Appropriate Decision Making in Diabetes Care

Dr. Fran Cogen Health Pro
  • I love watching the Academy Awards each year. Interestingly enough, with the exception of the award for Best Supporting Actress, the Oscars are presented in the order a movie is developed: screenplay, script, through best director and ultimately "best in show." The glamour awards are presented near the show's conclusion; which suggests that to reach the final end product, the movie, all those technical supporting players are essential.


    This scenario can be applied to our diabetes team. The physicians see the children and teens last and give our sage advice. However, much information is filtered into our decision making with the assistance of those supporting team players. The loss of one link in the complex pathway of the diabetes visit wreaks havoc in the clinic and often patient care (not to mention interminable time in the waiting room). And, having recently experienced the absence of one of those links behind the scenes, my patients and I have a renewed appreciation for the work that is essential for comprehensive diabetes care.

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    It is important that our families and children understand the components necessary to provide appropriate decision making in diabetes care. The employees at registration who do the scheduling and return appointments are the backbone of our practice and ensure that our patients are seen in a timely fashion. In addition, the administration assistants help document most recent patient and referring physician addresses, as well as current insurance issues, which have a major impact in terms of labs, supplies, etc. Many of my patients have a very close relationship with our schedulers who manage to miraculously squeeze them into my appointment schedule.


    What comes next?


    1. Vital signs (blood pressure, pulse etc.), height (accurate) using a stadiometer, and weight measurements usually obtained by either a nurse or patient care technician.

    2. Laboratory support by a phlebotomist to draw blood for hb A1c and other labs (thyroid function tests, lipid panel, celiac antibody panel etc). We use a DCA analyzer for hb A1c measurements, which only requires a finger stick to obtain capillary blood (very popular with our children and teens).

    3. Diabetes team member (nurse or patient technician) to download meters, review insulin pump information, document insulin regimes, evaluate log books etc.

    4. Visit with the dietician (if you are lucky and the dietician is at the same site).

    5. Visit with the psychologist (if on site and as above).

    6. Visit with the physician or nurse practitioner to evaluate and weave all this information together to formulate a treatment plan.


    Much work goes into each patient and with the absence of any of these team players, we experience inefficiency and in many cases, anxiety.


    A prime example of the loss of a significant link in the process occurred when our expert phlebotomist and vital signs/weight/height taker was ill and unable to attend our clinic. I had a full schedule and the "show had to go on..." In addition, I had no nurse, patient care technician, or other auxiliary staff to assist. I functioned that day as the vital signs/height/weight measurer, phlebotomist (much to the chagrin of my patients who could not believe that I was capable of drawing blood), the patient care technician/nurse in which I downloaded all meters, reviewed all logs and lastly as the physician. It helped me truly appreciate the value of those people "behind the scenes."


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    The phlebotomists at Children's National Medical Center are much beloved (and revered) by our patients and families. Children with chronic illnesses deserve to have procedures performed by the most competent and compassionate professionals. If lab work cannot be obtained due to incompetence or indifference to pain, etc, the healthcare provider cannot evaluate the necessary information to make safe medical decisions.


    As the final link in the diabetes visit, I truly appreciate the fine work that our supporting team members provide. Without our players "behind the scenes," diabetes visits would become chaotic and inefficient, resulting in disgruntled family members and unsatisfactory care.


    The next time you visit your diabetes care team, look behind that curtain and thank the supporting actors (technicians). They really care about you.


Published On: April 07, 2009