Diabetes Management

For the systems based practice competency, the graduate must be able to appropriately use system resources and assist patients in accessing health care that is safe, effective, patient-centered, timely, efficient and equitable. For this competency, I had a goal of understanding and implementing care for at least one patient who was dealing with an aspect of a long term medical condition. I believe my current competency level is satisfactory. Some of the stories I would like to discuss involve my experiences in medical school with diabetes management. During part two, I had the opportunity to do my family medicine rotation at the Philip Heit Center for Healthy New Albany. I worked with several different physicians in clinic who saw patients of all ages for both follow up visits as well as for acute complaints. I also spent a half day with the in house pharmacist and another half day with the dietician. The pharmacist and dietician independently saw patients who were referred to them from the other physicians in the clinic.

This was a cool experience to see the continuation in management of the patients seen in clinic. There was a level of detail the pharmacist and dietician were able to approach with their patients that made each visit special. Several of the patients we saw together were following up for their diabetes management. We discussed several types of insulin and delivery methods, including common brands like Novolog, Levemir and Lantus. I had not previously realized there was such variation in the amount of medicine each brand dispensed. This added another layer to my consideration when thinking about starting or managing insulin therapy for a diabetic patient. I had never really considered this aspect before and the impact a small detail like medicine volume could make, especially in the case of a medication such as insulin that is administered several times daily.

During part 3 I did a hospital medicine rotation. A few of the attending physicians I worked with encouraged me to work through some modules online pertaining to hospital medicine. One of the topics discussed was managing diabetes. I remember being really excited to piece together the knowledge presented with what I had already previously learned, like with my experience in family medicine in New Albany. Later on in the rotation, one of the patients I saw was a female truck driver. We were consulted to help her set up a plan to manage her diabetes. She told me that she wanted to find a way to manage without insulin so she could keep her job. We were able to get her off sliding scale insulin and onto metformin. This experience helped solidify the important of my goal to the development of my career. I think success is defined as improving or learning in one area of utilizing resources and improving patient care. I hope to continue to pursue this goal for other aspects of patient care within medicine. I will track my progress with the help of my attending physicians during residency. I think there will be adequate opportunities to realize progress in this goal within my training.

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