Diabetes care

Dr. Thomas Selznick and patient Tonya Lara Keller

An interview with Thomas Selznick, D.O., Livonia Family Physicians

Thomas Selznick, Livonia

May-June 2019

What’s the key to making sure all your diabetes patients get all their tests completed (A1c test, eye exam and nephropathy testing, blood pressure)?

For me, the key is micromanaging patients and frequent follow‑up. If a patient is on insulin, I see him or her every month. If I don’t hit all the testing on one visit, I can do it on follow‑up visits.

It’s important to check a patient’s A1c frequently. You have to check their numbers and call them to change medication if their blood sugar is too high. As a general rule, I’ll see patients every three or four months, unless they’re on insulin. In that case, I see them every month or two. I micromanage so I don’t have to deal with too many problems in one visit.

At the same time, checking blood pressure regularly is important. I can adjust medications when I need to. When you see patients only twice a year, it’s hard to get blood pressure under control.

Is it more difficult to make sure patients get a retinal eye exam when patients have to see an ophthalmologist?

We make it easier for patients by doing a retinal exam in our office. We have a retinoscope and refer patients with abnormal results to an ophthalmologist with whom we have a relationship. It’s easier to make them go when you tell them you’ve already detected something out of the normal range.

What about nephropathy?

It’s easy to do nephropathy testing. All you need is a urine sample. We have a medical assistant and a care manager who puts the performance measures in the patient’s chart for us. It’s reminder to me during the office visit that the patient needs a test.

What’s the biggest challenge in diabetes care?

Helping people afford their medicine, especially with Medicare patients. With oral medications there are many choices. But with insulin, patients need to hit a deductible or Medicare patients have to contend with the doughnut hole. It’s a huge issue.

How do you coordinate care with specialists? Do you have a system for communicating with them?

If necessary, we refer patients to a nephrologist. We’ve recently partnered with one who comes to our diagnostic center once a week to see patients. But there aren’t many patients who need a nephrologist.

I monitor most patients myself and seldomly refer to specialists. This way, I’m able to monitor the variety of medications they’re taking and don’t need to be concerned about duplicate testing. Most often, if a patient sees a specialist, they only go twice a year, but I like to manage their care by seeing them more frequently.

Do you provide special education to patients with diabetes?

We have a diabetic educator in the office. She’s in my office three days a week. She discusses diet and medication compliance. She also teaches patients how to use insulin.

Older patients may have barriers to using insulin, such as coordination and vision. They may have trouble seeing the numbers so they need extra help.

Is there anything else we haven’t discussed that you feel is important?

A doctor treating patients with diabetes has to be willing to micromanage the patient. You should see patients frequently. You don’t need to spend a lot of time for each office visit if you just saw the patient in the last month or two. And you have a chance to pick up on health changes while they’re in your office. Most of my diabetic patients have other chronic diseases. You need to make the time. It’s a commitment.