How To Influence The Overwhelmed Patient With Diabetic Neuropathy

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Author(s): 
Kathleen Satterfield, DPM, FACFAOM, FAPWCA

The patient with diabetic neuropathy is truly overwhelmed.
He or she has gone through the discovery of the disease and perhaps a subsequent refusal to believe it. The patient may not have been following the diet or medication regimen, and now he or she is facing neuropathy and other complications. These patients are now facing decisions about shoes, medications and perhaps even surgical decisions. There may have been career changes, difficulty paying bills and even shifting relationships.
Diabetes is a life-changing disease and it can sometimes be a devastating, life-ending disease without the patient’s involvement in managing his or her diabetes.
As physicians, we want our patients to hear our voices among the many others that are vying for their ears and hearts. Unfortunately, our voices may be neither the loudest nor the strongest.
Long gone are the idyllic and unrealistic Saturday Evening Post days of the Norman Rockwell covers depicting grandfatherly physicians whose every word was respected and listened to without question. In years past, there was more respect for physicians, whose knowledge was held in more regard because of a wide difference in the amount of education between the doctor and the working class patient. In the past, patients did not have the easy access to modern media that gives patients a wide array of medical information today.
Current curricula offer standardized patient labs at most podiatric medical colleges. There is an examination suite in which the student physician interviews and examines patients, and is under observation by hidden video camera. The “patients” are actors who have been trained to mimic the signs and report the symptoms of particular illnesses. This is a powerful tool to help medical students learn to interview and examine their patients.
However, this exercise is not as effective in determining the skills of medical students at helping their patients to get and understand the message because these actors are not actual patients utilizing the information they receive there. Only time will tell.
Perhaps the most difficult thing of all is how one can influence the overwhelmed patient when the doctor is overwhelmed as well. There are endless treatments for neuropathy and that fact alone means that there is no perfect treatment for neuropathy. That is perhaps the definition of “overwhelmed.” In other words, if there were only one type of nail in the world, there would only be one type of hammer. In this case, we do not even know what our “nail” looks like. Neuropathy largely remains a mystery.

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