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Kidney Disease, Diabetes and Patient Empowerment
“Patient” is not a third-person word.
Effective diabetes management does not come from the exam room, but rather from the living room, gym, dining room and grocery store of every individual with diabetes.
Diabetes, more than any other disease, has patient empowerment as one of the cornerstones of its treatment. In a survey of diabetes educators, 98 percent selected patient empowerment as the most helpful from a list of 12 patient-care approaches.
What is patient empowerment? Why is it so central to diabetes? What can the rest of medicine—and nephrology in particular—learn from this?
Patient empowerment is both a process and the outcome of that process. It is a way to train patients to think critically about their disease so they can make informed decisions. These decisions may differ from the ones a doctor would make. The decisions may not be what are clinically best for a patient’s disease, but empowerment means patients have the autonomy to make decisions based on factors that incorporate more than idealized clinical outcomes.
The patient-empowerment philosophy fundamentally changes the physician’s role from one of attempting to steer the disease’s clinical course to one of training patients to increase their capacity to think critically and make autonomous, informed decisions. Empowerment is not something one does to patients. Rather, empowerment begins when physicians acknowledge that patients are in control of their care.
The traditional route of physician-directed care is often an exercise in frustration for both physician and patient. Comprehensive diabetes management requires hour-by-hour attention from the patient, including diet decisions, medication administration, foot inspections, blood-sugar assessments and regular exercise. Regardless of the wishes and philosophy of any provider, the reality is that patients must contribute to their own care. Outside of a nursing home, they cannot surrender that to a doctor, nurse or other provider.
Once physicians recognize that self-care is the only way forward, equipping patients with the skills to make good decisions becomes their number-one job.
Comparing diabetes management to chronic kidney disease (CKD) care, the parallels become clear. In both, dietary restriction and modification are a central tenet of health. In diabetes, carbohydrate intake is regulated and recorded. In CKD, diet is modulated based on the needs of the individual patient. Some patients need potassium restriction, others phosphorous control and others tight sodium restriction. Patients with diabetes often need to check, record and interpret blood sugars multiple times a day. In CKD, patients need to check, record and interpret blood pressure at least once daily. A motivated CKD patient records the blood-pressure readings for the doctor to interpret. An empowered CKD patient understands variations in blood pressure and knows when to skip a dose and which blood-pressure medication is alright to stop in cases of low blood pressure or intercurrent illness. The medications we use in CKD are potent, and in the wrong clinical situation can quickly turn from beneficial to harmful. An empowered patient understands this and knows how to interact with the prescribed medications to prevent harm and stay on the beneficial side of the drugs.
Chronic kidney disease management is advancing and would do well to follow the empowered-patient path that the diabetes community has blazed.
Note: The content within this article has been republished.