I had the pleasure of meeting with several of my co-bloggers: Ann Bartlett and Beth McNamara, along with Alli Bush (our MyDiabetesCentral.com editor) at a holiday brunch last week. Naturally, we were delighted to compare notes and between the four of us were able to come up with many ideas for future topics. I jokingly described my role in diabetes management with teenagers and we agreed that I should address this in my blogs.
The unique characteristic in diabetes management is that the actual person (with, of course, the exception of small children) is responsible for his or her own management in terms of self-care skills. Caring for persons with diabetes, therefore, is really about providing scientifically evidenced-based information, choices, and expert guidance based on the individual needs of the patient and family. In truth, however, the success of the individual will be a combination of his own self-care skills and the support of his team.
I have been always interested in team sports. My adult son is a sports fanatic and every conversation is often couched in sports terminology. Thus, I learned terminology by proximity and clearly became enamored of team sports, particularly baseball. Indeed, my first chair of pediatrics (a former defensive football player at The Ohio State University then coached by Woody Hayes) gave us fledgling pediatricians positions after we demonstrated our particular styles of practicing medicine. I was the third baseman (and proud of it) because according to my chair, I rarely "let things pass into the outfield." (Translation: I worked hard to avoid missing the initial diagnosis.) The team approach was developed as I became an experienced physician.
Working with teens is a tough challenge because:
1. They have better things to do then visit you at their quarterly visit.
2. They often have not performed the self-care skills tactfully suggested at their last visit.
3. They will invariably demonstrate the same family dynamics if the parent or caregiver is present in the room.
4. The teen may not wish to discuss what is really bothering them, such as peer relationships, drug use, sex, alcohol, or other topics.
5. The teen is not always prepared with the appropriate information if their caregiver was not proactive in bringing the four meters from home, the two meters from school, etc.
6. The teen may just be in a bad mood.
7. Or, the teen may want to inform you just how well they are doing, even though at the last visit they did not even make eye contact with you!
It is imperative for the caregiver to put diabetes care in a context that actually means something to the teen. For many of my patients, that means sports! Most belong to a team, depending on the season. I therefore try to discuss diabetes management in terms of a sports team and positions. For starters, I note that everyone involved with the teen is part of their team, with different roles and positions. I assume the role of the head coach. I suggest different plays, recommend extra practice, etc. However, though I may be the head coach, I do not actually get to play the game. The teen or child is the captain of the team and decides just how and what they will do to win (or lose the game). The biggest difference is that this is not just one game, but an entire lifetime match. The Diabetes team and family members assume roles as the very necessary coaches (perhaps Bench, Batting, Pitching, Offensive/Defensive Coordinator). These coaches play the up front and personal roles necessary in the day-to-day practices and in the big games. However, the key to success is the Captain's choice in play. The coaches may call the shots, but the Captain actually puts them into play. He or she is the player that either hits a homerun or strikes out; scores a touchdown or goal. When they do win the game, the Coaches and teammates wildly cheer.
However, the game is ongoing; the season is never over. There will always be one more game to play with incredible practice required, changes in play calling, etc. The goal of the family and diabetes team is to infuse new energy and incentives to avoid diabetes burnout especially in a teen with long-standing diabetes. Sometimes we are successful and our teen matriculates into a young adult with the knowledge and confidence to maintain self-care skills, and sometimes not. The key, in my opinion, however, is to have that team and coaching network behind you.
GO NATS! (Even if they were last in the major leagues, there is always hope!)
Published On: January 05, 2010