Anne looked timidly around the room. “You want me to see a what?” she asked. The young intern (or was it a resident – she wasn’t sure) smiled at her.
“Mrs. Smith,” he said, “I would like you to talk to your family doctor about seeing a certified diabetes educator. Your hemoglobin A1C is over 11 per cent. We started you on medication here in the hospital, but you may need insulin. You’re going to need a lot of information.”
Anne felt confused and scared. Two weeks ago, she thought she was healthy. Now, her life was totally different. Maybe she smoked a little too much and yes, she could stand to lose a few pounds, but this? Two weeks ago, shortly after her 57th birthday, she had gone into the hospital with chest pains. She had hoped it was heartburn, but it turned out to be a heart attack. Next, she learned she has diabetes. Anne had seen countless doctors, nurses, and interns... you name it. Now she didn’t know what this young doctor was saying.
“I’ll call and make an appointment,” said Anne.
A week later, Anne walked into my office. I hadn’t seen her in a few years. She hadn’t had a blood test in a very long time.
“It’s good to see you, Anne,” I smiled. “You’ve been through a lot over the past month. I got the report from the hospital.”
“You don’t know the half of it,” she sighed. “I used to feel healthy. Now I’m on so many drugs... I don’t know what half of them do! I have diabetes, I guess. I know that means my blood sugar is too high, but how does that happen all of a sudden? My husband’s health isn’t great and the kids are worried sick. Now I’m supposed to test my blood and watch what I eat. I’m having trouble sorting everything out!”
I looked at Anne closely. I could hear her concern. As a family doctor, it’s my job to help patients with this kind of thing.
I said, “There’s a lot here to talk about, Anne. We need to take things one step at a time. I would like you to see a few different members of my team.”
“Team?” asked a puzzled Anne.
“Yes, a health-care team. It may seem odd to you, but you’ve already seen some teams in action. The group who took care of you in the hospital was a team of doctors, nurses, dietitians, clerks, students, and so on. Family doctors work with specialists to form a team. Here, in the office, I work with a team of professionals, each one expert in a different area. Our team includes a pharmacist, a dietitian, a respiratory educator, a diabetes educator, a behavioural health consultant, nurses, medical office assistants and administrative support staff. Other teams might include social workers, occupational and physiotherapists, and other experts who aren’t doctors. All of us work together with you to manage your medical conditions.”
Anne looked hesitant. “Can’t I just talk to you about my diet and diabetes?”
“Yes, of course,” I answered. “Some family doctors prefer working that way, answering all of your questions to the best of their ability. However, I find my team hugely valuable. I can talk to you about your diet in a general way, but I can’t go over the details of what you’ve been eating and guide you in the same way that a dietitian can. I can also discuss diabetes, but our diabetes educator has so much experience and knowledge that I’m constantly learning from her. She can teach you how to check your blood glucose properly. Down the road, if you need to take insulin, she can show you how to inject it. Our pharmacist can review all of your medications with you. He can talk to you about all of the new drugs you’ve started on, and how they interact. He can make sure that you’re not taking any herbal medication or supplements that might affect your health or your medications.”
Anne looked shocked. “You mean my natural herbal supplements might affect my medications? But they’re natural.”
“Yes, they are natural, but that doesn’t always mean safe. Our pharmacist can discuss all of that with you. You’ve got what we call a chronic disease – a medical problem that is not going to go away. The team can work together to help you manage your condition and live a healthier, productive life.”
Anne smiled a little. “Who would you like me to see first?”
“Let’s start with your diabetes educator, pharmacist and dietitian. I’ll check you over today and order some blood tests. Come back after you’ve seen some of the others,” I responded.
“Where do I go for these appointments?” Anne asked.
“These people are located right here in our clinic. Sometimes patients go to other clinics to see different team members, but we’re pretty lucky.”
“Will I see you during these appointments? How will you know what’s going on?” she asked.
“I may be able to stop in at the end of the visit. If not, don’t worry. I discuss every patient with every team member. They also write notes in your chart so that I know what’s happening.”
Anne agreed to the appointments and met with each team member. A few weeks later she came back to see me. She was delighted with the care she had received. She was checking her blood glucose regularly and eating better. Her medications made more sense to her. She even had set some health goals with our pharmacist. Eventually, Anne saw our respiratory educator who checked her lungs for damage from smoking. Our behavioural consultant also helped her when she decided to quit.
Health-care teams work. They can help patients with or without chronic diseases. While not all teams are exactly alike, they do share the same basic principle: a group of professionals, each with an area of expertise, that works with patients to help them take control of their health and their lives.