Does am Endo HAVE to be part of care team?

[davef]

Hi all,

I'm looking for some advice in relation to who should be in my care team.

At present my care team is me, my GP (family Doctor) and of course my DF Family. I really like my GP, he takes the time that is needed with me, he is willing to listen to me about what works and doesn't work. He was great in monitoring me in the early days and as I progressed (and learned) he did start "weaning" me of regular visits. After DX I saw him 3 days later, then a week later and week after that, then it went to two weeks and then a month, then 6 weeks and now it's at seeing him every 3 months.

I feel I have done very well in the past 5 months and he has done well by me, I don't feel my care is lacking in anyway. I believe my BGs are well under control, my 14 & 30 day average is 97.2.

I know there is a diabetes clinic in a local hospital, but from what I have heard, they are working from the old text books, so I haven't been inclined to go along there.

I'm not attending an Endo and what I'm wondering is, should I be seeing one? I'm sure if I ask my Doctor for a referral he'll be happy to give me one, I'm just not sure that I need to be seeing one at this stage.

What do you guys think?

[princesslinda]

Dave, i've never seen an Endo either, as I feel my internist listens to my concerns and has been very supportive in helping me get the test strips I feel I need, etc.

If/when I feel my control starts slipping or the meds aren't controlling my blood sugars....or if I were to have to start insulin, i'd see an endocrinologist. Otherwise, i'm of the mindset "if it ain't broke, don't fix it." Just my 2 cents worth.;)

[fgummett]

Hey David, my initial reaction is usually that a GP is just that, a General Practitioner (why do they call it Practice?) and I don't see how they can possibly keep up with the latest on every medical condition BUT having said that it sounds like you are under good control and every 3 month check-ups is better than the every 6 months I see my specialist. Also if, as you hear, the specialists in your area are not that up to date they could do more harm than good... well :)
I'd still see about getting time with a dietitian and CDE Nurse in case they have some additional tips but it sounds like you are already doing really well.
You say, "at this stage" this may be all you need, but you already know, D is chronic and progressive so I wouldn't discount a specialist in the long haul
Maybe someone to help you stop smoking?
~ Frank

[Chappo]

My care team is:
-Family
-My colleagues
-My endocrinologist
-Myself

[morrisma]

Dave,
As Frank said, what you miss with a GP over an endo is the latest medical info and up to the minute new procedures.

Additionally, an endo's practice probably includes a diabetes educator and maybe a pump specialist both of whom specialize in providing the detailed care within their specialties. This means you get access to food & diet info, goal setting, and possibly help with insurance claims and justification all in one office.

That said, not all endos are created equal and your local options might not provide a significant advantage over your gp. I'd explain your concerns to your gp and see if he can recommend an endo that might add something to your care.

Cheers,

[davef]

If/when I feel my control starts slipping or the meds aren't controlling my blood sugars....or if I were to have to start insulin, i'd see an endocrinologist. Otherwise, i'm of the mindset "if it ain't broke, don't fix it." Just my 2 cents worth.;)

That's my thinking at the moment, if/when something changes then I'll look further.

Hey David, my initial reaction is usually that a GP is just that, a General Practitioner (why do they call it Practice?) and I don't see how they can possibly keep up with the latest on every medical condition BUT having said that it sounds like you are under good control and every 3 month check-ups is better than the every 6 months I see my specialist. Also if, as you hear, the specialists in your area are not that up to date they could do more harm than good... well :)

And if they have to practice, why practice on us! ;)

One thing I do know about my Doctor, after I told him about the Gretchen Becker book .... he went an got one, I take that as a good sign, somebody is open to continued learning and new ideas, is a good one in my book.

I'd still see about getting time with a dietitian and CDE Nurse in case they have some additional tips but it sounds like you are already doing really well.
You say, "at this stage" this may be all you need, but you already know, D is chronic and progressive so I wouldn't discount a specialist in the long haul

As you say, it's progressive and my idea is that when it does progress, then I will too and add an endo to "Team David", so long as he is up to the demanding standards of Team David :D

As it happens a very good friend is a community nurse in the town where I live, she completed a diploma for Diabetes Nursing/Care last year and does check in on me from time to time. Turns out that she was a lurker here on DF when she was doing her diploma and thesis, since she believes it is imperative that those caring for diabetics should listen to and learn from the experiences of diabetics, she got some flack from some lecturers for having that opinion, but stands by it.

In relation to dietitian, I don't actually see one, but the biggest customer for the company I work for is Weight Watchers Ireland. I have worked closely with them for 7 years now and have I learned a lot from them. Now they are beginning to learn from me about diabetes. That's not to say that I won't attend a dietitian if I feel the need, but I'm doing fairly good on weight loss at the moment, I don't feel I'm lacking in nutrition.

Maybe someone to help you stop smoking?

You know that nurse friend, well ..... we have a pact to quit on June 1st. I was going to quit Jan 1st, but decided to tackle one thing at a time. Now I am getting to grips with my diabetes management, I have set a date for quitting. I have cut down since Jan, in May I'll cut back further and then cold turkey from June 1st. We used to be able to buy cigarettes in packs of 10, the government banned them last year, so we can only buy packs of 20. For my mind, it was a foolish step by the government as I know I started smoking more when I couldn't buy 10's. Guess it might have made it harder for kids to buy them, but I really don't it has.

Thanks for the input,

[fgummett]

Cool!

And if you ever need a, "Comfortable Living Specialist"... you'll know where to cal...

http://www.diabetessupport.ns.ca/images/Sombrero/plumber.gif

:D

[davef]

:rofl:

Love the truck's graphics!

[Scrabblechick]

I'm going to see an endo, mostly because my GP's office is about 40 miles from here. I wanted a woman doctor to do my physicals. I'm just funny that way. Anyway, the endo I'll be seeing specializes in the D, and I know he's a good doctor. He also has an office here in town.

I'm seeing him May 1. I'm a little nervous, even though I know my numbers have been good, lately.

[fgummett]

I'm seeing him May 1. I'm a little nervous, even though I know my numbers have been good, lately.

Good luck..! Make a list of questions (check it twice) make sure you get your feet checked and take ownership of your blood results... don't just settle for, "they're fine..."... what exactly are they?!

[mortis505]

Dave, normally I stress to people that an endo is needed for good care, but each case is different. From what it seems you are one of the lucky ones that has a GP that actually listens to you. I say that if you are comfortable and happy with your current team, then why change it. And good on you for doing so well.

[Funnygrl]

For a type 2 well controlled without insulin- no, there's no reason to see an endo if you trust your GP.

[Janlaton]

Well, Dave, for 39+ years I was comfortable with my Family Practice dr. I did ask her one time if she thought I should see a specialist and she replied that since I was very well controlled with no complications she did not see the need to do so. I will say she is very knowledgable on the subject and I have been thru classes in the Diabetic Center locally. She has also had me see a dietitian.

Last fall when I was diagnosed with Diabetic Neuropathy of the Cardiovascular nerves she did as she had promised and called in 2 specialists: a cardiologist and an endo. For all that was done if I have a new question today I would call my PCP before I would either of the other 2. :) Then Endo did have me go back thru the classes in the diabetic center. I have not learned anything new BUT IT IS ALWAYS GOOD TO REVIEW!

Janlaton
40years of type 2

[Lulika]

Dave I would tend to agree with the concensus that if you are happy with the care you are getting, dont change it. I am delighted with my GP, she seems very knowledgable, adresses my concerns and takes a real interest. I see her every two weeks and she always remembers exactly what is going on with me; I dont feel the need, at this stage anyhow, to see an Endo. If I was to get god for bid, worse or complications, I might then seek a second opinion, but not for now :)

[Scrabblechick]

Frank, I have embarrassed family members by grilling the docs on "What does this MEAN? What ARE these numbers?" No worries that I'll settle for "Everything's fine." LOL.

[fgummett]

Frank, I have embarrassed family members by grilling the docs on "What does this MEAN? What ARE these numbers?" No worries that I'll settle for "Everything's fine." LOL.
Good for you! :) There's still too many that do just settle for a pat on the head from the Doc... and we gotsta edjumacate them :D

[Hammer]

Frank, I have embarrassed family members by grilling the docs on "What does this MEAN? What ARE these numbers?" No worries that I'll settle for "Everything's fine." LOL.

That's great Scabblechick! Several things I've noticed over the years about doctors.....one is that they see so many patients that they forget that the patients are anxious to know what's wrong with them. The doctor sees that there's nothing wrong with the patient or that whatever is wrong he can treat with a few pills, so to the doctor, it's no big deal. To the patient, it's their life....even if there's nothing wrong or if the problem isn't serious, the patient doesn't know that.

Another problem is that a lot of patients are nervous in a doctor's office. They are afraid that the doctor will find something seriously wrong with them. They feel like if they can just get out of his office, they will be okay, so they don't want to tell the doctor everything that's wrong with them, lest he find something serious. They just want to maybe get some pills and get out of there, and hope everything will be okay.

The last thing, and this bothers me, is that most doctors treat a woman patient lightly. I've seen it with my ex-wife, my daughter, and female family members. When I first heard of it, I thought the women were just being unreasonably critical of the doctor....until I experienced it first hand with my daughter. I couldn't believe how differently she was treated than I was.
The doctors act like, "Oh, it's just a woman....they complain about every little ache and pain, so I'll just give them some pills and shut them up." I guess it stems from the old attitude that if a man goes to the doctor, there must be some really wrong, otherwise, he'd never be here, since a man has to be half dead before he'll see a doctor.

I have since told the female family members that they need to be more forceful when they see the doctor (like you are). I said that they are paying the same amount of money as I am when I see the doctor, so they should be treated the same as I am. If the doctor tries to brush you off, yell at him, demand what you think you're entitled to when you see him. Don't leave his office until you're satisfied with the service he's given you.;)

[pegasus]

Dave,
I'm going to go a little against the consensus for this one. I agree that if you're doing well and get along well w/ your GP who listens to you, and you have the other supports as well, that's significantly beyond what most people using a GP only have. But I also agree that it's impossible if not difficult for GPs to keep up. I refuse to have an endo who isn't also an internist--and agrees to *act* as my internist (or GP [that term's less used now here, maybe because they got tired of practicing! :T ], some of them seem to be certified in it but will only practice in the specialty).

As far as I've seen after 40 years of T1, most medical issues that develop for me are diabetes-related, and someone w/that combination of skills will know how. That way he also has a stable of specialists to refer me to if something develops that I need specific care for. For insurance reasons (he doesn't take mine) I got a separate internist in his practice who's a lovely, knowledgeable person (she officially "refers" me to him, but I have to check in w/her once a year; I also use her when he's on vacation) but I wouldn't use her as the primary. It just seems to make the most sense to me to focus on the core medical practitioner as the "coordinator." "Internal medicine," or GP specialty, is its own field, and they have to keep up in the specifics of that, so I wouldn't want to rely on them for everything else as well.

But ... what you're doing seems to be working for you, Dave, and you're keeping a solid eye on what's happening, so do what works until you feel a need for change. That's really the only way to deal with this anyway! ;)

[pegasus]

That's great Scabblechick! Several things I've noticed over the years about doctors.....one is that they see so many patients that they forget that the patients are anxious to know what's wrong with them. The doctor sees that there's nothing wrong with the patient or that whatever is wrong he can treat with a few pills, so to the doctor, it's no big deal. To the patient, it's their life....even if there's nothing wrong or if the problem isn't serious, the patient doesn't know that.

Another problem is that a lot of patients are nervous in a doctor's office. They are afraid that the doctor will find something seriously wrong with them. They feel like if they can just get out of his office, they will be okay, so they don't want to tell the doctor everything that's wrong with them, lest he find something serious. They just want to maybe get some pills and get out of there, and hope everything will be okay.

The last thing, and this bothers me, is that most doctors treat a woman patient lightly. I've seen it with my ex-wife, my daughter, and female family members. When I first heard of it, I thought the women were just being unreasonably critical of the doctor....until I experienced it first hand with my daughter. I couldn't believe how differently she was treated than I was.
The doctors act like, "Oh, it's just a woman....they complain about every little ache and pain, so I'll just give them some pills and shut them up." I guess it stems from the old attitude that if a man goes to the doctor, there must be some really wrong, otherwise, he'd never be here, since a man has to be half dead before he'll see a doctor.

I have since told the female family members that they need to be more forceful when they see the doctor (like you are). I said that they are paying the same amount of money as I am when I see the doctor, so they should be treated the same as I am. If the doctor tries to brush you off, yell at him, demand what you think you're entitled to when you see him. Don't leave his office until you're satisfied with the service he's given you.;)

Ditto, Scrabblechick!
The irony is that so often men go when they're sicker and therefore more complicated to treat.

The other grotesque inequity when it comes to women's health is that medications have been developed over the years based on clinical trials on *men only,* and treat women (and children for that matter) as just, well, basically the same. That's why the Nurses' longegity study (I can't rememger if that's the same as the DCCT or another one) has been so key; it really shoved in the face of the medical establishment that women *are* different, have different physiologies and therefore essential, different needs. Now they're scrambling (sometimes) to catch up, sometimes seeing it as a way to extend patents (and reduce generic options).

Sigh.

So yeah, women really do have to be more forceful with their health-care providers--good for you for encouraging them to speak up!

[Kim_in_TN]

I was diagnosed by my GP but she has a full-time staff CDE. I see him every 3 months and now for the first time it will be 6 months before my next visit. She still sees me yearly for labs and a complete physical. I know that she would see me sooner if I had any concerns!

I've been on this schedule for 4 years now and do feel as though I am under very watchful care. If it ever gets to the point that I feel differently then I will perhaps look to make a change. It sounds like you are at the same "place" as I am. "If it ain't broke, don't fix it" ;)

[Hammer]

It's funny but I decide when I should see my doctor. He tries to have his staff schedule my next appointment when I'm in his office, but I tell them I'll call them when I feel like coming in. In the past, he tried to schedule blood tests for me, but I told the receptionist not to.

When they want you to have a blood test, the doctor has the receptionist fill out a hospital form that indicates what tests he wants done, and I take that form to the hospital, which is one block away. I tell the receptionist not to fill the form out since I won't be using it, but they fill it out anyway and give it to me. I turn around and throw it in the trash can on my way out.

I do think that the next time they want to do an A1C test, I may have it done....just for curiosity's sake. I don't think the A1C test is really that important. I figure, if I do my own tests every day, I know where my BG levels have been on a day to day basis, so what could the A1C test tell me that I don't already know? Also, I e-mail my daily readings to the doctor's office so he knows whats going on, plus I'll make a printout of the readings and take them with me when I go see him. So, why have an A1C?....unless it's just for curiosity's sake.;)