talking to your doctor

Diabetes Conversation Maps

David Mendosa Health Guide October 14, 2007
  • When we discuss with others what we’re learning, we retain that new knowledge much better than when we just passively engage with the new information. Now, a diabetes organization is partnering with company that is determined to show health care professionals how to actively communicate with those of us who have diabetes.

    The American Diabetes Association has already rolled out a program in which a Chicago-based company called Healthy Interactions Inc. will train more than 10,000 health care professionals during the next three years. These health care people are learning how to talk with us – not to us.

     

    The people from Healthy Interactions invited me to take part last week in a small-group training session held at a fancy Denver hotel complete with a delicious – and low glycemic – dinner. Most of the others learning the training seemed to be Certified Diabetes Educators.

    The new approach is based on sound theory. We retain only 10 percent of what we read, 20 percent of what we hear, 30 percent of graphics, and about half when we can both see and hear it. But when we discuss it with others our retention rates shoot up to 70 percent. I saw these numbers on a slide they showed us in the training and that I photographed. They sound right to me.

    These numbers are why the word “conversation” is key to the new training. The other word is “maps,” and it was harder to get my head around it – until I saw them and brought home a set for further study.

    The main tools of the training are a set of five large (3 foot by 5 foot) graphics presented in a form similar to a child’s board game. The health care professionals can use them to guide the discussions among small groups of people with diabetes. Thus they call the training Diabetes Conversation Maps.

    I enjoyed and learned from the conversations, and clearly the other trainees at my table did too, even though all of us work with diabetes all the time. In an article last week I wrote about how part of the discussion centered on statements on cards and determining if the statements were either myths or facts.

    If diabetes were like other conditions where people can rely on their health care professionals to make decisions for them, these health care professionals wouldn’t have to learn how to foster discussion among us. They would just tell us what to do, as sadly many have done until now. But diabetes self-management is the cornerstone of our success in dealing with diabetes, and now the powers that be are beginning to recognize that they need to encourage us not only in words but also engage us.

    Still, I take strong exception with a big part of map #4, “Continuing Your Journey with Diabetes.” Even the flag over this part of the map, “The Natural Course of Diabetes,” set my teeth on edge. And the content jarred me even more:

    “In type 2 diabetes, there is a gradual loss of the beta cells that make insulin. Over time, there are not enough of these cells to meet the insulin needs of the body and to keep blood glucose in the target range.”


  • At the training session I asked one of the facilitators from Healthy Interactions whether she had any proof of that statement. Instead, she replied that the reason for including it is so that patients wouldn’t feel bad about having to start on insulin. While I can appreciate that, I don’t believe the statement is true.

    Worse, I think that when people with type 2 diabetes believe that it is true, it becomes a self-fulfilling prophesy. I recently wrote about exactly this issue here.

    After the training, the lead facilitator and I exchanged email messages. “In the Life with Diabetes book, where much of the map content comes from in addition to American Diabetes Association-appointed subject matter experts,” she wrote, “it states that, ‘Because pancreatic function declines over time, insulin is often needed to achieve blood glucose goals.’” She provided three links and added that, “The main goal of this map is to communicate that diabetes as a chronic diseases that progresses if not effectively managed.”


    I wrote right back to her that their goal is certainly appropriate. But it needs to be matched by one that gives a positive reason for people with diabetes to manage their disease by telling them that complications are not inevitable, if they control their diabetes.

    I don’t doubt, as one of the links she sent me says, that “In most cases the disease eventually progresses.” That’s because typically diabetes is not well controlled. I remember an ADA doctor telling me that the average A1C in this country is about 8.5 - 9. That is not control, and with levels like that I am sure that the disease will progress.

    I also don’t doubt that the beta cells in people with uncontrolled diabetes will eventually not be able to do what they need to do, either because there are fewer such cells or because they become too few to overcome insulin resistance. But there is no proof that this is the result among people with well controlled diabetes.

    “It is not inevitable that we will not be able to control our blood glucose levels,” I concluded. “Patients need that encouragement. If not, the negative message of this map unmatched by a positive one can become a self-fulling prophesy. That’s not anything that you or I want. Do you think that you will be able to revise map #4 accordingly?”

    I figured that it was my responsibility at least to try, not having any idea how the people at Healthy Interactions (who often just call it “Healthyi”) would take my advocacy journalism. Then, I was delighted to hear back from Peter Gorman, the president of the company.

    “You make some excellent points,” he emailed me, “and that’s exactly what the Conversation Maps are intended to do – generate rich, meaningful conversations where people with diabetes can learn from one another. Of course, this discussion is guided by a healthcare professional. I have yet to hear that the Conversation Maps lead to a negative and discouraging conversation. On the contrary, the conversations as a result of going through a session often leave people with diabetes with significantly more hope and understanding of how they can manage their disease.


  • “Our process for making revisions to content is to collect all feedback such as yours and present that to our team of subject matter experts for their review and perspective. If they agree with the feedback and any recommended change, we make the revision for the subsequent printing of the Conversation Maps and materials. I am happy to present your feedback to our team for consideration. However, this process (which just took place for the second printing) will not take place again until sometime in 2008.”


    Hey, no advocate for people with diabetes could ask for more at this point. After my conversations with the people at Healthy Interactions, I know that I will remember to follow up next year.