362

Letters and Commentary

Two Words or One?

meter if a

third-party payor has begun to

While reading Tom Clancy’s novel, A Clear and Presellt Danger, I was struck by his description of the word crisis. He describes crisis as a combination of the symbols for two words, danger and opportunity, in the Chinese language. What an appropriate definition. All written words are symbols. Unfortunately, sometimes when two words are fused, a less-than-correct meaning is attached. One such misnomer has created a crisis of sorts for health care providers. Glucose meters for home glucose testing are often called glucometers. Here is a combination of two wordsglucose and meter-producing a third word, glucometer. Unfortunately, the result is not an appropriate definition but a powerful symbol that has created havoc for patients, caregivers, and suppliers. The problem is that Glucometer is merely a proprietary name describing only one of many home glucose meters available. When the word is used generically to mean any meter, chaos ensues; and the confusion has legal, financial, and educational consequences. Consider this: A patient approaches a supplier with a prescription from a physician for a glucometer. Is it legal for the vendor to display the variety of glucose meters available for use? Technically, the prescription names a specific product, when that is not always the intention. Is it within the law for the supplier to decide if Glul’ometer is generic or proprietary based upon whether a capital or a small letter is written’? Must the physician or clinic be contacted before the client can be made aware of all options available for home

glucose monitoring? Third-party reimbursement is a factor in most people’s health care. Misinterpretation of the word glucometer often leads to frustration before and after purchase of supplies. A patient or health care provider may experience difficulty in getting a specific glucose

Glucometer,

interpret glucometer since this interpretation limits reimbursement to only one brand. Suddenly, a client or health care provider has no options. No doubt these situations can be corrected but only after the timeconsuming process of clarification takes place. Whether this requires verbal or written communication by the client or health care provider, it saps as

one’s energy and can lead to dissatisfaction with the health care system. No one

enjoys haggling

over

bills, especially

when it can be avoided. Well-informed physicians, health care providers, and vendors take precautions to verify exactly what the word Glucometer-means. Lessastuteindividuals may not clarify and proceed to give advice, information, and instructions. Unfortunately, the clients are the ones at greatest risk for misinformation. Just as they begin to feel comfortable with a new technical aide, their confidence may be shattered by an innocent but incorrect response. People with diabetes don’t need confusion; they need simple, accurate instructions that foster their efforts to keep diabetes under control. It is time for us to move from danger to opportunity with this crisis. A concentrated effort by all can dispel the trend toward wider use of the word glitcometer- and facilitate communication about home glucose monitoring. All health care providers can participate in three ways. First, all must recognize that a problem exists. All of us know some classic examples of proprietary names that assumed the identity of a whole line of Letters will be published at the discretion of the Editor as space permits and subject to editing and abridgemel/t. Letten .Bhould he addressed to the Editor: James A. Faill, PhD, RN, Yile University School of Nursing, 25 Park Strc~et, PO Box 9740, New Haven. CT06536-0740. Downloaded from tde.sagepub.com at Harvard Libraries on June 30, 2015

Scotch tape, few. When sales and profits are the only things at stake, it may be possible to observe the phenomenon and forget it. But when controlling a health problem and getting medical bills paid are involved, all health care providers need to be alert to unfair advantage, limited access, and the danger of misinformation. Having recognized the problem, everyone involved must monitor verbal and written communication about glucose testing and cease to use the word

products: Kleenex, Q-tip, Sanka,

to name a

glucometer generically. Questioning, and correcting any misuse from any source raises the consciousness of other people and reinforces

clarifying,

specificity. Health care providers-and especially diabetes educators-can collaborate to facilitate change. A concerted

effort to shift back to the two clear words that deliver the appropriate message is all it would take. Diabetes educators can use their influence to alert vendors, sales representatives, pharma-

cists, dietitians, respiratory therapists, physical therapists, social workers, spiritual counselors, and that endless list of health care providers to the value of using glucose meter- rather than glu-

People individually and professional organizations can exert pressure on legislators to eliminate the generic use of the word glucometer in governmental communicumeter.

through

their

cation. A recent memo from the North Carolina Medicaid office states: &dquo;The Division of Medical Assistance has received numerous calls about the availability of a glucometer and companion medical supplies for diabetic pregnant women.&dquo; Five more sentences in the memo used the word glucometer. Several months ago, in a telephone conversation, a county health department nurse stated flatly &dquo;North Carolina only covers Glucometers: ’ Unfortunately, these two local examples are only the tip of the iceberg. A product

representative recently stated, &dquo;Oh,

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364

that’s not only in North Carolina, it’s other states, too.&dquo; This terminology cannot be allowed to enter government documents where implications for unfair advantage and widespread reimbursement problems are great. Insist upon the use of glucose meter unless the one specific product, Glucometer, is intended. It is not too late. Kleenex lost to facial tissue. Scotch tape became cellophane tape. Q-tips are known as cotton-tipped applicators, and Sanka shares the market with a wide array of decaffeinated coffees. Recognize words as the powerful symbols that they are. Use Gluco-

identify only

meter to

one

meter;

use

when any one of the many other available home glucose monitoring devices is intended. In this case, two words send a clearer

glucose

meter

message.

—Sylvia M. English, RN, MS, CDE Pitt County Memorial Hospital Greenville, North Carolina Jacob’s Island: A Fable

for Diabetes Educators* Jacob lived

pletely

high precipice comby the sea. From time, one of the people who on a

surrounded

time to lived on Jacob’s island fell into the sea. The sheer cliff walls around the island were so high that it was impossible to get people out of the water once they fell in. To deal with this problem, a group of ocean experts were assigned to the coastlines to try to help. Some of them tried to find ways to prevent any more people from falling into the sea, from presentations made to the National Diabetes Advisory Board and the CDC Diabetes Translation Conference in San Antonio, Teas, April 1990.

*Adapted

while others tried to find a way to get people out of the sea. But they were not able to solve either problem. Other ocean experts spent their time shouting encouragement and advice to people from the edge of the cliffs. Although most people managed to survive their initial plunge into the sea, living in the water caused them suffering and sometimes shortened their lives. Eventually some of them became exhausted and drowned, while others were bitten by sharks and were badly disabled. One night, without warning, Jacob fell into the sea. He was shocked and confused and began to flail around in the water. &dquo;Help, help, I’m in the sea,&dquo; he shouted. His cries attracted the attention of a nearby ocean expert, who ran to the edge of the cliff and shouted, &dquo;Jacob, you have to swim!&dquo; &dquo;How do I do that’?&dquo; Jacob sputtered. The ocean expert said, &dquo;Move your arms like this.&dquo; Jacob did. After a brief while he realized that he was not going to drown, at least not immediately. As Jacob swam, concerned ocean experts yelled advice and encouragement to him whenever he needed help. As night came, Jacob said, &dquo;The water’s freezing. I’m getting colder.&dquo; One of the ocean experts said, &dquo;Jacob, we believe that if you swim faster it will help keep you warm.&dquo; So Jacob swam faster, which helped a little bit, but then he was tired most of the time. Sometimes the ocean experts couldn’t agree about the best way to swim, and they would argue about whether Jacob should do the breaststroke or the backstroke. Jacob found these conflicts confusing and disheartening. One afternoon Jacob thought he saw a shark’s fin in the water. With a trembling voice he yelled to a nearby ocean expert, &dquo;I think I see a shark.&dquo; The

Downloaded from tde.sagepub.com at Harvard Libraries on June 30, 2015

ocean

expert said, &dquo;Now, Jacob, listen

to me. Float and hold

yourself perfectly

still. We believe that if you float the shark won’t see you, or at least it will take longer for it to find you. And even if it does find you, it will probably take a smaller bite.&dquo; Although Jacob tried floating, he didn’t find this advice very

reassuring. The islanders noticed that, as time by, more and more of them were falling into the sea, so they created a council of wise persons to decide what to do. The council proclaimed that the island needed more ocean experts working on the problems of preventing people from falling into the sea and getting them out. But it was also clear to the council that they had to find better ways to help the people who were already in the sea. One of the council members said, &dquo;You know, there is a group of specialists in the village whose talents and skills would be relevant to this problem.&dquo; The specialists were asked to help, and they agreed. As Jacob was swimming through the water, he looked up and saw the new group of specialists working feverishly on the edge of the cliff. &dquo;Who are those people?&dquo; he shouted. &dquo;What do they do?&dquo; Now, in the United States, they are known as diabetes educators, but that name wouldn’t make any sense to the people on Jacob’s island. So when he shouted out his questions, the ocean experts replied &dquo;They build boats.&dquo; Later that evening, as Jacob sat gently rocking in his well-stocked boat, he smiled because he realized that if you have to spend your life at sea, it is better to do it in a boat than in the water. went

—Robert M. Anderson, EdD

University of

Michigan

Diabetes Research and Training Center

Ann Arbor, Michigan

Two words or one?

362 Letters and Commentary Two Words or One? meter if a third-party payor has begun to While reading Tom Clancy’s novel, A Clear and Presellt Dan...
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