February 01, 2022
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As providers, we have just as much responsibility to create meaningful patient time as we do to provide medicine or procedures.
I’d like to tell you that I had an epiphany. Or, that there’s a gift inside my type 2 diabetes diagnosis. That somehow, caring for my own disease is teaching me to be a better healthcare provider — perhaps more patient, more supportive, or better able to understand diabetes.
Instead, I’ve learned that I gave fantastic care. And I’m also reminded of so much of what is wrong with our healthcare system.
As a licensed certified professional midwife (CPM), I’ve learned a good deal about diabetes in pregnancy.
Gestational diabetes and type 2 diabetes share many characteristics, such as blood sugar regulation issues, the need for exercise, and the importance of monitoring. Once they deliver their baby, most people will return to a nondiabetic state, yet live with an increased chance of a type 2 diabetes diagnosis later in life.
Even babies born through pregnancies involving diabetes run a higher risk of type 1 and 2 diabetes. In short, while it “goes away,” it can leave a legacy. That’s some news to digest.
In my practice, appointments lasted an hour, and always involved rocking chairs and tea. In this way, mothers and I had the opportunity to discuss their feelings and challenges of pregnancy, such as gestational diabetes. We moved beyond counting sugars and sat with the overwhelming feeling of having to add a strict diet, daily monitoring, and 45-minute walks to a busy mother’s schedule.
The best outcomes have their feet in relationships, and relationships take time — to sit and talk, reflect, and inquire. What we know about health is that people do better when relationship is added to the treatment plan, which means we, as providers, have just as much responsibility to create meaningful patient time as we do to provide medication or procedures.
If that’s where the best outcomes lie, that is where we ethically must be.
With my type 2 diabetes diagnosis, no one has taken the time to talk with me. No one has asked how I feel about my diagnosis. No one has asked how my kitchen is changing, or if I’ve found snack foods that I can carry in my purse. No one has asked if I feel frightened that there’s a silent disease making me more susceptible to everything from arteriosclerosis to severe complications from COVID-19.
I long to be cared for, to be heard, to ask questions about what recovery might look like. I want to not only understand if my response is in line, but I want to understand how to do this better. I want someone to tell me I’m doing an OK job.
When my clients were diagnosed with gestational diabetes, I was ready with a glucometer, test strips, and lancets. We reviewed how to wash hands, how to calibrate a glucometer, and how to count carbs and protein. I had a daily diary ready for my clients and would send them home with everything they needed to begin that very day.
I, by contrast, have been given handouts. I have been referred to an education specialist, a dietitian, and have a referral for an endocrinologist — all of whom are weeks out. I was sent to the pharmacy for my glucometer and supplies, where I found out that my insurance would not pay. The glucometers were in boxes, hidden away from curious hands. The strips were locked behind the pharmacy counter.
I’m overwhelmed making so many changes at once, and I find myself occasionally feeling like I can’t get it right. There’s no one to remind me that diabetes is a lifestyle, which takes time — of course there will be obstacles.
My partner is trying to learn with me, and I am grateful for his support. But I know he eats donuts in the car. Sometimes I am resentful.
What I have learned is that I am on my own, and I don’t think it’s the best thing. So I’m moving beyond the healthcare system for help and support. I’ll return for my A1C and assorted screens, but I’m going to have to find my own community, whether it be Facebook or a walking partner.
I’ve learned — again — what it was that first drove me to midwifery. The medical model offers lifesaving technology and there’s a lot of good people. But the care model I find most effective involves more than referrals and handouts. So I’m making my own treatment plan, grateful that I think I’m seeing a way forward.
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