When I reflect on my position as a registered dietician and certified diabetes educator (CDE) for the Pediatric Diabetes Program at Visiting Nurse Service of New York (VNSNY), I think it helps tremendously that I consider myself a kid at heart. I still love video games, comic books, sports-and occasionally, I still watch cartoons. This gives me something in common with my pediatric patients and helps me chip away at the notion that I am just another adult healthcare professional coming into their lives.
Take J. M., for example: a 16-year-old with Type 1 diabetes. For 3 years, J. M. had been using an insulin pump and, based on his excellent glycemic control, he was considered an ideal patient. I had been seeing J. M. once per month, and everything had been going well. Then, one day, I noticed a significant decline. J. M. had stopped checking his blood-glucose levels, and his values had become more erratic. It seemed as if he had grown tired of managing his diabetes. In J. M.'s case, this behavior was highly unusual. When I brought these issues to J. M's attention, I found out what was behind the sudden change.
J. M. had joined a traveling baseball team in his community in northern Manhattan, and he felt like the insulin pump was getting in the way of his game. J. M. told me that he had felt this way for a while, but he had not dared to mention his concerns to his mother or his endocrinologist. He was afraid of what their reactions might be.
Through role-playing, I helped J. M. find the words to share his concerns with his doctor. I also helped him negotiate with his mother to ask for the support that he felt he needed. Everything worked out pretty well. Just as we had practiced in our role-play, J. M. voiced his concerns to his endocrinologist. The outcome was that J. M. transitioned to using insulin pen therapy. He felt that taking insulin in this manner interfered less with his baseball playing. In about a month, he was back to his old self: showing consistent management of diabetes.
Working with J. M. taught me that young people with diabetes sometimes need to find their voices and speak up about their care. When they feel heard, they become more invested in the treatment process. I also think it is important to recognize that the patient is the leader of their care team. As clinicians, we may feel one particular treatment is "gold standard," but the person receiving the treatment is the best judge of what will work for him or her. Coaxing J. M. to continue with an insulin pump would not have been in his best interest. Listening to J. M. and recognizing his right to lead his care led to a treatment plan he was happy with and that resulted in excellent outcomes.
I want to credit my colleagues for the excellent partnership we have forged with the Mount Sinai Pediatric Endocrinology Team-a tribute to our teamwork! Working together, we keep patients like J. M. from viewing us as just another group of adult healthcare professionals. By staying mindful of what it's like to be a kid at heart, we build the trust of our young patients.