Inspiration for this article developed from a recent dietetic training period at a French hospital. The opinions shared in this post are solely my own. The name of this hospital will remain anonymous, but I can attest in my opinion that the health standards in this hospital (including hygiene, meals, nutritional care, patient satisfaction) were average to exemplary.
Read other articles in this series on French hospitals here: French Hospital Chefs and Taste, a Battle with Dietitians, Chromodulated Chemotherapy to Treat Cancer and Ketogenic Diet to Treat Epilepsy.
Is the French Health System Unique?
Have you heard rumors about how the French healthcare system is one of the best in the world? Well I am here to tell you the truth. It is true. The French health system is a socialized program (and is currently operating on a large financial deficit) but what I really appreciate is the French system’s emphasis on preventive care.
The fine balance between preventive care and healthcare costs
This article is about my experience during week 2 of training in a French hospital. Take a read and answer the question at the end-is the French investment on preventive care worth the time and cost?
Four Patients With Four Different Stories
On Monday morning I met patient A, patient B, patient C and patient D. Four different patients who have Type II Diabetes. In a nutshell these were their profiles: a house-husband and former alcoholic now on disability, a middle-aged woman who is a housewife and is the main caregiver for her sick husband, a busy businessman who recently had two toes amputated for not taking care of his diabetes and an unemployed, physically active ‘control conscious’ husband who feels guilty and hides his disease from his family.
Three patients had uncontrolled diabetes and one patient had excellent blood sugars. All of them ‘stuck’ for a week in the hospital. (These patients were not ‘sick’ but volunteered/ signed up through their general practitioner to stay for five days in the hospital to learn how to take care of their diabetes). The overall objective at the end of the week was that the patients would go home with the keys on how to have better control of their blood sugars. All the patients reached success!
How did it happen? First before I answer, some facts:
What can happen if you have uncontrolled diabetes for long time periods or blood sugars that are regularly unstable?
You can have a stroke, heart attack, kidney failure, eye problems or amputations of toes, foot, lower legs, among other complications.
How do diabetics have better control of their blood sugar?
The main ways are by eating a balanced diet with only moderate amounts of carbohydrate (sugars and grains) and by taking the right doses of their personalized diabetic medicines (insulin and oral medicine such as metformin).
What was the general agenda for Type II Diabetic education week?
- The patient arrived Monday morning and got settled into their semi-private room. The nurse with the nurses’s aide did a thorough exam and interview with each patient. Patient was given their agenda for the week, along with instructions on the importance of regularly taking their blood sugar in the hospital. The dietitian came by to meet each patient and collect the three-day diet record (showing their regular eating habits) that the patient had completed at home.
- Patients had to take their blood sugar 6 times during the day (half hour before meals, half hour after). A nurse would take their blood sugar twice during the night. Each patient had to learn what was hyperglycemia and hypoglycemia (high and low blood sugar respectively) and what to do about it.
- From the results of the blood sugars, the endocrinologist would continuously change the type and dose of the patient’s medicines to find the right balance before the week ended. Those patients who were not on insulin and couldn’t control their blood sugars by oral medicines were put on insulin.
- Each patient’s diet was analyzed by the dietitian. The dietitian then worked closely with each patient to find a compromise with the patient’s lifestyle, budget and tastes to comply with a diabetic healthy balanced diet. The dietitian taught a class on healthy eating and organized all the patients to eat together in the hospital’s cafeteria. This opportunity to eat in real setting was also used as a learning experience for the patients.
- There were seminars on foot care by a podiatrist, accepting the disease by a psychotherapist, legal issues by the social worker. The patients also had time to have open discussions with the group about how they felt about their diabetes (constraints, frustration and long-term issues).
- After the initial interview, the medical staff met to discuss each patient’s case and formulate personalized objectives for each patient. After the week finished and before the patients left to return home, the staff met again to look at the progress of each patient. (This last staff meeting formed the basis for each patient’s long-term medical and dietary goals).
- There was an exit consultation by the doctor, nurse and dietitian. At the exit consultation, the patient accepted the goals set up by themself and the medical staff and a follow-up appointment scheduled for three months later.
Here were some of the highlights from the week:
- The former alcoholic, now house husband, had come into the education program with his diet very high in saturated fats and very poor control of his blood sugars. Adjustments to his medicines along with education about eating less saturated fats were his long-term goals.
- The single businessman (who was so busy working he didn’t take care of himself) decided to take some time to reflect on how to change his ‘workaholic’ lifestyle. His goal was to find a way to eat healthier and take better control of his blood sugars so his complications wouldn’t progress any further.
- The housewife who was a caregiver for her husband saw the doctor change her diabetic medicines from an oral form to insulin to help keep her blood sugars (which were very high in the afternoon) in better control. This patient was also encouraged to exercise (she did in only limited amounts) and to decrease the amount of her afternoon cookie snack (which brought her blood sugar up high every afternoon). She realized the importance of portion control and physical activity and felt motivated to make steps in the right direction.
- The unemployed husband and his supportive wife (who also sat in on many education sessions) learned to accept his disease more openly. He had a physically active lifestyle and healthy eating plan even before he came to participate in the education week. He was the only patient who had excellent blood sugars. He didn’t need much dietary education, his issues were more of a psychological support, which is also important for good health.
This week of education on Type II Diabetes was a real inspiration for patients and the staff involved. Could something or does something like this happen in your country? What are your thoughts?
These patients spent a week free of charge in a French hospital. They had a specialized doctor, intern, dietitian, nurse and nurse’s aides that spent time to educate them on living with their Type II Diabetes. It is a big investment by the social health system and the staff involved.
If this week helped one of these patients prevent a serious complication of diabetes, could we conclude that this investment is both cost and human effective?
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