An excerpt from Care: How People of Faith Can Respond to Our Broken Health System.
“Why do you have to be such an asshole?”
Roger was visibly angry with me and ready to get up to leave. Forty-five years old, he worked long hours repairing cars and had very poor control of his diabetes.
I looked him squarely in the eyes and said, “Because I don’t want to be the doctor they call from the emergency room to tell that you have had a stroke. I want you to live a long life and watch your grandkids grow up.”
There was a pause. He looked back at me intently and said, “No doctor has ever talked to me before like they cared what happens to me. So what do I need to do?”
Roger was diagnosed with diabetes eight years earlier. He was first given pills, and then about a year ago, he was started on insulin shots. He only took the insulin when he felt bad, though, and as a result his numbers weren’t good, especially his hemoglobin A1c. This is a test of the average amount of sugar in a person’s blood over a three-month period. Normal for the number is between 4 and 6. As long as the number is below 7, things are OK. It should never go above 9. Every time we tested Roger, he was over 10. It was almost certain something bad was going to happen. I had just told Roger, “If you don’t control your blood sugar better, you are going to have a stroke, have a heart attack, go blind, or kill your kidneys, and we will have to cut your legs off. And I want to be perfectly clear. If we cut your legs off, you will not grow new ones.”
That’s when he, understandably, called me an asshole.
What became clear, as is all too often the case, is that Roger didn’t really understand what diabetes is.
Once he came to see that I actually had his best interest at heart, we were ready to start over from square one, beginning with my simpleminded way of explaining diabetes. It wasn’t exactly accurate, but it was close enough for him to feel like he was part of his own care and could make decisions in his own best interest.
I began by telling him how our bodies turn food into energy.
Roger seemed to understand, and it was clear he wanted to know more.
“Roger, diabetes is a complicated disease. The more you know, the better off you will be. You need to make yourself an expert in diabetes. It doesn’t do you that much good for me to know all about diabetes. We will teach you if you want to be in control of your own future.”
A tear came into the corner of his eye. “Doc, I am so sorry I called you an asshole. I just didn’t want to seem so dumb.”
I wanted to come closer and hug him, but because of our COVID-19 protocols, I had to just acknowledge that I understood. We were finally heading down a good path. But from this point on, it wasn’t going to be me, the doctor, who would help Roger, but our dietician and health coach who would be walking this journey with him.
“Roger, the pills and insulin will help you, but there is so much you can do to help yourself. Our dietician will be calling you, and the two of you will work on the best way for you to eat healthy food going forward, and one of our health coaches will be working with you on a plan for exercise, caring for your spirit, and a lot of other ways to get this under control.”
In our work at Church Health, we have health coaches embedded into our clinics who work with patients like Roger on behavioral changes that can improve the trajectory of diabetes. We have shown that their work improves outcomes better than all the new drugs to treat diabetes that are advertised on TV. These days, every other commercial advertises a new diabetic drug that claims to lower hemoglobin A1c. While these drugs do have their place, their benefit comes at quite a price, and that benefit is not nearly as powerful as the happy people in the commercials want you to believe.
A few years ago, we began looking closely at what we could do at Church Health to help our patients better manage chronic diseases like diabetes and hypertension, which often occur together and result in people taking multiple prescriptions—or not taking them if they can’t afford them. We have the resources of a wellness center, health coaches, a teaching kitchen, a behavioral health clinic, an optometry clinic, a dental clinic, and our medical clinics. We value quality improvement.
What could we do better for patients with diabetes?
We bore down on the question and created a system that didn’t depend on which provider a patient saw. Now providers had an entire care team to work with. No matter which provider a patient saw or which health coach the patient worked with, standard processes kicked in. This allowed us to document everything that happened, evaluate, and improve. Many patients can reach their goals and manage their blood sugar levels by understanding their lives as a whole rather than thinking a pill will do all the work.
In my years at Church I’ve seen more patients than I can count with diabetes, hypertension, and heart disease—all chronic conditions that can be prevented in many cases by a better understanding of the difference nutrition and movement can make. As we’ve demonstrated with our work with diabetes, for many people, better nutrition and movement can make enough difference to avoid years of medications that don’t bring as much improvement as healthier living.
G. Scott Morris is a physician and ordained minister. He is the author of Care: How People of Faith Can Respond to Our Broken Health System.
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