A graduate of the University of Utah, Michelle currently practices at Wasatch Internal Medicine in Salt Lake City, UT, as the clinic’s diabetes specialist. At Wasatch Internal Medicine, she sees patients both in the clinic and in their homes via a “house call” program she developed for homebound elders. Check out Michelle’s blog about her work as a nurse practitioner & diabetes specialist here!
When she isn’t helping us insulin-challenged-folks, she’s spending time with her family and friends, traveling, making really gorgeous jewelry and wheel thrown pottery, taking pictures, watching stand-up comedy, and co-chairing the Diabetes Mixer with MJ Tran. I met Michelle and her partner-in-crime, MJ when they invited me to be a guest speaker at their second DIABETES MIXER in Salt Lake City, UT.
GINGER: Why diabetes? What is it about people with diabetes that drives your passion for helping people?
MICHELLE: During my nurse practitioner program, I happened to be in wheel-throwing pottery class where I met an endocrinologist and nurse practitioner from a local diabetes specialty office. I mentioned that diabetes was one of the conditions I feared most (that and cancer), because at the time, I knew I didn’t know enough about diabetes to be effective. I was invited to do some rotations in the diabetes specialty clinic so that I could learn more. I jumped on the chance and loved it! I was fascinated and excited by how much you could help someone by being a good listener and tailoring health information to meet individual needs. I was also very interested in the technology, I wore every pump and continuous glucose monitoring system just to see what it was like, so I could be better informed when I discussed them with my patients. I extended my 4 week rotation and stayed 8 months!
GINGER: What are the top three things you believe people with diabetes need from their diabetes specialist?
First and foremost, you have to have a connection with your health care provider. Mutual respect and good communication are the building blocks to this connection. Does your diabetes specialist listen to you? Do they understand where you are coming from? Communication is a two-way street. If your health care provider doesn’t take the time to listen to you, how can they expect a patient to take the time to listen to them? Does your health care provider know anything about you outside of your diagnosis? In order to provide patient-centered care, health care providers should know more about you than your last A1C and if you are due for refills.
Second, your diabetes specialist needs to be able to provide sound advice that is clear, and tailored to you. There are many facets to managing diabetes: carbohydrate counting, exercise, stress reduction, medications, injections, glucometers, insulin pumps, CGMS, laboratories, eye exams, etc.
Can your diabetes specialist address all of them with you in a way that makes sense? With the advancements in knowledge and techology, it is important for health care providers to stay on trend with the latest and greatest in diabetes management. Is your provider familiar with the latest research and devices that might be relevant to you?
Third, health providers should be proactive about screening, diagnosing and managing conditions that co-exist with diabetes. For instance, individuals with type 1 diabetes may have other autoimmune conditions such as Hashimoto’s Thyroiditis or Celiac Disease, while those with type 2 diabetes may have high blood pressure and high cholesterol among others. Depression is also higher among individuals with chronic conditions, such as diabetes. Your diabetes specialist should be screening for associated conditions when it is pertinent to your medical history and treat accordingly.
GINGER: What are the top three things you believe most people with diabetes DON’T GET from their diabetes specialist?
MICHELLE: The top thing most people probably don’t get from their diabetes specialist is time. Some clinics are set-up to be “patient factories” where you get limited face-to-face time with your health care provider because there are so many patients to be seen that day. Diabetes specialists need to spend enough time with patients in order to fully undertand how patients are feeling and what might be going on with their body, so individualized health education and advice can be provided. Health care providers also need to have enough time to write letters of appeal to insurance companies for medication and device denials.
Second, diabetes specialists aren’t always aware of community resources and events that might be beneficial to individuals with diabetes. Resources might include websites, the diabetes online community, formal support groups and JDRF/ADA activities. Some areas might provide community events such as lectures, Diabetes Mixers, and meet-up groups (such as the Delinquent Pancreas
GINGER: What are some of the most challenging aspects of your work with PWDs?
Wearing blue for BLUE FRIDAYS!
MICHELLE: The biggest challenge is trying to figure out the best treatment options that fits within a patient’s insurance benefits, financial circumstances, and lifestyle.
GINGER: What are the most rewarding moments/parts of your work with PWDs?
MICHELLE: I always appreciate hugs! It’s always nice when a patient refers a family member or friend to see me; it shows that they trust and believe in me to care for those they love.
One of the most rewarding moments in my career has been watching attendees at the Diabetes Mixer engage and connect with one another. The Diabetes Mixer, an unusual idea that some had doubts about, was a huge success under the co-leadership of MJ Tran. MJ and I could not be more proud of how the events have turned out, and look forward to co-producing bigger and better Diabetes Mixers in the future.
GINGER: What advice would you give to a PWD looking for a good diabetes specialist? What should their standards be? What should and shouldn’t they overlook in how their Endo-NP cares for them?
MICHELLE: First, make sure they like taking care of individuals with diabetes, I know a number of endocrinologists/endocrinology specialists that would prefer to care for non-diabetes conditions (thyroid disease, osteoporosis, growth hormone, etc). Endocrinology specialist does not equal diabetes specialist. Second, make sure you and your provider have mutual respect for eachother and good communication; you need to be able to connect on some level. Sometimes, there are personalities that just don’t work well together. Third, make sure your provider has enough time for you and your needs. Check with the receptionist to see how long your appointment is, and decide if your needs can be addressed in that amount of time. Fourth, make sure your provider is knowledgeable enough to provide you individualized treatments and health information. No one fits a mold, especially when it comes to diabetes. Your health related plans and goals should be tailored to you.
GINGER: What is one thing you wish your patients would do for YOU so you could perform your role better?
MICHELLE: Bring in your glucometer (I like to download them and review the numbers), get your eye exams annually, and quit smoking.
THANK YOU, MICHELLE!