in helping patients to be accountable. I had no idea how I would
achieve it, but I was convinced, and from that moment my paradigm
was transformed. I no longer believed that it was just a matter of
the patient following or choosing not to follow recommendations.
A couple years ago our practice started working on Patient Centered Medical Home (PCMH) Certification. A few months ago we
received NCQA recognition as a level 3 PCMH. During the process
of becoming PCMH certified, I realized that there were many, many
things the practice had to do, but almost none, if any, had anything
to do with patient responsibilities and their compliance. There
was nothing that I saw that addressed patient accountability and
responsibility directly, or even indirectly. It seemed as though this
part was avoided, and completely left up to the provider/practice
to figure out on their own. I decided at that moment that I was not
going to work so hard and diligently to get all of the other pieces of
PCMH in place and not include (create myself and add in on my
own) some type of patient accountability to be embedded in the
PCMH process/model.
After thinking long and hard, I decided that the one place I knew
for sure that I had solid ground to stand on was requiring our diabetic patients to bring a blood sugar log to their appointments. We all
know the excuses that patients make and the continuous avoidance
of bringing the logs to us. We know they don’t check their blood
sugar like they are supposed to, and we know that it is impossible to
control your blood sugar if you don’t know what your blood sugar
level is. The A1C has been a wonderful blessing, and a game-changer
for sure. But it isn’t enough by itself. We need more. So, I made a
policy for all diabetic patients in our practice, that they must bring
a written blood sugar log to their diabetic follow-up appointments.
I kept talking with each diabetic patient about the importance of
checking the finger stick blood sugar regularly in order to control
it, until the patient was in agreement with me that it was vital and
critical to controlling their diabetes. In order for me to help them,
I needed to see the log. Once we were in agreement, we moved forward. I told them all very clearly that if they don’t bring their log the
first time, that