This month, we feature Allen Bennett King, MD, CDE, FACP, FACE, assistant clinical professor at the University of California Natividad Medical Center. Dr. King is the cofounder and medical director of the Diabetes Care Center in Salinas, California.
I don’t believe there are many MDs who arealso CDEs—like yourself. Why did you takethe time to obtain the CDE credential?
I jokingly say, “I receive no respect from CDEswhen lecturing CDEs if I don’t myself havea CDE.” Really, I feel that education is thecornerstone of diabetes care. As a physicianspecializing in diabetes, I should respectits importance by taking the time for thecertifying examination.
What is the most important thing you havelearned from your patients with diabetes?
In medical school, doctors are taught twothings about patient relationships: controland disassociation. We are taught that we areresponsible for any bad outcome. This is taughtby the interns to the students, the residents tothe interns and the attending physicians to theresidents.
Diabetes care is different. Ninety-five percentof all care is done by the patient and not bythe physician-educator. This care is basedon the patient’s self-awareness (such aschecking blood glucose), education and self-empowerment.Self-empowerment is thecornerstone of this triangle and can only bedone by the patient with the support of thehealthcare team. We don’t control patients; infact, we can’t even control ourselves most ofthe time.
In the first few days of medical school, wedissect a human body, which we call a“cadaver.” To survive this traumatic step, welearn to disassociate from the patients and totreat them in a dispassionate manner so thatwe can be “rational” in our approach.
What patients have taught me is that they cancontrol their own diabetes if given the righttools and emotional support. They have taughtme to recognize depression and denial and tonip it in the bud. Also, a patient can be botha friend and a patient. They taught me thedifference between empathy and sympathy.Empathy can occur without losing yourclinical, logical approach. While I have stressedcompliance and adherence, adherence is whatthe patients indicate is the best approach.
What does it take to be a good diabeteseducator?
We assume that the educator is educated andis a CDE. Beyond that, the educator must listento the patient. Listening to what the patientsays but also what they don’t say. It’s key tolisten to how they say it, noting expression andbody language.
Have empathy with patients to realize whatgreat changes they may have to make intheir lifestyle to accommodate their diseasemanagement. Realize that one treatmentprotocol is not for all patients. Some patientsmay make all the changes necessary with oneeducation session. Some may require many.Some may not change at all. With the latter,you may not change them to meet your owngoals for them, but at least you can be theirfriend and hope that over time they maychange.
How is the Diabetes Care Center in Salinasstaffed, and what is its focus?
Dana Armstrong, RD, CDE, and I foundedthe Diabetes Care Center in 1998 in orderto provide outpatient treatment, educationand research for patients in our area andthroughout the nation. Our focus, first andforemost, is compassionate and practicalpatient care, utilizing the latest diagnostic andtreatment programs by our staff of physiciansand mid-level providers. Our research toucheson new and practical applications of glucose-sensingtechnologies, simplified insulin dosingguides for patients on rapid-acting insulin, newuses of medications for the treatment of type 2diabetes, an outreach program for primary carephysicians’ offices to improve their delivery ofdiabetes care, and testing of new devices.
Could you give your two cents on theproblems with reimbursement for educationservices?
It continues to be the same problem ofinsurance carriers giving lip service topreventive care but paying little or nothing foreducation. When a serious health event occurs,which quite possibly could have been avoided,they step up to the pay window and reimburseall providers according to their contracts. Thisis very disheartening.
Insurance companies pay for coronary arterybypass graphs costing thousands of dollars,but these same insurance companies paylittle for the outpatient treatment of diabetesto prevent the coronary disease in the firstplace, and they pay even less for education. If Icould change things, I would encourage manymore nurses, pharmacists and dietitians tobecome CDEs by recruitment campaigns andsubsidized educational programs paid for bypharmaceutical and insurance companies.
What is your impression of diabetes caretoday?
Diabetes care today is horrible. Primary carephysicians who do not have the time, focus,staff or systems for care deliver 90 percent ofall care. This is why we push for enlarging thepool of CDEs in our nation.
Some of Dr. King’s publications that help otherproviders give quality care to diabetes patients
Diabetes Care Center Treatment Guide for Diabetes
King A, Armstrong D, Healy S.
Pocket-sized booklet containing diabetes treatment algorithms. Also has information onhypertension, dyslipidemia, CAD, retinopathy, nephropathy and foot care. Available fromthe Diabetes Care Center at (831) 769-9355; or send e-mail to firstname.lastname@example.org.
The Dosing Card for Rapid-Acting Insulin
Laminated folding card giving carb amounts for patient use. Available from the DiabetesCare Center at (831) 769-9355; or send e-mail to email@example.com.
New Drug Treatments for Diabetes
Armstrong D, King AB.
Lincolnwood, IL: Publications International, Ltd. 2001. Available from Amazon.com.
The Diabetic Bible
Armstrong D, King AB.
Lincolnwood, IL: Publications International, Ltd. 2004. Available from Amazon.com.