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

The most basic thing is communication. If you want to be certified, you have to learn communication skills for half a year.

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

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

Shannon

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. This title does not exist in China. At present, there are many researches at home and abroad that support the focus of diabetes education and management on diet 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 control of diabetes. Nutritionists have advantages in knowledge and skills in this kind of management, but as an expert who has obtained a doctorate from the University of Sydney and a senior diabetes teacher qualification, she believes that managing patients well and enabling them to do the right thing is not as simple as being qualified.

In Australia, if you want to be certified as a diabetes teacher, you have to study communication skills and psychology for half a year. Only people with diabetes knowledge qualifications can sign up. Therefore, diabetes knowledge is not the focus of the assessment, but communication skills are the way to start helping diabetics. The most important skill, and this determines whether the patient can receive the information you want to express, how much confidence they have to go back to execute, and whether they will really go back to execute. Effective communication is meaningful, otherwise it is useless.

Friendly greetings, smiles, and eye contact are essential, not because there is such a rigid requirement, but because "I treat every patient as my own family", so it can be done naturally. Only by making the patient comfortable and communicating with him in a language and speed that the patient can understand will it be possible to communicate.

Teacher Lin Shanshan also tried to learn some dialects to communicate with patients. For example, the word soy sauce is called soy sauce to people from northern China, and "soy sauce" to Cantonese. In her opinion, it is also very important to understand the patient's eating habits, because the patient must think, what's the use of reasoning with me, you don't know what I eat. Just like in 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 here mainly eat tsampa and yak meat, and there are few vegetables. This is definitely not in line with a healthy diet. How to help them improve their standards? Fresh local vegetables are hard to come by. Teacher Lin Shanshan replied that there are many Australian aborigines who come to her clinic. They are very similar to Tibetans and rarely have fresh vegetables and fruits. How to do it? It can only be done little by little, and she will recommend canned food, such as canned fruit, to improve their diet structure little by little. Moreover, the health literacy of these aborigines is relatively low, and they may spend more time chatting about the weather, clothes, and building relationships. The last sentence is to eat less meat and add a little fruit. Remember this when you let the patient go. enough.

Knowing what people with different eating habits eat every day is a very important homework for nutritionists, so that patients will think that the nutritionist understands his diet, which is very helpful for building trust and improving compliance, and these are not tested in textbooks and exams to the experience.

Building trust is not to make patients unable to do without a nutritionist. On the contrary, Ms. Lin Shanshan will let 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 watch; the more important reason is , What she has to do is to strengthen a concept from the very 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, so it is necessary to teach patients to manage themselves instead of forming dependence on medical treatment.

Ms. Lin is very familiar with the diabetes management experience in mainland China. She said, we often mention five horse-drawn carriages, so who will drive the horse-drawn 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 himself.

In order to allow patients to have the ability to independently manage and take care of themselves, Ms. Lin Shanshan divided nutrition knowledge into three levels: elementary, intermediate, and advanced to gradually teach new patients, and told them the importance of learning knowledge to take care of themselves from the very beginning.

It’s not that the old patients can’t get in touch with Ms. Lin other than meeting two or three times a year. They can communicate with her through Ms. Lin’s social media if they have any questions. Ms. Lin also encourages patients to do the same. If you solve your problem, you don't need 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 patients to have various negative emotions such as distress, loneliness, anxiety, etc. Sometimes Ms. Lin will tell patients that she has had similar experiences and admit that such emotions exist. She will ask patients how they want the doctor to help him, because Patients also have a lot of experience, and sometimes they 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 interact with patients is very important. "If you want justice, make 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 still pricks her fingers 7 times a day to understand the feelings of patients. In fact, she would be afraid herself, and she would ask others to help in the beginning. She knows how difficult it is and how stressful it is after piercing it herself. "We have a holiday when we go to work, and patients have to prick their fingers, get injections and take medicine 365 days a year."

The patient's disobedience is often because we have not found an entry point, and we have not made him willing to listen and understand what we want to express. This is also what Taiwanese diabetes management experts have repeatedly emphasized to have empathy.

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 impact of the disease on the body. impact, be prepared for prevention.

Teacher Lin finally said: "Medical science is developing rapidly, but we can't treat all diseases, but we can comfort (comfort). Diabetes treatment is largely "curing people". We can't cure diabetes, but we can Take care of people."