Just Takes One

I had a patient today with diabetes and a nonhealing foot ulcer. He has already has a below the knee amputation on the left. He's probably going to need another one on the right, due to the ulcer.

My attending starting to talk to him on the importance of good diabetic control to avoid even further complications. The patient cut him off and said, "Doc, I mean no disrespect, but I don't want to hear it." He said that no one ever listens to him, people just sit and lecture him about his illness, and he doesn't want any more of it. The attending is a very, very caring man and really tried to talk to the patient on a more personal level. The patient just shut down.

Once the attending left, the patient told the med student and me his reason for being so angry. It seems he had a bad experience once with a nurse. She told him that he needed X units of insulin. He said that X units had cause him to have an episode of hypoglycemia - he got shaky and passed out. Hypoglycemic episodes can be scary as well as life threatening.

He told her what had happened the last time he took X units. He asked, "So, how many units do you think I should take now?" She looked at him and said, "X." No difference, no acknowledgement of his past symptoms, no regard for his fear of another bad event.

All it took was one bad encounter, and this patient has closed himself off from having an honest conversation about his diabetes. It's sad, but it happens all the time. I think we healthcare providers forget that just one encounter with us can make a lifelong impression -- for bad and for good. We need to listen to our patients, let them know that we really hear what they are saying, and approach things as a team. The only way to be effective providers in patients with chronic diseases is if we're both on the same side.