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Join us as we sit down with Gary Marc Rothenberg, a podiatrist, to explore the unique connections between Olympic-level perseverance and the day-to-day challenges of chronic disease management, specifically diabetes. We discuss how celebrating small victories, integrating mental health care, and addressing social determinants of health can inspire better patient outcomes.
Gary Marc Rothenberg is a podiatrist.
He discusses the KevinMD article, “Celebrating silver: 3 best practices for meeting people where they are with diabetes adherence.”
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Transcript
Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Gary Rothenberg. He’s a podiatrist, and today’s KevinMD article is “Celebrating Silver: Three Best Practices for Meeting People Where They Are with Diabetes Adherence.” Gary, welcome back to the show.
Gary Rothenberg: I appreciate the opportunity. Thanks for having me, Kevin.
Kevin Pho: Gary’s been on the show in the past, so let’s jump right into your most recent article, Three Best Practices for Meeting People Where They Are with Diabetes Adherence. Tell us what this article is about, for those who haven’t had a chance to read it yet.
Gary Rothenberg: Absolutely. This article came out in the summertime when many of us were captivated by the Olympics and the Paralympics. Watching the athletes compete at such a high level got me reflecting on my patients who live with diabetes.
We often discuss adherence and engagement when it comes to health care technology and managing diabetes. That led me to think: Is the gold medal always the ultimate goal for everyone? Of course, striving for the best outcome is important, but what about celebrating silver or bronze—acknowledging the effort it takes just to get on the podium, so to speak?
In this article, I draw a parallel between the athletes who make it to the Olympics and my patients. Not every patient can achieve 100 percent adherence or perfect engagement with their care plan, but that doesn’t mean their efforts are insignificant. Every step forward, even if it’s not perfect, is worth recognizing and celebrating. That’s where the idea for this article came from—acknowledging and supporting the small wins that reflect meaningful progress.
Kevin Pho: That’s a powerful metaphor. From a podiatry diabetes standpoint, what would the gold, silver, and bronze medals represent when it comes to your patients?
Gary Rothenberg: Great question. In podiatry, especially for patients with diabetes, my primary goal is to prevent lower extremity complications. These complications can include diabetic foot ulcers, infections, hospitalizations, and, in severe cases, amputations.
When I think about the gold medal for my patients, it’s about perfect adherence. That would mean they’re checking their feet daily, wearing appropriate footwear at all times, managing their blood glucose levels within the target range, and following every aspect of their care plan without deviation.
But let’s be realistic: Is wearing the right shoes 100 percent of the time achievable for everyone? Probably not. Many people have cultural practices, personal habits, or lifestyles that make it difficult. For example, in some households, people don’t wear shoes indoors. Does that mean they’ve failed? Of course not.
The silver medal might be adhering to most of the care plan—doing their best to follow recommendations even if it’s not perfect. For instance, if someone is managing a diabetic foot ulcer but misses a few milestones in their healing progress, they’re still making meaningful strides. A bronze medal might represent a patient who faces significant challenges but still takes small, consistent steps to protect their health. Every level of effort matters, and it’s our job as providers to recognize that.
Kevin Pho: Tell us about your approach in action. When a patient with diabetes comes into your office, how do you implement this gold, silver, and bronze framework? Can you share an example?
Gary Rothenberg: Absolutely. With every patient with diabetes, I emphasize three foundational aspects of care at every visit. First is maintaining good glucose management. This is backed by robust evidence showing that keeping blood glucose levels in the target range helps prevent complications like retinopathy, nephropathy, and neuropathy.
Here’s an example: A patient might come into my clinic with a hemoglobin A1C of 11 percent. That’s well above the target range, but instead of focusing on the number as a failure, I ask questions. What’s getting in the way? What barriers are they facing? I’m not their primary care doctor or endocrinologist, but as their podiatrist, I still see it as my role to understand the bigger picture of their health.
I also use tools like Epic, which lets me pull in trends for A1C levels. If I see that their A1C has dropped from 11 to 8.5, that’s progress. It might not be the gold medal of hitting their target range, but it’s a meaningful improvement—what I’d consider a silver medal. Recognizing that progress is essential. It motivates patients and shows them that their efforts are making a difference.
Kevin Pho: Celebrating small wins is so important, especially when patients are trending in the right direction. Talk more about why acknowledging those incremental successes is meaningful.
Gary Rothenberg: It’s all about motivation. When I acknowledge a patient’s progress, it helps them feel seen and valued. For example, if I point out that their A1C improvement is a step forward, it reinforces that their efforts matter. I think most patients want to do well—they’re what I call “provider pleasers.” They genuinely want to follow our advice, but they need to understand why it’s important.
That’s where the coach analogy from my article comes in. As providers, we need to act like coaches. A coach is part of the team, guiding and supporting the players while being equally invested in their success. It’s a shared responsibility. When patients feel like we’re on their team, they’re more likely to stay engaged and motivated.
Kevin Pho: You mentioned barriers earlier. What are some common obstacles patients face when trying to achieve their A1C goals?
Gary Rothenberg: Many barriers stem from social determinants of health (SDOH). For instance, if a patient is managing a diabetic foot ulcer, they might need to wear a special offloading boot or shoe. But if they work in a factory that requires steel-toed boots, that’s not feasible.
In such cases, I work with the patient to find compromises. For example, I might say, “I understand you need to wear your steel-toed boots at work, but when you’re home, treat the offloading shoe as your house shoe.” These kinds of adjustments are critical because they address the reality of patients’ lives rather than holding them to an unrealistic standard.
Kevin Pho: With SDOH factors playing such a significant role, how do you engage other team members or resources to support your patients?
Gary Rothenberg: Collaboration is essential. At the University of Michigan, we have an incredible network of social workers who help connect patients with resources. However, there are never enough social workers to meet the demand, so we also rely on tools like findhelp.org to identify local support services.
Certified diabetes care and education specialists (CDCES) are another invaluable resource. Unfortunately, only about 5 percent of patients with diabetes access these specialists, and even with private insurance, the number only increases slightly. These educators provide critical support, especially for patients with newly diagnosed diabetes, significant complications, or those who are struggling to meet their goals. We need to prioritize making these resources more widely available.
Kevin Pho: Let’s talk more about the dynamic in the exam room. How does the coach approach differ from a traditional, paternalistic provider-patient relationship?
Gary Rothenberg: The key difference lies in language and attitude. As coaches, we move away from judgmental or binary questions like, “Did you check your blood sugar today?” Instead, we open conversations by asking, “What challenges are you facing in managing your blood sugar?”
Labeling patients as “diabetic” or implying they’ve failed doesn’t help. Instead, I tell my patients, “Whatever your number is, it’s OK. It’s just data that helps us decide what to do next.” This nonjudgmental, exploratory approach builds trust and encourages patients to be honest about their struggles. It’s about partnering with them, not prescribing solutions from a place of authority.
Kevin Pho: You also work for a health technology company. How does technology play a role in achieving these goals?
Gary Rothenberg: Technology is a powerful tool for extending the trust relationship between patients and providers. At Podimetrics, we use remote temperature monitoring to help prevent diabetic foot complications. It’s like a continuous glucose monitor, but for the foot.
When we detect abnormal foot temperatures, it prompts a nurse to call the patient. Often, we uncover issues before they escalate. It’s not just about collecting data—it’s about using that data to intervene effectively. This kind of technology allows us to stay connected with patients between visits, offering support when they need it most.
Kevin Pho: We’re talking to Gary Rothenberg, a podiatrist, and today’s KevinMD article is “Celebrating Silver: Three Best Practices for Meeting People Where They Are with Diabetes Adherence.” Gary, let’s end with some take-home messages for the KevinMD audience.
Gary Rothenberg: My main message is to celebrate progress, not perfection. Recognize the small successes and trends rather than focusing solely on static numbers. That’s what I’ve found most effective in motivating patients and achieving positive outcomes.
Incorporate technology early, and build on the trust relationship with your patients. Lastly, let’s address the myths surrounding technology and health care disparities. Many underrepresented populations embrace remote monitoring and other tools as a way to improve their health care experiences. By leveraging these technologies, we can work toward reducing inequities and achieving better outcomes for everyone.
Kevin Pho: Gary, thank you so much for sharing your perspective and insights. Thanks again for coming back on the show.
Gary Rothenberg: It’s been a pleasure. I appreciate you having me, and thanks to your listeners.
