WASHINGTON — “It's almost as if [health care providers] have a secret strategy for discouraging people” from monitoring their blood glucose levels, according to William Polonsky, Ph.D.
To help his colleagues avoid these negative behaviors, Dr. Polonsky, a certified diabetes educator and founder of San Diego's Behavioral Diabetes Institute, listed six surefire ways to dissuade diabetes patients from regularly testing their blood sugar:
▸ Be vague about your testing recommendations. Just tell patients to “check every day or so.”
▸ Ignore blood glucose logs. If patients bring in the results of their blood glucose tests, don't look at the results or comment on them.
▸ Don't explain anything. Don't let patients know how to understand and use their test results.
▸ Hide your own discomfort. If you don't know what the glucose test results mean, just say the results are “very complex.”
▸ Be controlling. Explain how patients can use their results to limit and control their lives. Be punitive if you can.
▸ Use the “red circle” approach. If you do look at their test results, look at them quickly and draw a red circle around the highest number you can find; then say, “What happened here?”
“If you practice this with your next 10 patients, I guarantee you that none of them will check their blood sugars any more,” Dr. Polonsky said at the annual meeting of the American Association of Diabetes Educators.
For those who want to encourage patients to test their glucose regularly, Dr. Polonsky suggested the following strategies:
▸ Make it meaningful. Make sure the blood glucose data answer their questions, such as how exercise affects their blood sugar or why they feel tired at certain times, he said. (See box.)
▸ Use the “Noah's Ark” principle. The idea is to perform blood glucose tests in “before and after” pairs so that patients can see how their actions affect their glucose readings. This is probably the most important concept, he said.
▸ Look at the patient's testing results. “I know we're all so busy, but I'm pretty sure this might help,” he said. “I hear so much about my colleagues saying, 'Just fax me your results,' and then no one ever gets back to [the patient] or the fax gets misplaced.”
▸ Congratulate people on the effort, not the numbers. “I'm not going to critique [the patient] on what that number is,” said Dr. Polonsky. Instead, “I'm going to say, 'Hey, you checked your blood sugar. This is great. Thanks.'”
▸ Find better ways to help patients understand the information. “Help people to see patterns, because for many of our patients, it's not so clear.”
▸ Watch for patients who base their self-esteem on their results. “We need to challenge them. We need to say over and over again, in a really kind way, 'Wait; there are no good or bad numbers. This is just information, and all of it is valuable.'” Dr. Polonsky's institute gives patients tiny stickers that go right under the window of any blood glucose meter that say, “Hey, remember, it's just a number.”
That doesn't mean that patients don't still need to be counseled generally on what to do about too-high or too-low glucose readings, he noted during his session, which was sponsored by Roche Diagnostics, maker of blood glucose monitors. “Instead of using the word 'bad,' I use the words 'safe' and 'unsafe,' as in, 'This number tells me you're not in a safe place.'”
Although many providers think that diabetes patients don't understand how serious their disease is, that's not actually a problem, said Dr. Polonsky. “Most of our patients understand it's a serious disease; the problem is many of our patients don't believe this is an urgent disease. [They think], 'I can deal with this later.' Using the words safe and unsafe is my way of trying to say, 'You're not safe right now, so this is urgent.'”
It's also a way of not sounding condescending, “as opposed to, 'You've been bad again, I see,'” he added.
▸ Find better ways to promote action from patients. “What we should be always practicing saying and asking our patients to think out loud, is, 'What, if anything, can I do about this?'” Dr. Polonsky said. “We want to help our patients get into that kind of thinking so that the immediate thought is not, 'I can't believe I messed up again,' but [instead], 'It's just a piece of information; what can I do about this?'”
