Doctor Doctor…Give Me a Minute

September 27, 2013By 4 Comments

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I am always preaching about being a your own advocate as a patient, and making sure you are armed with the right questions in preparation for a diabetes check-up.  Unfortunately, our healthcare today is what it is, and doctors nowadays not only get reimbursed for only a 15 minute visit, but they also in some cases are paid by your performance, like your A1c result.  The “pay for performance” concept includes the idea that: insurers reward providers when their patients’ care meets the applicable guidelines and decrease reimbursement for visits when it does not , for example, the A1c guidelines set by the ADA.  What this means, is that in those 15 minutes that your provider is supposed to tackle the pile of questions and issues that come up with diabetic patients, they are supposed to get down to the nitty-gritty of blood sugar management, period.  What about your over-all health?  What about all the other things that diabetes can disrupt in your life, your other body systems or your mental well-being?  Who is supposed to help you with all of that?

There are WAY too many diabetics, both Type 1 and Type 2, who rely solely on their primary care physician for one reason or another, to do all their diabetes related care and prescribing.  Stop and think; the doctor who just saw a sprained ankle, strep throat, and a rash is now supposed to analyze your blood sugars?  Hmmm.  Many patients, depending on their geographic location, don’t have the luxury of having a nationally recognized diabetes center, or even an Endocrinologist, anywhere near them, so they don’t have a choice but to go to their local PCP.  These patients should be seeking resources and joining online communities such as JDRF, ADA and the Joslin Diabetes Center website forums, so that they can at least stay abreast of what their primary care physicians should be bringing up with them.  Again, be YOUR own advocate, no one else will do it for you!  If you go to your doctor with a short list of immediate health care needs, instead of going in and telling him every last detail of what you ate for dinner last night, you will get much more out of your visit and maybe even leave the appointment with some solid advice.

I have been in-between Endo’s for the last year and a half.  I was very happy with my adult Endo, but left him temporarily to see the specialist in the Pregnancy Clinic at the Joslin Diabetes Center in Boston.  After giving birth, I put off minding any attention to my own personal doctor appointments for many months.  I knew I was due for an overall diabetes wellness visit, but hadn’t gotten around to making the appointment back at my usual adult Endo office.  I went to see my primary care physician earlier in the summer with a barrage of symptoms… ultimately they were all due to exhaustion, insomnia, weaning from breastfeeding/hormone changes, and life in general being a bit overwhelming causing me to have physical discomfort.  I ran down the list of things I was experiencing like hair loss (normal after pregnancy, but diabetics are at an increased risk of thyroid disease), bloating (um, I think that’s just called post baby body), dizzy spells (a side effect of the exhaustion I’m sure), and itchy skin (I tend to get this when I’m anxious or overwhelmed).

Not only did the doctor, oops, I mean the nurse practitioner (the actual doctor can only see you once a year), barely look at my chart, or make eye contact with me, she didn’t ask any further questions.  Just going off of the general symptoms I gave her, she ordered a MASSIVE amount of unnecessary tests including a brain scan and a heart monitor!!  She also drew blood for everything from lupus to hepatitis!  I looked at her and asked with a puzzled look, not telling her I had any clinical background, and said “is this all really necessary?”  She said, well yes, because you have diabetes.

Stop. Right. There.  That’s it.  She ordered all these tests, assuming I am similar to that of a poorly controlled type 2.  She never asked me what my A1c was, she never asked if I had any current complications, and she also NEVER took into consideration the fact that I was only a few months postpartum and that my hormones were all over the place!  All I was really looking for was a thyroid and an anemia test, pretty simple.  I was so annoyed that she didn’t probe further, that I took it upon myself to cancel most of the appointments she ordered for me.  I didn’t think my health insurance (or me) should be paying for some very unnecessary things.  I understand practitioners need to cover their butts, however if they just took a few extra minutes to ask a few more questions, they could determine that I probably don’t have a tumor or severe diabetic complications out of the blue.

I ended up being just fine, and chalked it up to exhaustion, anxiety, and fluctuating blood sugars.  I have since been able to follow-up with my Endo and get down to the more important things, like the medications I was on prior to pregnancy for slight proteinuria (kidney’s leaking protein) and a statin for cholesterol.  I am also very lucky in that the adult Endo that I used to see for over 10 years, who had moved out of the state, came back to work at the hospital I used to see him at.  He remembered my medical and personal history and took that all into consideration during our appointment.  These kinds of doctors are few and far between, and I am very lucky.  Although he was almost an hour late for our appointment, I didn’t think twice, because he gives his patients the care they deserve and he would spend just as much time with me.  Not every doctor is able to do this.

For those of you who just can’t seem to catch a break with either your primary care or your Endo, don’t give up…but don’t also give into the symptom checker on Web MD!

 

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  1. Alexis says:

    I like to say that if you don’t drive your own bus (the one chock full of PCPs, nurse practitioners, disease specialists, files of test results, and health insurance and perscription bills), you end up stranded. It’s easy to feel alone and want to give up. Thanks for encouraging everyone to keep fighting!

  2. Jennifer says:

    Thanks for this post! I am an RN and also feel for those who don’t have the where-with-all to think about the questions to ask or show concern for the decisions their doctor makes (excessive testing!). I was diagnosed with T1D when I was 3 weeks postpartum with my first child. I am now (9 years later) 25 weeks pregnant with our second daughter. I noticed that you have recently dealt with the issues of diabetes and pregnancy and was wondering what your favorite resource was that out there- my endo and CDE (local Joslin affiliate) together with my regular OB are helping me manage things now but I still feel like there is more I should know. Maybe it’s because of my nursing background, but it seems like everything I can find is just the basics. Do you know if anyone has written anything from a T1D standpoint? I’m mostly concerned again about the few weeks postpartum and also my decision to try breastfeeding.
    Thanks again, this was a great read!
    Jennifer
    Birmingham, AL

    • Diabetes says:

      Hi Jennifer! Thanks for your comment. There is a great book out there by Cheryl Akon, about Type 1 diabetes and pregnancy. Also, JDRF has a new Type 1 Pregnancy Tool Kit that is free and really up to date with information. Congratulations on your baby and I’m glad you found the information on my blog helpful!! Best wishes!

  3. Veronica says:

    Regina, thanks for making me feel “not alone” in the fight to get a Dr. to actually listen. It is very sad that the insurance industry has taken over the quality of our medical care. A 15 minute visit!!!!! It takes longer to check in!

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