aa-65 - Special Report Looking Upstream Marjorie Cypress,...

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249 Editor’s note: This article is adapted from the address Ms. Cypress deliv- ered as the recipient of the American Diabetes Association (ADA) Outstanding Educator in Diabetes Award for 2004. She delivered the address in June 2004 at the ADA’s 64th Annual Meeting and Scientific Sessions in Orlando, Fla. For many, the phrase “looking upstream” is a familiar term related to preventive health care. It was used by John McKinlay in an address to the American Heart Association in 1974 1 to describe his frustration with med- ical practice. He used the analogy of a rapidly flowing river to represent ill- ness and said that physicians are so caught up in constantly rescuing vic- tims from the river that they have no time to look upstream to see who is pushing their patients into the water. He further discussed frustration with what he termed the “downstream endeavors,” which he characterized as short-term, problem-specific, individ- ual-based interventions, and chal- lenged health professionals to refocus and look upstream, where the real problems lie. I would like to share some thoughts I have about upstream think- ing in terms of diabetes and diabetes educators. Diabetes Education and Downstream Endeavors When I think of the downstream endeavors of diabetes educators, I do not look at them as a negative because we do rescue people, often from lack of education about self-care, or from fear. We provide hope and a means for improved health through self-man- agement and empowerment. We also help people with diabetes understand their disease, teach them what they need to do to manage it, and motivate them to follow treatment regimens. And, we are present to listen to con- cerns and offer support. Diabetes edu- cators make a difference in people’s lives. We also carry out upstream endeavors, through secondary preven- tion. We help prevent people from falling into the river that flows toward diabetes complications and heart dis- ease. We do this by ensuring that peo- ple get their screening examinations and helping them control their dia- betes, blood pressure, and lipids. Recently, our role as diabetes educa- tors has expanded as the diabetes community has begun to look upstream to diabetes prevention. We know from the Diabetes Prevention Program 2 that lifestyle change can prevent or decrease the risk of devel- oping diabetes. Health Promotion and Diabetes Prevention Diabetes educators often look upstream on a more individual level. For those of us who see people with diabetes every day, our role in pre- vention arises when a patient’s son, daughter, or sibling brings the patient into the clinic. We may notice a phys- ical resemblance and recognize that perhaps this family member also has risk factors for diabetes. At that point, we can begin some risk factor counseling, or we can teach the patients with diabetes so that they will, in turn, teach their families how to decrease their risk of developing diabetes. When we see patients individually
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This note was uploaded on 04/07/2011 for the course HLTH 300 taught by Professor Randypage during the Winter '11 term at BYU.

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aa-65 - Special Report Looking Upstream Marjorie Cypress,...

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