Keys to Being an Informed Patient
With a little diabetes know-how, you can better understand your care—and improve your health
When Mila Ferrer’s son was diagnosed with type 1 diabetes at age 3, she struggled to understand all the new health information. “I went to college. I have a marketing degree,” says Ferrer, now a diabetes advocate with the organization Beyond Type 1. “But whenever you read medical jargon—bolus, basal, insulin sensitivity—there’s a lot of stuff you don’t understand. You are required to do tasks you have never been trained [in].”
What health care providers refer to as “health literacy” is the ability to understand health information and services so you can make smart decisions about your treatment. This can include information about diagnoses, medication, and even insurance. Read on to learn tips for becoming a well-informed, proactive patient.
The Doctor Is In
During an office visit with a doctor, diabetes educator, or other member of your health care team, you’ll encounter a lot of new information—and quickly. Here’s how to make sure you understand it.
If you don’t understand something your doctor, nurse, or diabetes educator tells you, let them know. “You have the right to say ‘I don’t know this word; would you explain?’ or ‘Do you have any written information on that so I can take this home and read with my family?’ ” says Rima Rudd, MSPH, ScD, senior lecturer on health literacy, education, and policy in the Department of Health and Social Behavior at the Harvard T.H. Chan School of Public Health. If you think of a question between appointments, write it down and bring it next time.
Once you have an answer from a provider, make sure you understand it. Try teaching it back. In other words, listen to your provider, explain in your own words what he or she said, and ask “Is that right?” If your provider says yes, you’ll know you’re on track.
Understand Your Numbers
Diabetes is a condition with a lot of numbers to recall: carb counts, insulin-to-carb ratios, blood glucose readings, insulin doses, and more. Some measurements sound the same when they mean very different things. Take, for instance, a two-point difference in your blood glucose level versus a two-point difference in your A1C. If your fasting blood glucose is 100 mg/dl one day and 102 mg/dl the next, that’s a tiny difference. But if your A1C goes up 2 percentage points—from 7 percent to 9 percent, for example—that’s a big change.
“Numbers can tell us when action is needed,” Rudd says. Key numbers to know include your A1C, blood glucose, blood pressure, cholesterol, and weight. Ask your provider to give you a “traffic light” system to know when to take action on your numbers. The numbers in the green zone mean everything’s OK. Those in the yellow zone tell you to act now. And digits in the red zone signal danger. You can get more tips in a diabetes self-management class, which your care team can help you find.
Bring Someone With You
Consider bringing another adult to listen while you talk with the doctor, especially if your English isn’t strong. Your companion can chime in with questions, take notes while you focus on the doctor, or explain something in a way you’ll understand. He or she will act as your advocate, but you’re in the driver’s seat. If you want an interpreter, your doctor is legally required to provide one, in person or over the phone.
Learn the Lingo
Your provider might use a lot of complicated terms. If you don’t know what a word means, ask. Some of the most common terms people with diabetes might need to know include:
- A1C = an average of blood glucose levels over the past two to three months
- Hypercholesterolemia = high cholesterol
- Hyperglycemia = high blood glucose
- Hypertension = high blood pressure
- Hypoglycemia = low blood glucose
- Myocardial infarction = heart attack
Rx for Success
It’s crucial that you understand your prescription medications, from what a drug does to how to take it. Misunderstandings can be dangerous, so keep these tips in mind.
When prescribing a new medication, your doctor will talk to you about what it does and how to take it. (If not, ask!) If you still have questions, check your medication label and package insert—the paper that comes with your prescription and explains how to use the drug—both of which provide additional information.
You can also ask your pharmacist, some of whom are certified diabetes educators, which means they cangive you vital information about diabetes management.
Jane Fadesere, PharmD, MBA, MPH, a community pharmacist and director of the Minority Women Pharmacists Association, says your doctor and your pharmacist can answer the following questions, which are the most important to ask about any medication you take:
- How does this medication work?
- Should this medicine be taken with or without food?
- Does it matter what time of the day I take this medication?
- What side effects are most common?
- Can I drink alcohol with this medication?
Get Extra Help
Medication therapy management programs help people keep track of and manage possible interactions among their multiple medications. The programs are available through many pharmacies and are often covered by insurance or Medicare if you take medications for several medical conditions. Check with your insurance provider to see if you qualify.
With the amount of jargon health insurers use, you practically need a dictionary during open enrollment. Next time you sign up for health insurance, refresh your knowledge with this information.
Pick the Right Plan for You
Most employers offer more than one kind of health insurance plan. A health maintenance organization (HMO) is usually cheapest. It requires a primary care provider to refer you to a specialist—such as an endocrinologist—before it will pay for that care. It also usually does not cover out-of-network care except in some emergencies. An exclusive provider organization (EPO) only covers in-network providers, but you don’t need a referral for them. It can save you time and the co-pay you’d spend on that initial primary care visit. A preferred provider organization (PPO) is usually more expensive, but you don’t need a referral to see a specialist and it usually covers out-of-network care, though those providers might be more expensive than in-network providers. You can ask for a list of in-network providers to see if your current diabetes care team is on it.
Another consideration: whether the plan will cover your current medications and medical devices, such as an insulin pump or continuous glucose monitor (CGM). Before you choose a plan, ask for a list of covered drugs and devices—known as a formulary. Plans on your state health care exchange should also list this information.
Prepare to Pay
If you have a PPO, you must pay a co-pay, or a small portion of the cost of your office visit. The fee may differ depending on whether your doctor is in or out of your network; in-network co-pays are generally lower. If you have an HMO or EPO and see an out-of-network provider, you may have to pay the full cost of the appointment that day. Your insurance card lists your co-pay costs on it.
Understand the Paperwork
Two types of paperwork—which you can also get electronically—explain the bulk of what your insurance covers and what you’ll owe. An explanation of benefits (EOB) comes after you’ve seen a provider, but it’s not a bill. It is a summary of the care you received, how much of it is covered by your insurance, and how much you still owe your provider. Your insurance may cover all or part of your care, or it might not cover an item.
A bill tells you the amount you owe for the care you received and when that money is due. It comes from your doctor. Even if you paid a co-pay at your appointment, you might still owe more money. Look at a bill carefully. If it does not list each part of your cost—the charge for a specific procedure, for instance—ask for an itemized bill that lists all of your costs. Make sure you were not charged for anything you did not receive, such as medication.
If you can’t pay the full amount of a bill, ask to speak to your health provider’s billing department. You may be able to pay a lower total cost or small installments of your bill each month until it’s fully paid. Some hospitals and state and local programs offer assistance to low-income people who are unable topay their bills.
Can’t tell an EPO from an EOB? Head here for common insurance terms and their meanings.