-ADEA conference that I hope to cover over the next couple of weeks, as time and brain capacity allows.

One of the buzz words at this year’s conference was the concept of ‘patient centred care.’ As a consumer, it felt extremely frustrating to sit in on several sessions hearing all the talk about it, while knowing that in reality it’s not always being delivered. 

On the first afternoon of the conference, I ducked into a workshop chaired by Diabetes WA about putting person centred care into practice. In attendance were mostly diabetes educators and other healthcare professionals. Melinda of Twice Diabetes was also sitting in on the session with me, and she has shared some of her thoughts on patient centred care here.

Professor Timothy Skinner took to the stage to tell us that there was no ‘one’ or ‘right’ definition of patient centred care. He gave us four statements for attendees in the room to consider.

“All the decisions that affect the progression and outcomes of diabetes care are made by the person with diabetes.”

“All the barriers to effective diabetes self-management are in the individual with diabetes interpersonal (social) and intrapersonal (psychosocial) world.”

“All consequences of diabetes are experienced by the person with diabetes.”

“Every individual is always making the best decision they can to optimise the quality of their life.”

Professor Skinner noted that person centred care occurs when healthcare professionals act in congruence with these four statements. I still don’t quite know how I feel about these. In one way, I agree that the person with diabetes should be the ultimate driver of their diabetes decision making. Or, that this should be the ultimate goal. Yet if these are assumptions that healthcare professionals are making in light of an undesirable outcome, then they certainly seem to imply blame on the patient.

Our table then had to discuss this prompt.

I really thought that this statement reinforced one of the sentiments that I continually echoed throughout my time at the conference. I don’t represent all people with diabetes out there. Melinda and I were likely among the more ‘switched on’ and ‘connected’ consumers. While I might head into a clinic appointment with a list of notes and knowing exactly what I want to ask, this may not be the case for every other person out there.

I had a very frustrating economics teacher in High School who used to answer questions with questions. But in this instance, this is exactly the approach I would be giving to patients expecting to be told what to do. Healthcare professionals need to start empowering consumers to make their own decisions. Healthcare professionals should be arming consumers with information and resources that will assist them in making their own, informed decisions.

My attention waned towards the end of the session, and I think it was simply because I don’t believe the answer to providing patient centred care should be so complex.

Patient centred care is simply delivering what the consumer wants, rather than what the healthcare professional wants. If the consumer doesn’t know the answer to this question, then healthcare professionals need to be supporting the consumer to find out what it is that they want.

Disclosures: Diabetes Australia provided me with a media pass to attend the ADS-ADEA 2017 conference, with the view that I was interested in attending and delivering my own honest insights to the wider diabetes community.

A Medical Alert Bracelet That I Actually Like Wearing!

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I’m not fond of Medical Alert Bracelets.

They’re fidgety.

They don’t look nice.

Every time I see one of those small round stainless steel emblems on someone’s wrist, I automatically think of some kind of allergy or sickness that I hope I won’t get.

In the past, I’ve only worn my bracelet when I’m travelling, alone or a fair way from home. Situations where an emergency may be more likely to happen…

Earlier this year, I made somewhat of a resolution to put more of an effort into wearing my Medical Alert bracelet. I’ve kept it in plain sight atop my chest of drawers, so that I’ll remember to put it on when I go to grab my wallet and keys and watch. I think I’d rate my adherence to this resolution a 4 out of 5.

However, I still can’t get super excited about wearing it.

Catalogues from Australian Medic Alert arrive in my mailbox every year, showcasing their latest and greatest ranges. But to be honest, nothing really appeals to me. It’s that same round stainless steel emblem, perhaps with a fancier band and a price tag that I know I won’t get my money’s worth from.

Last month, I was contacted by Lace from a company called American Medical ID in Texas. American Medical ID have been around since 1994, and their aim is to bring people stylish Medical ID jewellery options that they love and would be proud of wearing.

Lace kindly sent me this Lynx Trilogy bracelet, and it is probably the nicest Medical Alert bracelet I have ever worn.

What I love most about American Medical ID is that there is no annual membership tied to the purchase of a Medical ID bracelet (although it is available as an optional add on). I have been extremely frustrated by price hikes from the Australian Medic Alert Foundation, and I am starting to question whether I actually need to be paying $49 a year just to have my identification details stored in a database. I’ve almost always got identification on me when I’m out and about.

The most important thing to me is that a Medical ID can identify my medical condition in an emergency. Paramedics here in Australia are trained to look for bracelets, necklaces and even tattoos, so big tick there. This bracelet also has plenty of room for engraving, with four lines of 15-18 characters available on both the front and the back of the bracelet. I’ve simply gone with my name, ‘type 1 diabetes’ and ‘insulin dependent,’ but there was plenty of room to add more.

I was also most impressed to see that American Medical ID have an online store for Australian customers, trading as Universal Medical ID, and a dedicated Australian customer service team.

After 2 weeks with this bracelet, I absolutely love wearing it.

I’m also really happy to find more choice in the Medical ID market here in Australia, because I shouldn’t have to wear or pay for something I’m unhappy with.

Thinking about a Medical ID for yourself? Lace has provided me with this guide on how to choose your own Medical ID.

You can find American Medical ID here, and their Australian contingent, Universal Medical ID, here.

Disclosures: American Medical ID sent me a Lynx Trilogy bracelet after reading one of my earlier blog posts on Medical ID. All thoughts and opinions expressed here are my own.