 Provided by Clinician 1
I will be the FIRST person to say, I’m not a “rah-rah” type of person. I was the proverbial “bando,” chorus-singer-type, honor-roll student in high school. The idea of my putting on cheerleader garb, standing in front of a crowd, and yelling for a team...cheerleading looked too physically exhausting, and I was never the physical “prototype” to fit into that mold. Suffice it to say, I was the antithesis of THAT picture in high school. Which has NOT changed one iota in the last 20-plus years...thank goodness.
However, I am, as I suspect most of us are, pretty used to the PERSONAL coach/cheerleader role as clinicians...only, on a more personal level. We just do this on a one-on-one basis during patient visits. We coach them on their diet, exercise, medications, other lifestyle modifications, counseling sessions, etc.
But...let’s face it. When we do what we do, day after day, it can get discouraging, especially when some patients just NEVER seem to change...or their A1C or LDL values NEVER seem to drop. Especially when we review numbers, whether for an insurance audit, or a medical home review, or, as some of us have, for our own patient outcome-based bonuses. (Fortunately, I have not had that last one come to pass, but I know others who have.)
As I have reviewed our medical home data for the past six months, I have been encouraged that we have gotten reticent patients in for visits and labs. Certain parameters have improved quite nicely. Of course, now that we HAVE most of our formerly “non-adherent” patients in, we now realize that these were the ones with the most outrageous A1Cs and lipids as well. It has been a bit discouraging to see THOSE statistics drop as a collective whole...even while knowing why...and acknowledging that it’s truly a good thing that these patients are back again in the “fold.”
So this week, despite the above disappointment, I had the opportunity to realize why being a “cheerleader” is often a good thing...why our motivation to people CAN work at times...and despite the occasional day-to-day struggles, why my proverbial beating-my-head-against-the-wall really CAN make a difference at times.
Patient number one: A genuinely wonderful young man, whose BMI was > 55, with co-morbidities of DM, HTN, hyperlipidemia, sleep apnea, etc. I counseled him about his risks of dying last year, because I could see that he was headed in that direction.
I really don’t think it was anything that I said...truly I don’t. I think he had finally reached the final point of frustration...of NOT being able to function or do anything. After years of not really caring what happened to himself, he decided to undergo a Roux-en-Y procedure last November. Since then, he has lost 125 lbs. His weight today was 285 lbs...I’ve taken him off both DM meds, cut down one HTN med, and his last A1C was 5.8. While he has a way to go, he looks and feels wonderful. He has had no complications from his surgery, and his eating and exercise habits are perfect. “I have a new lease on life,” he said on his way out today.
Patient number two: A woman in her early 50’s with “pre-diabetes,” HTN, and hyperlipidemia for the past several years. She had last come in 14 months ago for a “sick visit,” and got a lab slip for a routine follow-up exam. She used that old slip to get labs 2 weeks ago...and in the ensuing 14 months, now was “officially” diabetic with an A1C of 6.6.
Every other visit over the past few years, she would PROMISE to lose weight, exercise, watch her diet, yah dah, yah dah, yah dah. Same story...but this time, there was a different outcome. THIS time, she had the “scarlet letter D” on her forehead. Yes, I told her...this IS DIABETES. I thought she would cry for a moment...and I felt badly giving her this news.
“No...I needed to hear this. I have put it off long enough,” she said.
Out came the “cheerleader” in me. “You are NOT alone in this...and I will be your biggest support,” I told her. We discussed diabetes, the classes I would enroll her in, the testing. I gave her a free meter (thank you drug reps), outlined our plans for the next few weeks, and talked to her about checking her glucose.
When we were finished, she started to smile. “I’m really OK with this. Thank you.”
We set up our follow-up appointment; I gave her another lab slip.
Then, once alone, I crashed into my desk chair. Because cheerleaders get tired, too.
Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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