Doctors!

[wolf 06488]

Good-Morning, everyone:

I just wanted to bounce something off you guys & see if other people are feeling the same way. I've been a Type I Diabetic now for about 15 years (April of 1994). And I've had Endo, after Endo... And one thing I've noticed other then the rotten attiudes & lack of care. Is the lack of knowledge these doctors have. They seem to string all sorts of fancy words togeather to make themselves look smarter & seemingly, are pulling numbers (injection amounts) out of their asses. I live in Connecticut & I've been to about 6 Endo's (even Yale) over the course of my 15 diabetic years (I'm 25 now) & they are going down hill. One doctor I had couldn't remeber from a previous visit what tests he sent me for (and he was the chief of the department). I have a lot of stoires I could go into, but I don't have the time. It just seems like they knew more about Diabetes when I first got it & actually gave a ****. Now it just seems like they pack as many people into one day as they can, to make as much money as they can. Give you a few perscriptions, mumble off a few numbers not caring as to what effect it might have. I'm just curious, does anyone else feel this way?

[Jonathan_R]

I haven't been at it as long as you, but yes.

[Subby]

I've seen mixed quality with endos since I started 18 years ago. Probably the worst was the first one, he took my testing book, gave me a "score" and berated me for deviation, gave me (what I now know to be) virtually arbitrary dosage changes, and got angry if I asked any questions about such things as what affects my blood sugars. Probably the best was my last one, who was quite forward thinking and seemed knowledgeable, encouraged the pump (to great result for me), listened and reflected on my day to day experiences, and was generally positive. Still had issues and some big brick walls though, to the degree I am on the move again.

I guess a general downturn you have experienced could be luck of the draw, or it could be a sign of the health system/education around you getting worse. Partly also, it might be these days being older and more experienced you just can't get fooled so easily as before (as we learn through hard error that when it comes to some endos they often DON'T know what they are talking about with certain things, no matter how much they smile or growl or seem wonderfully charismatic).

[Mindstorm]

I'm still going to my pediatric diabetes endo/doctor and when I bring up the subject of going to a non-pediatric endocrinologist he kind of wrinkles his nose and suggests I do a lot of research before doing such a thing. I believe it's for the very reasons you have stated, in that the endocrinologists who deal with adult diabetics, as a whole, provide a lower quality level of care and attention to detail as compared to what you'll find at a pediatric diabetes clinic (to be fair, the one I go to is fantastic and filled with the most wonderful people I've ever met in the medical world).

I don't want to set appointments at a hospital or something, but maybe I can find a doctor who cares. For now I'm going to travel 3.5 hours back to my pediatric diabetes clinic and keep getting care from my awesome doctor(s), even though I'm 23 now. If I had to put up with any amount of **** or poor treatment from my endo I'd just ask to stay on-file with my doctors at Duke hospital and keep getting prescriptions through them. There's no reason to treat us like inferior human beings when most of us have a very clear understanding of the ins and outs of our form of diabetes.

[wolf 06488]

You know, I might sound bitter in saying this... But I've given it a lot of thought after posting my last comment. "Most" of these doctors arn't Diabetics themselves.... Out of all the Endo's I've spoken to & the APRN's the have worked in a Endo's office. I would say 98% don't even have Diabetes. And what I hate is just because the went to school, took some classes & read some books. They think they know what it is to have diabetes. As I've said to otghers, you don't know what it is till you actually have it. And what I find is that it's easy for them to say "cut back or add" to either food or insulin because they don't have to live with what happens if & when something goes wrong.

[Granny Shanny]

My doc doesn't have diabetes either . . . but his WIFE does! He's pretty well versed! :D :D :D

All kidding aside, I think this is just another symptom of the total breakdown in health care in this country. A caring individual who chooses a career in medicine is in for a battle royal, not only with the insurance companies over what and how much treatment will be paid for, but (since going into solo practice is almost unheardof anymore), they may be at odds with members of their own group if they want to spend more than 5 or 6 minutes per patient, because they aren't bringing in more money by seeing more patients. Years ago a medical group might be 10-15 docs, but now they are huge money machines with dozens of specialists, their own labs, radiology, etc., everything under the sun is consolidated under each group's own "roof" . . . and there are strict orders that one NEVER refers a patient outside their own group. It does nobody any good . . . not the patients obviously! But not the idealistic young doc either . . .

All I can say is that if you have ANY latitude in choosing your caregiver, interview them carefully. Let them know you expect to be treated like an intelligent adult, and make your choice accordingly.

[KCP]

Mindstorm: Funnily enough i moved form pediatric care at age 20 and really wish I hadnt had to cos adult care is not as focussed~!

[xMenace]

I am totally with you.

My endo has no clue how to set rates. He totally guesses. He sees lots of patients and has been at it for a long time, but he still guesses.

I don't show him my numbers anymore. I tell him what I'm doing, what my rates are. He writes them down. Then he pushes statins at me. If I don't see him, then I have to deal with my PCP who thinks more than three tests a day is a waste of time. Gawd, we can't win.

If I ever go postal, it'll be at a clinic or hospital with lots of doctors around.

[Jonathan_R]

To elaborate on my previous post, my experience has been something like this.

In November of 2007 I developed flu like symptoms, except no fever. This perplexed me, so I just rested and drank lost of gatorade. I was also going quite a lot, and had and unquinchable thirst. After a couple of days, I still didn't feel any better. If anything I felt more lethargic. My wife talked me in to going to the E.R. I drove myself there (looking back, I probably shouldn't have). I rested my head up against the door while driving four miles to the hospital. Upon arriving, I sign in and list my symptoms as flu like. After a while of sitting there, I so feel like passing out. So I advise the staff. They do eventually see me, and I suggest they do a finger stick. To this day, I don't know why I thought of that. At first they try and tell me that they'll get the blood work later in the room. I insist on the finger stick. It read "Hi". I ask what "Hi" means, and they said "Hi". I think to myself, that was helpful.

I find out later that I was admitted with a BG level of 750. Durring my stay in the hospital (about a week), the best they could get me down to was 200's. After this, I see my PCP for the first time. Now I know myself. I have always seen specialists. Pulmonologists for asthma, Nurologist for siezures, so I ask my PCP if I should see a specialist for my diabetes. He assures me he can handle it and how he's been quite successful. Six months later he says he doesn't understand what's going on, and refers me to a specialist.

The specialist has me go through "education" only to find out that I am already well informed. The endo wants me on a pump, but the insurance denies it. My blood sugars, while under the endo's care would go over 600 and drop to 33.

I have since moved, and have been pretty much with out a physicians care for a year. I finally go see one, and he thinks the diabetic diet is no carbs.

It has alweays been my dream to control diabetes with food and exercize. I know type 2's can do that. So a couple years ago I began some research on this. I'm a bit closer, but I'm not convinced yet. I need to run some tests.

So anyway, I don't trust doctors. It frustrates me that I know more than they do.

[sarahspins]

Now it just seems like they pack as many people into one day as they can, to make as much money as they can.

Yep... but to a point, it's a supply and demand thing.. ALL of the endos around here are busy that way... which is part of why I think they get away with it. They double and triple book their appointments, and no one benefits from it.

On the flip side, all I need one for is for Rx's and ordering tests..I don't expect or need much guidance.

[fenagle]

I couldn't agree more. Insurance limits who we can go see. I have been warned to stay away from all of the others in the area that are in my plan. It is so easy to say don't eat that bowl of ice cream or that plate of pasta. They don't understand because most have not been in our shoes. My PCP and endos have not known how to handle me since I only have 1/3 of the ol' pancreas and that presents problems that they just don't know what to do with.

[art]

I had a urologist like that.
During follow up visits I was asking myself "does this guy even know who I am?"

I feel for you..Art

[DeusXM]

Another part of it could be simply there's an increased prevelence of people with diabetes. Leaving aside the exponential growth in the number of T2 cases as one factor, the other is that the potential T1 gene pool has grown from non-existent in 1900 to something much larger now.

Until the 1920s, if you had T1 you died and you generally did it before you had a chance to reproduce. Now that T1 is a survivable condition, there are simply more people out there passing 'bad' genetic material onto their offspring. So simply put, there's more people with T1 out there than ever before, there probably aren't enough doctors out there qualified in the subject.

Then there's the fact that you might see your doc once every six months, while in the meantime he or she probably sees hundreds of other patients whose diabetes management skills range from being able to selfset up basal rates on their pumps to people who don't understand what glucose is. They also probably deal with patients who say they test regularly and never eat carbs yet come in with A1Cs in the 10s because all they do is eat pizza and not take their med. That's a lot of people and a lot of diversity and a lot of lying, and I don't think anyone can retain their commitment to treating that without becoming burnt out and jaded.

It has alweays been my dream to control diabetes with food and exercize. I know type 2's can do that. So a couple years ago I began some research on this. I'm a bit closer, but I'm not convinced yet. I need to run some tests.

Will have to say you have to stop this now. If you have T1, you have an entirely different medical condition to T2. You NEED insulin, end of. Insulin is an essential hormone for survival and as a T1 you don't produce any. You CANNOT control T1 through diet and exercise alone.

Treatment of T2 bears no relevance to treatment of T1, it's like trying to treat lung cancer the same way you'd treat a cold.

[Delphinus]

If I ever go postal, it'll be at a clinic or hospital with lots of doctors around.

LAWL

I would pay to watch that.

[retired60]

Yep... but to a point, it's a supply and demand thing.. ALL of the endos around here are busy that way... which is part of why I think they get away with it. They double and triple book their appointments, and no one benefits from it.

On the flip side, all I need one for is for Rx's and ordering tests..I don't expect or need much guidance. I'm the same way with my doc, just write the scripts and I'll take care of the rest. It does not make my day to go every time I stump my toe.

[foxl]

Yep... but to a point, it's a supply and demand thing.. ALL of the endos around here are busy that way... which is part of why I think they get away with it. They double and triple book their appointments, and no one benefits from it.

On the flip side, all I need one for is for Rx's and ordering tests..I don't expect or need much guidance.

It is supply and demand, but another question is, WHO OWNS your MD office??? Weird question, you think?

The truth is, anymore many MD offices are corporate-owned, they are salary workers, but there is a behind-the-scenes office manager who sets the pace, establishes bonuses, and takes money AWAY for low productivity. Small wonder the Docs no longer love their work!

I have a friend whose salary was just docked for the next year, for not bringing in enough money to the practice. And I know how hard that friend is working ... it can truly suck!!!

[Granny Shanny]

Not a weird question at all. Thanks for getting this point across much better than I did! :D My guess is your friend's patients love her for being more attentive & spending more time with them, but the blankety-blank corporation punishes her for giving good patient care. It not only sucks, it's totally insane!

It is supply and demand, but another question is, WHO OWNS your MD office??? Weird question, you think?

The truth is, anymore many MD offices are corporate-owned, they are salary workers, but there is a behind-the-scenes office manager who sets the pace, establishes bonuses, and takes money AWAY for low productivity. Small wonder the Docs no longer love their work!

I have a friend whose salary was just docked for the next year, for not bringing in enough money to the practice. And I know how hard that friend is working ... it can truly suck!!!

[foxl]

Not a weird question at all. Thanks for getting this point across much better than I did! :D My guess is your friend's patients love her for being more attentive & spending more time with them, but the blankety-blank corporation punishes her for giving good patient care. It not only sucks, it's totally insane!

Nah she still feels hated by ALL sides! I have nothing but sympathy for most MDs, really. We have got to fix the system ...

[Granny Shanny]

Nah she still feels hated by ALL sides! I have nothing but sympathy for most MDs, really. We have got to fix the system ...

Boy, that's a hard row to hoe. I feel for her.

And yes, we have GOT to get the system fixed!

[Scratch]

I'm very lucky to have found a GP who is knowledgeable about diabetes but respects the fact I have far greater understanding of my body's quirks and metabolism than he could possibly have by looking at some numbers.

I'm probably going to be moving within the next year. I wish I could take him with me.

[henry2002]

I know I'm going against the grain here but I have an excellent endocrinologist who is very up on diabetes care. I saw him a few months ago before I started on my pump and he calculated doses and worked out appropriate starting settings for my pump. At every visit he reviews my lab work with me, checks my blood sugar log and makes suggestions if needed, checks my weight, blood pressure and feet. I never feel rushed and he is always willing to answer my questions. I see him again next week and I know that I will receive the same level of care. He never rushes me or brushes me aside. I feel very lucky to have him on my team.

[sarahspins]

It is supply and demand, but another question is, WHO OWNS your MD office??? Weird question, you think?

It's not weird... but I have to say, that when I have followed an endo who had been at a hospital sponsored group practice and started their own private practices, things got much worse, not better. I went through that not once, but TWICE, eventually going back to the original group, where the seems to be an unusually high turnover in doctors (this is actually the same practice where i started seeing an endo.. I've seen no fewer than 5 different doctors there in the past 8 years - and only one that was there when I started going, is still there.. and I keep wondering why I don't just see him, but he never has appointments available). Most don't stay for more than a year. I don't know if they leave because they're unhappy, or they leave thinking they can make more money elsewhere, or what, but they do come and go fairly quickly.

The difference is with that office though, even though I can't be assured that my doctor will be there 6 months from now, is that the office staff doesn't seem as stressed, I can still get seen by a doctor who at least has the benefit of all of my records, I don't end up waiting 3 or even 4 hours to see the doctor for less than a minute (really, who has time for that?). Since what I need/expect isn't all that difficult, I don't want to be wasting half a day on it (or more, if I have to leave because it's taking too long and need to reschedule).

[Real4]

Now it just seems like they pack as many people into one day as they can, to make as much money as they can. Give you a few perscriptions, mumble off a few numbers not caring as to what effect it might have.

Were you to generalize some, what you are saying about Endos pretty much goes for the professional classes as a whole.

Certainly, newscasters, to pick a class, are full of **it.

Lawyers?

"Scientists" who push climate change?

When education has been turned into passing a test and winning your teacher's favor and success is defined as money, that's what you get.

And that's why civilization is now ending. Not in a minute or two, but more rapidly than one likes to ponder.

[DanG]

And that's why civilization is now ending. Not in a minute or two, but more rapidly than one likes to ponder.

WOW!!
You can speak that type of real sense more often - great comments.

DeusXM - as far as the number of docs out there that know diabetes now versus 35 years ago - I doubt if there ever has been a good number of docs that know diabetes. I really value the the first doc I saw 35 years ago - he said I would know more about my diabetes than he would ever know. Hence, I do what I can on my own and, as several others have already said - I see the doc for the Rx, and that is all. There is no relationship to be built with a corporation. Get the Rx and go figure out your life, on your own, and with DF friends - that is wisdom.

Fixing the system? - the DC fix being rammed down the throat of the kountry will NOT fix the system. That solution will only exacerbate the complaints anyone has mentioned in this thread. The solution is to take all your medical care into your own hands. Fine, go have the guy stitch your large gash when you cut your finger - but as far as insulin? - do it yourself, you will do much better with life rather than the frustration a nincompoop doctor can throw your way. Life throws us curveballs and we don't need a supposedly caring professional to add to the curveball handling. You need the Rx? - go get it, nod your head to what the doc sez, and move on because you know more about your diabetes than he ever will. Pay attention to your life - don't ever think a doc cares or knows what your life needs to manage diabetes.

[DeusXM]

as far as the number of docs out there that know diabetes now versus 35 years ago - I doubt if there ever has been a good number of docs that know diabetes. I really value the the first doc I saw 35 years ago - he said I would know more about my diabetes than he would ever know.

Yes, but I would respectfully point out that just because you or I may know more than a doctor when it comes to treating our individual diabetes, it does not follow that the doctor knows nothing or has nothing to contribute.

I'm not interesting in 'building a relationship' with a doctor - what I am interested in is their scientific perspective when it comes to analysing my numbers. They can't know the full story simply because no, it's impossible and indeed completely unreasonable to expect a person who works within diabetes as a job to have the same perspective or understanding as someone who lives with it 24/7 and I think that's part of the problem - unreasonable expectations.

You get out of your doctors what you put in - if you talk to them honestly, genuinely share the information and knowledge you have and they don't and respectfully listen to their take on the situation, you will get a far, far better treatment experience. If you're rude, unco-operative and take the view that they're just there to sign the prescriptions, that's all you'll get out of them.

Yes, there are bad doctors out there and no, I can't offer a perspective on a health system that is clearly very different from the one I grew up in. But I will say that I've had the good fortune of seeing some excellent doctors who have done a great job of realigning my rudder when I was sailing in the wrong direction and didn't even realise it.

When it comes to dosing, no, I wouldn't trust a doctor or endo to give me a proper fixed dosing recommendation - but if they said things like "you might want to look at increasing your dose by a bit at this time" (rather than giving specific numbers), I'd be inclined to listen.

[wolf 06488]

I'm glad I'm not the only one who feels this way.

[bituufg]

there are many diferent doctors and its nice that your going to e one but like i said there are many different kinds such has dentists, children doctor, dentist, surgen,xray,Physiatrist,snd many more each one takes different college time but even if its going to take a long time in college you can tell them that you want totake the crash coarse and there will be less college years but you will go there more during the week, for your high school courses you should ask your counsler when your going to pick you classes,,,and as for the low income.....i mean you can get a job when you turn 16 or 18 if you want.

[xMenace]

I'm not interesting in 'building a relationship' with a doctor - what I am interested in is their scientific perspective when it comes to analysing my numbers. They can't know the full story simply because no, it's impossible and indeed completely unreasonable to expect a person who works within diabetes as a job to have the same perspective or understanding as someone who lives with it 24/7 and I think that's part of the problem - unreasonable expectations.

You get out of your doctors what you put in - if you talk to them honestly, genuinely share the information and knowledge you have and they don't and respectfully listen to their take on the situation, you will get a far, far better treatment experience. If you're rude, unco-operative and take the view that they're just there to sign the prescriptions, that's all you'll get out of them.

...

When it comes to dosing, no, I wouldn't trust a doctor or endo to give me a proper fixed dosing recommendation - but if they said things like "you might want to look at increasing your dose by a bit at this time" (rather than giving specific numbers), I'd be inclined to listen.

I agree to a point, but I've had precious few bits of wisdom ever thrown my way, and I ask for them as best I can. Mostly I find they manage by numbers: "Your A1C is fine, your LDL is a bit high - here's a statin, and your albumin is showing - here's an ACE. Cya in six months. Please call my nurse for bloodwork."

Pfft!

[wolf 06488]

there are many diferent doctors and its nice that your going to e one but like i said there are many different kinds such has dentists, children doctor, dentist, surgen,xray,Physiatrist,snd many more each one takes different college time but even if its going to take a long time in college you can tell them that you want totake the crash coarse and there will be less college years but you will go there more during the week, for your high school courses you should ask your counsler when your going to pick you classes,,,and as for the low income.....i mean you can get a job when you turn 16 or 18 if you want.

What are you talking about? LOL. Did you even read the discussion matter for this thread?