The Process

Our own Dr. Centor writes in his blog today about “the process.” It really hit home after seeing a patient today who never seems to make progress on his weight loss and diabetes goals.  We are constantly telling (berating) our patients to make major changes- quit smoking, eat less, exercise more, and on and on.  I feel like a broken record, and a frustrated broken record at that. And they never seem to take our advice.  But, as Dr. C opines, the result is not what is important, it’s the process.  As long as you are moving the ball down the field, you are doing good work. 

Each opportunity to work with our patients gives us a chance to espouse better lifestyle choices, better medication adherence, better processes. Our words are not magic. Sometimes they work; sometimes they just add another piece of straw. We must learn to focus on the process. We must try different motivational tactics. But we owe it to our patients to try, even if we believe that our actions are futile.
He makes a great point, and you should check it out the whole thing, as I haven’t done it justice.

 Keep it up, and one day you will get that patient that quits smoking, loses 20 pounds, has a HbA1c move from 11 to 7 9 (well, it might be 3 different patients).  It really does happen, and those are the great days. 

While I’m thinking about it, only 41 more days until college football season.  Another one of the great days…


Diabetes Education

First, welcome to new readers!  I’ve kept this blog kind of quiet for the last few months, but feedback has been good, so I am rolling it out to the whole residency today.  Lucky you!

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Just a quick post today about diabetes education as it came up in IM IV clinic last week.  Both VA and UAB have great help available to you for teaching your patients about their diabetes.  It is a life changing diagnosis and really hard to adequately cover in an office visit, even if you didn’t also have to talk about hypertension and back pain and obesity and cancer screening and…

At TKC- you can choose: Diabetes education, AMB (hint, save it as a favorite)
at VA, it is under consults: Diabetes Nurse, Patient Ed.

Services at both places include dietary education, glucometer teaching, insulin administration (including basal/bolus regimens), counting carbs, what do to on sick days, and recognizing and managing hypoglycemia.  They also cover things like eye and foot health, long term complications, and managing stress.

Medicare and BCBS pays for 10 hours of education once (ideally after diagnosis, but ok to refer someone diagnosed 20 years ago, if they never got any teaching), then 2 hours every year after that. At UAB, the first course is 5 hours, then there is a 2 hour follow up course.  The refresher course is 2 hours.  The diabetic educators will send you the pre/post tests of your patients, and you can highlight the things that tripped them up on the test.

At the VA, there is both a comprehesive diabetes managment group class and 1:1 education for insulin administration and complications managment. 

There is also a great website developed by the Division of Preventative Medicine here at UAB with a lot of (mostly free) resources for diet, exercise and medication managment. 

Sadly, none of the payers are covering nutrition education for non-diabetics (or pre-diabetics) quite yet. You can get nutrition education for your patients at the VA with the MOVE 123 program.   Hopefully now that obesity is a “disease”, we’ll start to see more reimbursment.  In the  meantime, here’s something we can all agree on.