Darren B. Taichman, MD, PhD
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From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University.
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners what risks and benefits of treatment they discuss with their patients with type 2 diabetes. What glycemic goals do they recommend, and why?
Do your learners adjust glycemic goals according to their patients' characteristics? Which characteristics do they consider, and what adjustments do they make?
The ACP recommends that clinicians aim to achieve a hemoglobin A1c level between 7% and 8% in most patients with type 2 diabetes. Some published guidelines discussed by the ACP recommend a lower target. Why does the ACP recommend less stringent glycemic goals? What do we know about the risks and benefits of tighter glycemic control?
Will this paper alter your learners' practices? Will it alter yours?
Ask your learners to define “social determinants of health.”
How many can they name?
Which social issues most commonly affect the care of your learners' patients? What services are available to help individual patients navigate these social issues? Which ones are beyond the reach of these services?
Where do the boundaries around what is within our sphere of responsibility as physicians end? At the hospital doors? Can we fix everything? Is there a point at which we are allowed to say, “Not my problem”?
Do your learners believe that the recommendations in this position paper will help address the negative effects of social determinants on health? Use the accompanying editorial to frame your discussion.
Ask your learners what food insecurity is.
Do your learners know whether their patients have to worry about getting enough to eat?
How might such insecurity affect a patient's health and the care of chronic conditions? How might it affect the care of a patient with diabetes, or a patient with heart failure?
Do your learners ask patients about this issue? Would it be insulting to ask? How could they ask in a sensitive way? What would your learners do if they learned that their patient had difficulty getting enough to eat? Invite a social worker to join your discussion. What options are available to help?
Ask a patient on your team's service whether he or she worries about getting enough to eat outside the hospital. If so, would he or she be comfortable talking about this with your entire team present? How do concerns about food influence the patient's health care?
Listen to an audio recording, read by Dr. Virginia Hood.
Ask your learners whether they share Dr. Quagliarello's disquietude.
Do your learners agree with the connection the essay seems to make between our actions at the bedside with patients and our interactions with strangers who appear to be homeless and/or beg for money?
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Taichman DB. Annals for Educators - 17 April 2018. Ann Intern Med. 2018;168:ED8. doi: 10.7326/AFED201804170
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Published: Ann Intern Med. 2018;168(8):ED8.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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