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Re: [IP] Comments appreciated
On 8 Sep 00, at 22:26, Tom Wellman wrote:
> 1. What is the single most important advice would you give
> your doctor?
I am a person with a medical problem, not a medical problem with a person
attached. My life involves many more things than blood tests and insulin
shots or boluses. I have a job, a family and a life that I have to continue
with - my treatment plan should not dominate everything else but should
integrate in a seamlessly as possible.
> 2. What advice would you give your CDE or Nurse?
Forget everything you heard in school or seminars more than two years ago.
There is no such thing as a non-compliant person with diabetes. Those you
want to label with that term are really suffering from non-realistic and
badly planned treatment protocols. Try to live your own life according to
the protocol before you demand that a patient attempt to follow them.
> 3. What advice would you give your Pharmacist or Doctor's
> office staff?
People with diabetes are long term patients - if we need to get advice from
the doctor or pharmacist we should be treated just like a collegue of the
doctor or pharmacist. Many times we are asking a question that can be
answered yes or no and the answer to the question can keep us out of
medical trouble. Don't write us off as cranks/crocks (what the medical
staff around here calls patients who are easily dismissed as idiots or drug
seekers) without first making sure what we are asking for and what we
need. There's a lot of difference between a crank asking for another
prescription for narcotics and a diabetic who is afraid of a site infection
asking for antibiotics.
> 4. What is the most important thing that hospital personnel
> can do to improve the care of diabetics during a hospital
Learn about the condition, pay attention to the little things. We've all
heard horror stories about the nurse insisting on giving the patient their
insulin (even Humalog!) and then forgetting to give them their food. And
everybody is surprised when the patient has a bg crash? Caregivers in the
hospital setting must NOT try to manage the person with diabetes if they
are competent to manage it themselves. They should ASSIST instead. The
most important thing is to remember that not all people with diabetes are
identical and the same stupid practices they've used for forty years are
actually dangerous to someone on a tight control protocol.
> 5. As a care giver, what advice would you give your medical
> professional about your involvement in the treatment
> decisions of your child, parent or significant other?
Listen, listen, listen. Share information, be willing to answer questions even
if they don't seem to be immediately obvious and listen, listen, listen. Then
think about how you would react if it was your family member who was
> 6. From an emotional/mental/spiritual standpoint, what can
> medical professionals due to help you improve your care?
Remember that all people have value as persons. Respect their emotional
states and recognize that diabetes causes emotional, mental and spiritual
trauma in addition to the gross physical effects. Be quick to recognize
symptoms of depression, moodiness or anger, and be willing to guide the
person to seek counseling or help from a professional who is experienced in
dealing with people who have a long term medical condition. NEVER SAY
"it's not that bad" to a patient. At that moment, for that patient, it IS
that bad. Make a list of resources in your area that can help, from the
hospital chaplin and local ministers to the mental health agencies. Help your
patients understand that it's not bad to seek help - it's bad not to seek help
with these kinds of problems. They are not alone - and as a professional
it's part of your responsibility to make sure that they recognize this.
> 7. What was your single absolute worst treatment nightmare
> which could have been avoided through better
> care/education/thoughtfulness on the part of the medical
When I was in the hospital being trained on MDI, about 14 years ago, the
nurse came in and demanded that I take my shot. It was thirty minutes
before mealtime and Regular insulin had to be taken before the meal. Then
she left because she was working a split shift. The duty nurse who came on
assumed that the first nurse had brought my food to me. An hour later
when I called and said I needed my food because my bg was around 45 she
began trying to get the tray delivered - but it had been taken back because
it had sat at the nurses station until the pickup time. I called again and the
nurses finally got some crackers and milk - but by that time my bg was
about 25, I had a splitting migrane as I usually get from a low, and I was
shaking, my temper was getting ready to detonate and I had eaten every
sugar tablet that I had in my room... I was demanding to see the charge
nurse, the doctor, the ombudsman, the nursing supervisor and the director
of the diabetes center... finally, they brought the food - almost three and a
half hours after I had taken my shot.
The sad thing is that this type of incident happens with regularity at most
> 8. In one sentence, how would you describe the effect
> diabetes has had on your life and the lives of your family?
Not good. It has prevented me from continuing my education because if I
don't have the medical insurance from my employer we go bankrupt. I have
been unable to do many things because I've had to eat, maintain a schedule,
and always have to carry a ton of junk with me. Since I've gone on the
pump things have improved a lot, but there's still that pile of junk and my
wife is fearful of letting me drive a long distance by myself or go sailing
without a crew. She's always worried when I travel, because she's seen me
at my worst when my bg crashes and is afraid of what could happen if I'm
in a strange place and that happens.
My five year old sons know how to do a bg check, and have even asked me to
check them. One of them has been talking about how his friends fathers
don't have medicine boxes. He's quick to notice when we run into someone
else who has a pump and he gets excited because there's someone else who
has a medicine box like Daddy. My children have also learned to offer me
food if I start acting oddly. I don't like the fact that my children
sometimes have to take the responsibility of taking care of me by trying to
determine if my bg is crashing...
> Please feel free to respond in any way (privately if you
> like) to these thoughts.
I hope you do well in your speaking! Be an aggresive advocate and take no
Rev. Randall Winchester
WD4HVA (email @ redacted)
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