Part 1: Questions
“I never want to be on dialysis, and I don’t want to deal with this diabetes”.
That was the first thing my Tuesday afternoon patient said as she walked into the room for her initial visit with me. Her family doctor had just discovered that she had diabetes along with some kidney damage and had referred her to me for assessment and advice.
Scenarios like this unfold in the offices of diabetes specialists, family doctors, and other physicians every single day. But what was she really saying and where was this coming from?
I’ll discuss this through two lenses: that of a physician and that of a researcher.
First the physician. This person is scared, and she needs two things: information and reassurance specific to her unique situation. She told me about one relative who had severe diabetes and another who died while on dialysis. She was scared and overwhelmed by the diagnosis and the future. I knew that I could assess her and tell her what is available and what is known about the area. I couldn’t make everything go away, but I could outline a set of concrete options that she could do to help take control over her future and her new situation.
As a researcher, my job is to identify research questions that may not yet have an answer. Two obvious ones that she was asking could be rephrased as:
- Can you make this diabetes go away?
- Can I eliminate or at least minimize the chance that my kidneys will fail?
There are clearly many other questions that could have come out of our interaction, but I will focus on those for now.
The takeaway messages here are:
- People with diabetes need clear answers to their questions about themselves.
- Patients are always asking potential research questions. The job of a researcher is to hear the questions hidden in conversations with a patient and make note of them.
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About the author
Hertzel Gerstein
Hertzel is an endocrinologist and professor at McMaster University who is in high demand as a speaker, advocate, and educator on diabetes-related topics. His research focuses on using large, international randomized trials to identify and test new ways of preventing type 2 diabetes, reducing serious health outcomes like strokes and death, and achieving type 2 diabetes remissions.
