Every successful model of care includes patient self-management, Bertha Safford, M.D., told participants at the AAFP Practice Enhancement Program in Spokane, Wash., May 20 -21. " This is the hardest part," she added.
"We have to remove the guilt," said Safford, noting that the patient who comes in the least often feels the most guilt. If you're a patient with diabetes, seeing the physician "is like being sent to the principal's office," she said.
"There are no noncompliant patients. Instead, the patient is the manager and you are the coach," said Safford, who then launched into a story about a patient she once considered noncompliant. This patient with diabetes wasn't taking her insulin. Probing, Safford learned the young woman worked two back-to-back jobs and repeatedly had her insulin stolen at work. On top of that, her husband provided her fast food in the car on the way to her second job.
"She wasn't noncompliant, she was just coping with her life," said Safford.
When Safford learned her patient wanted to have a baby, she got the husband involved. He started bringing his wife healthy, homemade sandwiches to eat between jobs. He also delivered her medication -- an insulin pen. Diabetic group visits also became part of the patient's routine.
"She's one of my success stories," said Safford, "but it started with me changing my mindset."
