Subby
02-19-2008, 02:53 PM
I got orange-juice-on-sunday'd yesterday at my endo's.
That's the term that comes to my mind when I think about how many endo's have dealt with me over the years when it comes to diagnosing blood sugar problems. Here's a semi fictional example:
ME: I've had such a lot of variation lately. I know there are lots of factors but I think something is really out and I get semi-patterns. Here's the tests and data from the past few weeks, can you help with any observations or ideas?
DR: <staring blankly at me> Yes lets look, but remember your A1c is good, all things considered.
ME: Ok I agree that's good, but these fluctuations make me sick and knock me around all the time. What about for example, Friday there?
DR: <staring blankly at the data> On Friday there, that could have been a bad injection site.
ME: OK I don't think so, I avoid all those lately.
DR: But we can't rule it out, that could be it.
ME: OK then, I can't argue with that statement. But wait, What about the rest (ie, fluctuations all over the place)?
DR: <staring blankly at the data> Hmm, you had an orange juice on Sunday. That stuff often has so much sugar. Gees you take a lot of tests. Stop worrying so much about it all. That was a great BG that afternoon there. Now how are your feet feeling?
ME: Hmmm. <wow, another few weeks/months/whatever trying to record as many factors as possible, flushed away with "stop worrying" and "sorry it's all too slippery for us doctors to engage with properly, I'm just going to be obtuse instead">
Now, I am not talking about honest, useful advice (which can be short and to the point too). But the OJ syndrome involves quick superficial assumptions, (it's the OJ causing instability, or suggesting lack of care in diet) not verifying anything properly with the patient (does this amount of OJ USUALLY spike you at all?), and moving on with it established that either a) it's too hard and annoying to get into the issues properly or b) it's unreasonable to want some avenues of progress (or movement towards such) via quality scientific deduction.
An unwillingness to say "hmm, I'm not sure. It is tricky with the 1 minute window I have with your data... lets try looking at this or that issue properly over the next few months. here's how... "
And often, it involves - leave me alone I have another 400 patients to see today.
I am beyond fed up with this attitude, even my wonderful latest endo (and she is, compared) is not immune from it. Not much in the world gives me bigger stress spikes than this kind of interview these days.
I am going to work towards a more practical diagnostic framework that I take to these situations to minimise this endocrinological squirm... and try and see insulin therapy as something where there is hope of some kind of useful, if not necessarily clear, diagnostic discussions to be had, with better directions coming out of it rather than a sore head.
That's the term that comes to my mind when I think about how many endo's have dealt with me over the years when it comes to diagnosing blood sugar problems. Here's a semi fictional example:
ME: I've had such a lot of variation lately. I know there are lots of factors but I think something is really out and I get semi-patterns. Here's the tests and data from the past few weeks, can you help with any observations or ideas?
DR: <staring blankly at me> Yes lets look, but remember your A1c is good, all things considered.
ME: Ok I agree that's good, but these fluctuations make me sick and knock me around all the time. What about for example, Friday there?
DR: <staring blankly at the data> On Friday there, that could have been a bad injection site.
ME: OK I don't think so, I avoid all those lately.
DR: But we can't rule it out, that could be it.
ME: OK then, I can't argue with that statement. But wait, What about the rest (ie, fluctuations all over the place)?
DR: <staring blankly at the data> Hmm, you had an orange juice on Sunday. That stuff often has so much sugar. Gees you take a lot of tests. Stop worrying so much about it all. That was a great BG that afternoon there. Now how are your feet feeling?
ME: Hmmm. <wow, another few weeks/months/whatever trying to record as many factors as possible, flushed away with "stop worrying" and "sorry it's all too slippery for us doctors to engage with properly, I'm just going to be obtuse instead">
Now, I am not talking about honest, useful advice (which can be short and to the point too). But the OJ syndrome involves quick superficial assumptions, (it's the OJ causing instability, or suggesting lack of care in diet) not verifying anything properly with the patient (does this amount of OJ USUALLY spike you at all?), and moving on with it established that either a) it's too hard and annoying to get into the issues properly or b) it's unreasonable to want some avenues of progress (or movement towards such) via quality scientific deduction.
An unwillingness to say "hmm, I'm not sure. It is tricky with the 1 minute window I have with your data... lets try looking at this or that issue properly over the next few months. here's how... "
And often, it involves - leave me alone I have another 400 patients to see today.
I am beyond fed up with this attitude, even my wonderful latest endo (and she is, compared) is not immune from it. Not much in the world gives me bigger stress spikes than this kind of interview these days.
I am going to work towards a more practical diagnostic framework that I take to these situations to minimise this endocrinological squirm... and try and see insulin therapy as something where there is hope of some kind of useful, if not necessarily clear, diagnostic discussions to be had, with better directions coming out of it rather than a sore head.