She does not have diabetes but wears an insulin pump and measures her blood sugar 7 times a day. Why?

The most basic is communication. If you want to be certified, you need to learn communication skills in half a year.

The core is empowerment. If you want to control sugar, 95% of the time depends on the patient.

In less than an hour of sharing, I have a general understanding of what a good nutritionist can do for diabetic patients, and why elderly patients only have the opportunity to see her two or three times a year.

Shannon Lin

Advanced Nutritionist (APD)

Senior Diabetes Educator (CDE)

University of Sydney PhD (Chinese Diabetes Education)

CEO of Australian Nutrition and Diabetes Professional Guidance

In Australia, Ms. Lin Shanshan is not as simple as a nutritionist. She is also the CEO of Australian nutrition and diabetes professional guidance, a title that is not available in China. At present, there are many domestic and foreign studies supporting the focus of diabetes education and management on dietary management and nutritional support, because this is one of the important reasons for the onset of diabetes and one of the important reasons for poor diabetes control. Dietitians have knowledge and skills in this management, but as an expert who has obtained a doctorate degree from the University of Sydney and a senior diabetes teacher qualification, she believes that managing patients well so that patients can do the right thing is not as simple as being qualified.

In Australia, if I want to be certified as a diabetes teacher, I have been studying communication skills and psychology for half a year. Because only those with diabetes knowledge qualifications can sign up, diabetes knowledge is not the focus of the assessment, but communication skills are the way to help diabetic patients. The most important skill, and this determines whether the patient can receive the message you want to express, how confident they are to go back and perform, and whether they will actually go back and perform. Effective communication is meaningful, otherwise it is useless.

Friendly greetings, smiles, and eye contact are essential, not because of such a rigid requirement, but because "I treat each patient as my own family" and can do it naturally. Make the patient comfortable and communicate with him in a language and speed that the patient can understand, so that communication is possible.

Ms. Lin Shanshan also tries to learn some dialects to communicate with patients, such as the word soy sauce, which means soy sauce to people from northern China and "soy sauce" to Cantonese people. Understanding the patient's eating habits is also very important to her, because the patient will definitely think, what's the use of you reasoning with me, you don't even know what I'm eating. Just like during the on-site communication session, a health teacher from a diabetes hospital asked her for advice, saying that many diabetic patients in the Tibetan plateau area mainly eat tsampa and yak meat with few vegetables, which is definitely not in line with a healthy diet. How can we help them improve? Local fresh vegetables are hard to come by. Ms. Lin Shanshan replied that the patients who came to her clinic included many Australian aborigines, who were very similar to Tibetans and rarely had fresh vegetables and fruits. How to do it? Little by little, she would recommend canned food, such as canned fruit, to improve their diet little by little. In addition, these indigenous people have relatively low health literacy. They may spend more time chatting about air, clothes, building relationships, and finally saying that they should eat less meat and add a little fruit, so that patients must remember this when they leave. enough.

Knowing what people with different eating habits will eat on a daily basis is an important homework for a nutritionist, so that the patient will think that the dietitian understands his diet, which is helpful for building trust and improving compliance, which are not tested in textbooks and exams. to experience.

Building trust is not to make patients inseparable from the nutritionist. Instead, Ms. Lin Shanshan makes her old patients come to her clinic only two or three times a year. One of the reasons is of course that she is too busy to see; the more important reason is What she wants to do is to strengthen a concept from the beginning. The most important thing in diabetes management is the patient's own management at home, which accounts for more than 95% of the time. Therefore, it is necessary to teach patients to manage themselves, rather than forming dependence on medical treatment.

Ms. Lin is very familiar with the diabetes management experience in mainland China. She said that we often mention the five carriages, so who will drive this carriage? We rarely mention it. In fact, the patient is the one who drives the carriage, so it is important for the patient to learn to take care of themselves.

In order to enable patients to have the ability to independently manage and take care of themselves, Ms. Lin Shanshan divides nutrition knowledge into three levels: primary, intermediate, and advanced, and gradually teaches them to new patients, and tells them the importance of learning knowledge to take care of themselves from the very beginning.

It’s not that the elderly patients can’t contact Mr. Lin outside of the two or three meetings a year. If they have questions, they can communicate with her through Ms. Lin’s social media. Ms. Lin also encourages the patients to do the same. She said that if they can simply and conveniently If you solve your problem, you don't have to spend time and money to see the outpatient clinic. Of course, complex problems still have to be solved in the outpatient clinic.

It is normal for a patient to have various negative emotions such as distress, loneliness, anxiety, etc. Sometimes Teacher Lin will tell the patient that she has had a similar experience, admitting that such emotions exist, and she will ask the patient how he hopes the doctor can help him, because Patients also have a lot of experience, and sometimes they actually have great ideas about solving their own problems.

Encouraging patients to learn and master knowledge requires skills. Diabetes educators are similar to psychotherapists. How to communicate and how to interact with patients is very important. "To be fair, turn it upside down." Whenever there is a new insulin pump, she will try it on, of course, the injection is normal saline; although the pregnant teacher Lin does not have diabetes, she has to prick her finger 7 times a day to understand the patient's feelings. In fact, she would be afraid herself, and at the beginning, she would ask others to help. She knew how difficult it was and how stressful it was when she had pierced it herself. "We still have a holiday for work, and patients have to prick their fingers, get injections and take medicine 365 days a year."

Patients are often disobedient because we have not found an entry point, and have not made him willing to listen and understand what we want to express. This is also the need for empathy that Taiwanese diabetes management experts have repeatedly emphasized.

When patients are willing to listen and communicate, with the help of some simple and easy-to-understand tools to explain what diabetes is, the development process of diabetes, as well as special glasses, fat models, blood vessel models, etc., patients can better understand the possible effects of the disease on the body be prepared for the impact.

Teacher Lin finally said: "Medicine is developing very fast, but we can't treat all diseases, but we can comfort. Diabetes treatment is to a large extent "treat people". We can't cure diabetes, but we can Take care of people."