On average, patients get about 15 minutes with a provider during a standard diabetes follow-up visit. What do YOU hope to gain from your next doctor visit? Many people take a passive approach and assume the provider has a plan for the conversation.
Imagine a completely different approach: present yourself at your doctor visit just as you would if you took your car to a mechanic. You wouldn’t walk into the auto repair shop and say “Hi, here’s my car.” No, you would describe any problems you are having, give lots of detail, share what you think might be wrong, and ask for recommendations. You would say something like this:
“When I step on the brakes it makes this loud screeching sound like screeeechhhhh. It only happens after it rains. The first time I noticed this was last month. It also pulls to the right every time I brake. Do you think I need a brake job or is something else wrong that I’m not thinking of?”
In the same fashion, present information to your provider so you both can discuss the details, complete an assessment, analyze the data, and come up with a plan within the 15-minute visit.
Your successful visit begins when you arrive on-time or early. Arriving early doesn’t mean you will get more time to talk but arriving late increases the likelihood that your visit may be cut short. Prepare your comments in advance and have written notes. Questions that are not written down are easily forgotten. Being prepared will help you feel at ease, confident and in control. Don’t be embarrassed to talk frankly about your concerns. This isn’t a conversation with your friend or neighbor, this is the person who is helping you make the most important decisions about your health.
1) Prepare like a pro.
When possible get the most recent data from your CGM device and/or pump to the healthcare office ahead of time. “Share” your data the day before your appointment then email your provider that the data is current and available to download and review. Waiting until you arrive at your appointment for the office to download devices often means that your provider will only review your data after you have left the office. This is a big missed opportunity!
If you are using a glucometer, prepare a paper log with your glucose values for the past two weeks. If the past two weeks are not typical (you had a cold or were traveling), also bring a log from a typical week. Please do not hand a provider your meter and expect them to scroll through the meter memory and make sense of it. Instead, provide a paper log and be prepared to give a verbal overview.
Prepare a verbal presentation of your current glucose values that you can convey in less than 1 minute. This means you need to give the topic good consideration before you arrive. Calculate your averages, highlight when you are having lows, how frequently lows disrupt your day, when you run the highest, times when you were taken by surprise, etc.
Sample presentation using a glucometer: “I test my glucose 3 times per day. For the last 7 days, my fasting glucose average is 145 mg/dl. Before lunch my glucose average is 168 mg/dl. Before dinner my glucose average is 125. I don’t understand why I am running so much higher before lunch. But I think my afternoon exercise is probably helping with the better number before dinner.”
Sample presentation using a CGM: “As you can see, my TIR for the last 10 days has been 65%. I am running high more than I would like with time above 180 at 30%. The hardest time of day is after lunch. I’m not sure how to fix this. But I absolutely hate to drop low and this happens almost every day in the mid-morning.
2) Give your best “state of the union” address.
Explain what you think is going on. Consider possible explanations for highs or lows. “My fasting glucose may be high because of my nighttime snacking.” “I think I’m dropping low before dinner because my dinner is often late and I don’t eat after exercise.” Sometimes you don’t have any idea why your glucose is dropping low. If you bring up the topic, you and your provider can problem-solve together to create a solution.
3) Identify what are you willing to change.
Be very up-front and direct about what changes you are willing to make and what behaviors you would like to improve. Providers are becoming hesitant to make recommendations on behavior change due to accusation such as “fat-shaming” or “body-shaming” and “glucose-policing.” Providers want to help improve your glucose values but don’t want to sound judgmental. Patients that take an assertive approach to their health goals and bring up topics that matter to them will find their providers enthusiastic to provide guidance and support. Open the channels of communication.
4) Ask for recommendations.
Strive to be open to what others recommend. It’s true that you know yourself and your experience with diabetes better than anyone. However, a provider may see things you cannot see (you may be too close to the trees to see the forest). Hear your doctor out and listen with an open mind. Inquire about what specific concerns your doctor has about your health; this openness will help create a great two-way dialog on sensitive matters.
Ask to be referred to a diabetes educator (Certified Diabetes Care and Education Specialist) every year. This is a covered benefit and education is meant to continue for a lifetime. Diabetes Care and Education is not a “once and done” service. Diabetes is progressive and life circumstances continue to change. Your diabetes care and education should continue year after year, just as your medical care continues.
5) Set one goal before your provider walks out the door.
Before discharge, make sure you are both clear on the plan moving forward. Instead of vague goals like “I’m going to exercise more.” It’s more effective to set S.M.A.R.T. goals. This kind of goal is specific, such as “I am going to walk for 15 minutes 5 days this week.” This goal is measureable, because you can count how many days you have walked in the week. Always strive to have attainable and realistic goals so that you set yourself up for success. Make each goal time- based so that you know exactly what you expect from yourself.
Clear and honest communication between you and your provider can help you both make informed decisions about your diabetes care and the important next steps. The goal is always to move you to the next level of diabetes control and toward better health. These outcomes can be achieved with thoughtful preparation, followed by a detailed presentation, honest assessment of what you are willing to do, and two-way communication about desired outcomes.
Here is your opportunity to make a world of difference in the care you receive.
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