Charlotte physician uses motivational interviewing to help diabetic patients manage their care

Dr. Todd Otten and patient, Wayne Frey

Dr. Todd Otten attributes his success to helping patients control their blood sugar to a patient-centered approach and his passion for helping patients with diabetes, which dates back to his brother-in-law who has had struggles with the disease and his grandmother, who lost her vision due to diabetes complications.

The patient-centered approach respects a patient’s responsibility for his or her own health care. With input from the doctor and office staff, the patient has a support system that can lead to better outcomes.

“Yes, I am the doctor, but you’re the patient; this is a team effort,” Dr. Otten tells his patients. He says the patient has to take responsibility for his or her own health care.

“And that works because they’re super excited when their numbers are good,” says Dr. Otten, who practices in a hospital-based office in Charlotte.

Dr. Otten engages his patients with a technique he calls motivational interviewing, in addition to shared decision making. He discusses lab results with diabetic patients and before discussing medications, he says, “We need to find out what the barriers are for them. I don’t have a canned answer. Everyone is an individual.”

Dr. Otten follows algorithms from the American Diabetes Association in terms of drug selection. “But I talk to the patient first to learn their barriers — whether it be fear of needles, a cost issue or a polypharmacy issue,” continues Dr. Otten.

Dr. Otten says he believes in making patients a key part of the decision process and that means finding solutions that are palatable to patients. “If they’re afraid of needles, they can come in and we’ll show them how to give themselves the injection,” he says. “It’s an interesting dynamic to convince someone that needs a medication or has to start insulin when they don’t want to.”

Bedside manner is also important. “But I’m also blunt with people,” says Dr. Otten. “Most of my patients respond to that. They may need to make changes, and the question is ‘How do I help them do that?’”

But there are times when it’s not in the patient’s interest to give them too much leeway. “If their blood sugar is not controlled, a patient may want another three months to see if they can lose some weight or make changes,” says Dr. Otten. “If a patient is close to his or her goal and wants to avoid taking another medication, I’ll give him or her a chance. But after that I say, ‘You have to make changes or I have to prescribe medication.’ Either they’re going to do it or not. We’re not going do this game of ‘give me another chance’ month after month. It’s too important.”

Reaching out to patients

The key to helping diabetic patients is to get them in the office to begin with. Office staff, including medical assistants, help track patients to make sure they get appropriate follow-up care. The office tracks patients through registry data received from insurance companies and has recently hired a quality coordinator to reach out to patients.

“The days of waiting for patients to come in with problems is changing,” says Dr. Otten.  “We need to reach out to people and get them seen. We start with letters. If the response is poor, the quality coordinator and assistants make phone calls.”

The staff is also well trained to look at refill patterns. They pay attention and will notice if patients are not refilling their prescriptions when they should. They also check to see which patients need a follow-up appointment.

“Staff training is important because we have a whole team doing chronic disease management. If you leave it up to the doctor alone, things can get missed,” says Dr. Otten.

Cooperation between the doctor and staff is also important.

“I encourage the staff to ask questions and I’ll come back with other questions and see where things stand,” explains Dr. Otten. “Sometimes it may lead to a visit instead of making snap decisions about what a patient needs.

“A lot of times physicians have a lot of pressure. We get into a routine and forget there’s a person sitting in front of us with real concerns beyond what their numbers are,” says Dr. Otten. “Those factors are important – often critically important – to getting them where they need to be. It’s about taking care of the person and understanding what makes them tick, what’s going to get them to change and keeping them out of the hospital.”