Mr. B, age 46 years, was a physician assistant who had worked for the same internist for 10 years. He and Dr. K had an excellent relationship. Their office was in an area with a high prevalence of diabetes, and many of their patients lived with the disease. Both practitioners had an interest in conducting public outreach about the condition.

Mr. B often conducted seminars and lectures in the local pharmacy, adult education classes, and the senior center in town. His lectures covered such topics as metabolic syndrome, coping with newly diagnosed diabetes, foot and skin care for people with diabetes, and understanding medications. He also discussed lifestyle modifications that could improve health, the connection between diabetes and cardiovascular disease, and how to properly monitor blood glucose. These seminars were generally well attended, and a number of people asked interesting and sometimes challenging questions. Mr. B found this community service to be very personally rewarding, and Dr. K was supportive of his endeavors.

Both Mr. B and Dr. K brought this educational attitude into the clinic as well. They stressed the value of empowering patients by helping them understand their conditions. Both practitioners found this strategy effective, although there were always some patients that just couldn’t be reached in this manner.

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One such patient was Mr. X, a 64-year-old African American who had been a patient for close to 15 years. Mr. X had diabetes, and despite numerous attempts to educate him on the importance of lifestyle modifications, medication compliance, and regular checkups, he was generally noncompliant and mostly disinterested. Not surprisingly, his diabetes was not well controlled. Both practitioners had tried unsuccessfully to convey the importance of controlling his blood glucose, but Mr. X seemed less interested in managing the diabetes and staying healthy than he did in waiting until there was a problem and then coming in for a “quick fix.”