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Planning for a Successful Health-Care Visit

by Janet Howard-Ducsay, RN, CDE

You have canceled your last two appointments with your doctor, but now the pharmacy says you need to have new prescriptions for your diabetes supplies and medicines. You can’t put it off any longer: It’s time to see your doctor about your diabetes. But this time, maybe things can be different: Maybe you can view your doctor appointment as an opportunity to get your questions answered and to get help with your diabetes care — rather than as an obligatory meeting you’ve come to dread.

Here are some tips for how to get what you need from your doctor visits for diabetes care:

Make time for it
First, schedule your appointments at times that are good for you. Do you tend to try to squeeze them in between picking up groceries and picking up the kids? Is there a big deadline approaching at work the day before your appointment? Your diabetes appointments are just about you, and they deserve your undivided attention. Try to make each session with your doctor or other health-care provider a time when you are not rushed, preoccupied, or multitasking. Turn off your cell phone during the appointment so you don’t get distracted.

Plan ahead
Start thinking ahead of time about what you want to ask or talk about at your appointment. A lot can go on between visits, and it can be difficult to remember everything you want to bring up. So keep a small notebook handy, and write down your questions and concerns as they come up. (Click here for a list of helpful questions to ask at your appointment.) Plan on telling your doctor about any major changes in your life or your daily schedule, such as starting a new job or traveling more than usual. Changes such as these — and even more minor changes — can affect your blood glucose levels.

Review your notebook one month, one week, and again one day before your appointment to make sure you haven’t forgotten anything important. At your appointment, keep your notebook out so you can refer to it, and use it to take notes on your doctor’s or other caregiver’s instructions.

Bring your meter and logbook
Bring both your meter and your logbook to your appointments. Make sure that your meter is well charged or has fresh batteries so your physician or the office staff can review your meter memory and/or upload it to a computer. Check with the office before your appointment to ask if they have the capability to upload data from your specific meter.

The numbers recorded in your logbook help your doctor see trends, or patterns, in your blood glucose levels. Seeing a pattern of highs or lows enables your doctor to recommend medication changes or changes in other parts of your diabetes regimen. Having actual numbers is much more useful than telling your physician, “My sugars are all over the place.” However, only accurate records are useful: Filling in your logbook the night before your appointment will be obvious to your doctor and won’t be helpful in improving your blood glucose control.

If your provider has not already specified what glucose ranges you should be aiming for before breakfast, lunch, and dinner and before bedtime, ask — and make sure to write it down in your notebook.

Facing the scale
Being weighed is a common feature of most diabetes checkups. Physicians (or their office staff) generally do it to maintain complete patient records and to comply with insurance policy mandates. Unfortunately, this requirement contributes to the dread many people feel about going to the doctor. For them, the numbers on the scale may represent failure, disappointment, the possibility of being scolded, or the futility of their efforts to lose weight.

If that sounds like you, consider developing a different attitude toward the scale. Regardless of the number, find something positive to say about yourself or your efforts to care for your health and your diabetes. For example, share with your doctor that you have started a walking program. Tell him you have found a lunch partner who also has diabetes and that you are eating healthy meals together at work. Really think about something positive you have been doing. Perhaps you recently enjoyed your first green vegetable ever or tried a new type of fruit. Remember that your weight is only one measure of your health. Developing healthy lifestyle habits such as being physically active and eating healthful foods can have beneficial effects beyond any effect they may have on your weight.

If you have dropped a few excess pounds since your last appointment, share how you did it, accept any positive reinforcement that is offered, and take pride in your accomplishment. If your physician chooses to respond to your weight loss with a negative comment — telling you it’s not enough, for example — respond with a positive attitude anyway. Try saying something like, “I will work on making the best food and activity choices I can for myself each day. I will update you on my progress with that at my next appointment.”

Discuss your medicines
Bring a current list of all of the medicines and the doses you are taking to each appointment, or bring the bottles of medicines themselves if that’s easier. Go over the list with your physician to make sure he is aware of what you’re taking. Identify before your appointment whether you will need to get new prescriptions from your doctor for any of your drugs or diabetes supplies. If you’re not sure when or how much of a drug to take, ask. For example, you might say, “Dr. Smith, I am taking 5 milligrams of glipizide 30 minutes before each meal. Is that correct?”

Include any over-the-counter or herbal products on your list, and mention if you have started taking any new products since your last appointment. Ask whether these new products might interact with anything else you’re taking.

If you are not taking your prescribed medicines, tell your doctor, and say why. It is better to be candid about what’s going on than to have your provider prescribe more medicines because your blood glucose levels are too high (which they are likely to be if you’re skipping your medicines).

Are your medicines too costly? Ask your provider if there are lower-cost alternatives. If there has been a recent change in your financial situation, the doctor’s office staff can provide you with information about pharmaceutical assistance programs that may help to cover the cost of your medicines and diabetes supplies. The Partnership for Prescription Assistance Program, which can be found online at www.pparx.org or contacted by telephone at (888) 477-2669, has the application forms for many pharmaceutical assistance programs.

Money is not the only reason people don’t take their prescribed medicines. Perhaps you are not taking them because you are depressed or sick and tired of having diabetes. Just saying it out loud can be a relief, particularly if you are heard by an empathic ear. Verbalizing how you feel can also open an important dialog with your doctor about your emotional well-being. In addition to offering a supportive ear, he may be able to suggest other resources, such as a therapist or diabetes support group. Similarly, if side effects or forgetfulness are causing you to stop taking your medicines or to skip doses, your doctor may be able to help you work out solutions to these problems.

Take off your shoes and socks
Take your shoes and socks off when you enter the examining room, and remind your provider to examine your feet. Tell him about any foot-related concerns you may have, such as any tenderness, redness, irritation, changes in sensation, or slow-healing wounds you have observed in your daily foot exams. If you’re having trouble trimming your toenails or finding shoes that fit, ask about a referral to a podiatrist. Even if you have no specific concerns about your feet, it’s important for your provider to check them for the presence of neuropathy, which can cause you to lose feeling in your feet and to not notice small or even large injuries.

Discuss your goals
Tell your doctor what your goals — or priorities — are regarding your diabetes. For example, your main goal may be to avoid highs and lows. Ask your doctor how this compares to his goals for your diabetes care. You may find that your priorities are somewhat different. For example, his main goal may be to bring your HbA1c level into target range.

If your and your doctor’s goals are different, it’s important discuss those differences and to work out a plan for going forward. You need to be clear about what you are willing and able to do to manage your diabetes. Your doctor should be willing to listen respectfully to what you have to say and also to explain the reasons behind his goals. Chances are, you can come to an agreement about steps you feel able to take that will help to manage your diabetes.

However, if your doctor is not willing to listen to what you have to say or to discuss how to achieve the goals that are important to you, it may be time to reevaluate whether this health-care provider is the best for you. If the physician does not have the time for a lengthy discussion, ask to speak to a certified diabetes educator to help you with setting and achieving goals related to your diabetes.

Bring your calendar
Bring your appointment book or digital calendar to schedule future visits. Ask whether your diabetes care provider’s office can schedule other routine exams, such as eye, dental, or complete foot exams, for you while you are there.

Even if your doctor takes a look at your feet at every visit, the American Diabetes Association recommends that everyone with diabetes have an annual comprehensive foot exam that includes an assessment of the skin on the feet, the shape of the feet and toes, the appearance of the muscles of the feet, and the pulses found on the feet. The exam should also include testing for loss of sensation on the feet using what is called a monofilament (a light, thin strand of nylon mounted on a handle), as well as one other method of testing (of which there are several options). Your doctor may wish to schedule a separate appointment for this exam or a longer appointment than usual, or he may refer you to a specialist for it.

When scheduling your lab tests, leave enough free time in your schedule before and after so no conflicts arise. Many people feel that if they miss a lab test, there’s no point in keeping an appointment with their health-care provider. This can begin a vicious cycle of missed appointments. If you miss a lab test, therefore, do your best to reschedule it quickly, and keep your appointment with your health-care provider, even if you won’t get to the lab first. Ask your health-care provider if you can check in by phone or e-mail to discuss your lab results when they’re ready.

Get the most from your minutes
Realistically, we all know that doctor appointments can feel rushed. Those 10–15 minutes seem to fly by, and you can feel as if you’re leaving with as many questions as you came with. With a few minutes of careful planning before your appointment, however, and an optimistic, confident attitude, each visit can leave you feeling better informed, which will strengthen your resolve to do your best at diabetes self-management.

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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

 

 

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