Patient Education: It Can Make All The Difference

I volunteered this week at the free clinic where I am a Spanish medical interpreter. I was reminded of a very important lesson: the need for patient education.

As I have mentioned previously, I am very interested in endocrinology and diabetes (both the research and clinical aspects). The Latino population in general is at a higher-than-average risk for diabetes, so a large proportion of the patients with whom I work have this disease.

A diabetic patient came in with high daily blood sugars as well as a high HbA1c (the test that monitors blood glucose over a 3-month period). The physician who patient saw was somewhat frustrated at the fact that his diabetes was uncontrolled, because the patient was on a high dose of NPH insulin.

So the doctor probed the patient. Did he ever skip doses of his meds (including the insulin)? Was he taking his insulin twice a day as prescribed, X units in the morning and Y units in the evening?

Turns out that the answer to the second question was "no." And not because the patient was trying to be noncompliant. He was taking all (X +Y) units of insulin once a day, because he had previously been on Lantus. He didn't understand that Lantus is a long-acting insulin, which means you can take it only once a day, while NPH is intermediate acting, which means you have to take it twice a day to appropriately control your sugar. (The reason he had been switched from Lantus to NPH was that the clinic pharmacy had run out of Lantus, an unfortunate occurrence which sometimes happens given that all the medications at this free clinic are donated.)

When the doctor explained this clearly, it was like a light bulb went off for the patient. He said he just didn't know, and thought that it was OK to keep taking the insulin the same way he had been taking it before. He agreed to make the change right away.

It is true that sometimes patients are just noncompliant, and that leads to uncontrolled conditions. But other times, they simply don't understand the (often very complicated) instructions they receive. Language and education barriers make this all the more difficult. And so it is the responsibility of the physician to make sure the patient does understand, so that he/she has the tools to control the disease, whatever it might be. A good lesson to remember as I make my way toward a career in medicine.