Dr. Ramiro Antuña de Alaiz > Ramiro's Story |
| I finished my training as an endocrinologist in 1984. During the course of my training I was taught that my role as a physician was to tell patients what I wanted them to do to take care of their diabetes. I was taught to focus on the illness but not on the patient's personality, priorities, family, or on how my recommendations would affect their way of life. My experience with the "traditional medical model" was mostly negative. The most frequent result of this approach was "noncompliant" patients and frustrated health professionals. I realized that the traditional medical model didn't work and that we needed to find a different approach to diabetes care. It was a blessing that around that time I read the first empowerment papers from the United States. I said to myself, "Wow this is it! It even has a name: empowerment" which, by the way, is very difficult to translate into Spanish (autopotenciation). However, I realized that the important thing about empowerment wasn't the strange name but the new approach to diabetes care that the name represented. |
| I have come to appreciate that providing excellent care to my patients with diabetes is more about responding to their emotions than focusing on the technical aspects of blood glucose control. When our patients know that we are truly listening to them and are taking their wishes and beliefs into account, our relationship with them changes dramatically. We become partners and friends and share in their successes and failures equally. |
| The following two examples illustrate how this approach to diabetes care has influenced my practice: "Carla" was an adolescent girl who was having problems with her mom, who was "policing" her BG booklet values continuously and punishing her when she got high numbers. Carla's approach to solving this problem was to only write down numbers in the desirable range, even inventing values to please her mom and avoid punishment. When her next A1 C was high I agreed to meet her without her parents. During that visit she told me the whole story. She said that even when she did everything right she sometimes got high numbers and was punished unfairly. I told her that our treatment is clearly far from perfect and that we doctors too often don't have an explanation for glycemic fluctuations. After talking it over for a while we decided that the solution was for her to keep a secret BG logbook hidden in her room with the real information to share with us and to keep a fake BG logbook in the kitchen to keep her mom happy. We kept her secret and eventually her mother stopped coming with her to the consultations. Her A1Cs have improved a bit but, more important, she is no longer being punished. "Juan" is a young man who has worn a pump for the last nine years. Juan is a metabolically successful insulin pumper. He wears a pump because in the past he had hypoglycemic unawareness and frequent hypoglycemic comas. Since wearing the pump he has not had a single episode of hypoglycemic coma. He has regained confidence and is driving to work again, so you might think he is happy. Not quite-he confessed to me that he hates wearing the pump but that his quality of life is so much better that he is willing to wear it. He dislikes the pump as much now as he did nine years ago when he first started to wear it. We make jokes about his "marriage of convenience." At every visit I ask him about how the marriage is going. Are they getting along? Is their relationship improving? His answer is always the same: "I hate it but I need it." And I usually say, "Not all marriages begin with love at first sight" and then we laugh together. |
| Developing such a trusting relationship with a patient can be time-consuming. Also, it requires a lot of active listening and nonjudgmental advice, but it is well worth it because the rewards are enormous. I am very thankful to all my patients for challenging me to better understand the human being hidden behind every diagnosis of diabetes. Patients living with diabetes search continuously for a balance that will allow them to enjoy their lives while maintaining reasonable diabetes control. Our role is to help them do both. |
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Ramiro M. Antuña de Alaiz |
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