One of the biggest tools that we have
within the physician practice,
is the construct of shared decision making.
Because what that does is share power
between a team of clinicians and patients.
One of the things that I have learned
is that patients vote with their feet.
Sometimes people may disagree with the plan,
but don’t have the social power to verbalize that.
And so what they’ll do is say, ‘Yes, doctor,’
and then they’ll go home and not do it.
And what we see is, ‘Oh my gosh, they’re so nonadherent.
They didn’t come back for their visit.
They are taking their medications.
They must not care about their health.’
I’ve never met anyone who wants any of the diseases
that they have, any of the complications.
And so it’s up to me
to invest in knowing what you’re likely to do
so that the treatments reflect your preferences.
Because really, at the end of the day, informed,
activated, engaged patients follow the plan of care
that makes them healthier.
For your diabetes to be successfully managed,
lifestyle modification is the foundation.
You can throw lot of drugs at individuals,
but if they do not focus on the lifestyle modifications,
you will just be kind of chasing your tail, as it were.
It doesn’t take a long time
for me to say,
‘What do you usually eat for breakfast, lunch, and dinner?’
I don’t critique it at all.
I try to look for where’s the gap?
If I didn’t hear a single vegetable,
then my follow-on question is,
‘Do you have any vegetables that you like?’
You want to just find something they’re willing to eat
and then sort of
imagine with them how to incorporate it into their diet.
The other question is, ‘Who prepares your meals at home?’
Because I’m going to fail if I send it to the dietician
and she gives you this wonderful list of things to eat
and you say, ‘Thank you very much.’
And then you go home
and your mother prepares you a wonderful meal
that’s not modifying their diet.
That’s a problem.
We can also teach people where to shop.
A lot of farmers’
markets have leftovers at the end of the farmers’ market
that they make accessible.
Sometimes what we ask people to do
to keep up the treatment plan is impossible for them to do.
It’s impossible because of
the way that they live or the way that they work.
We do a lot of work explaining to people why so many
bad products are available for low-income communities.
Why the starch and the sugars
in everything that’s affordable to buy?
Talking to people beyond changing behavior,
right? But kind of bringing people together
to understand why we end up learning those behaviors
and keep repeating them.
When it comes to exercise
we like to see moderate
to vigorous physical activity, 30 minutes most days.
And the reason for that is that
one bout of exercise on one day
has an effect to improve glucose over a 24-hour period.
When I talk to my patients,
I tell them, ‘Don’t join a gym, unless you really want to.’
You need to do this physical activity,
but you also have to incorporate joy into your life.
And so I want you to find a way that does both
at the same time.
“So tell me the kinds of things that you do
when you like to engage in physical activity.”
“So I like walking,
I like hiking,
I like tap dancing.”
“It’s a lot of fun. A lot of fun.” “Yes.”
We have this
three message that we try to do all the time,
how can we eat better,
how can we move more, and how can we enjoy life together?
Enjoying life together is this idea of connection
that is important, for example,
to diminish stress and anxiety.
Communities that we serve sometimes feel very isolated,
so those groups helps people also to connect,
and to learn with each other.
We teach them something new that they didn’t know,
but we ask them to teach each other,
because creating that network is important.