Endos and Don’ts

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

Kate’s post last week got me thinking about why I persevere with paying a lot of money to see an endo (see my reasons below) and I got a sense of deja vu. Way back in the day when we were younger and brasher I recall having similar conversations and I dug out an anecdote of a visit to the endo sent to me in the early 90s by a D friend that seemed to sum up how he and many of us felt-enjoy, I still get a good laugh out of this….

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Today I trotted off to see my endo. I’ve been pumping for about 6 months and have not had the need to see anyone since than but the main reason I went was to get my fitness to drive form filled out.

I rock up and he asks me who I’ve been seeing since I started pumping and he’s not at all happy with my answer. I told him that I’ve met with several pumpers here in Adelaide and in Melbourne and have received all the information I’ve required. That as a result of that I’m feeling content and confident with my treatment. I was quite furious at his blatant disregard and lack of interest in a peer education and support strategy especially seeing that there exists no adequate medical support for pumps in SA. 

dTraBenT9I would like you to go and see Ms Latoya Jackson, the new educator down at the Shithole Royal Hospital” he says in his smug endo manner.

“I don’t feel the need to see her thanks very much. I have all the supports I need and I’m not interested in seeing someone else. Besides, Shithole hospital wont accept my private health cover (all but the one I’m on) so I can’t afford to see her. Besides, even if cost wasn’t an option; I have nothing I want/need to discuss with her. Basically I feel that you just want me to pay you cash so I can become your guinea pig and I’d rather not” I say quite calmly.

“But John, I know there’s nothing to gain from seeing her but I think you should pay to see her anyway” He says confidently.

I’m indignant and uninterested. I went to see him for a few specific reasons and had a few other questions I wanted to ask him but it was all about him and not my concerns. I always try to avoid letting health professionals control what’s discussed but some old fuddy duddies are so impossible to negotiate with. Each time I’d try to tell him about what I’ve learnt or how I came across my knowledge he was quite dismissive because it didn’t come from one of his ‘approved’ avenues of proper medical procedure, “John, I know you think you know but you don’t cos really I think you’re quite moronic. John you must realise that unless you pay me or one of my colleagues a lot of money to teach you nothing than you really don’t know anything. OK?!”.

Then we get to my HbA1c. It was 6.2 previously and now is 6.6. He has concerns. I was very proud of myself that I managed to restrain from standing on his desk and urinating all over it.

There were a few elevated readings that he worried about and wanted me to try and get my control tighter. I told him that I agreed and that I was not quite obsessive compulsive enough right now and that I’ve actually been chilling out a bit and not stressing so much which has meant my control has gone up…to still an EXCELLENT level. He has a phone call that he needs to leave the office for and I start darting my eyes about the room looking for things to steal, problem is he only has useless possessions and none of that weird and interesting doctor toys and shit.

I was really disappointed in the visit. I left with unanswered questions and I didn’t actually gain any new knowledge or confidence from seeing him. He told me my Hba1c which I could have bribed the lab to do anyway and he filled in my fitness to drive form -big deal. He didn’t listen to my concerns, he didn’t take me seriously and he didn’t respect my choice of education and support -a proven model of success.

Anyway I’m home now and I’ve found my high-school chemistry set so I’m going to try to do my own pancreas transplant and finally prove to my endo that I’m in complete control….. I’m sure if I told him I was considering that he’d give me some disapproving look and call an assylum instead of actually attempting to display a sense of humour.chemistryset

 

 

 

 

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In the interests of being balanced, I thought I should set out why I’m not ditching my endo anytime soon.  I don’t see dieticians or diabetes educators and nobody has suggested that I should in the last 30 years or so but I persevere with an endo because:

*Not all endos are like the one described by John. If you’re unlucky enough to end up with one like that-move on. My endo is positive and down to earth and appreciates how hard it is to keep my a1c in the 7s without trouble with hyps.

*I find having a set appointment to discuss diabetes and my Hba1c keeps me a little bit more focused on my diabetes. That said, just getting my a1c sent directly from the lab might be just as effective.

*I have been hypothyroid as well as diabetic since childhood and my endo can review thyroid stuff as well as my bone density which is an hereditary problem for most of the women in my family.

*There is a school of thought and some evidence (I think) that seems intuitively appealing that continuity of care leads to better health outcomes. The American Academy of Family Physicians defines the concept as follows:  “Continuity of care is rooted in a long-term patient-physician partnership in which the physician knows the patient’s history from experience and can integrate new information and decisions from a whole-patient perspective efficiently without extensive investigation or record review.”  Essentially I take this as meaning that if my endo knows my long-term health history, they’re not going to send me for a whole lot of unnecessary checks and tests or panic me unnecessarily.

*If something health-wise does blow up, it can be easier and quicker to access the right health-care through your existing networks of health professionals.

*About every 3rd or 4th appointment I do have something about which I want a medical opinion. It’s never specifically about my blood sugars or insulin but about new studies or meds or complications real or potential eg, is amylin worth investigating as an adjunct to taking insulin?  Who should I see about my frozen shoulder?

So, for now I’ll keep my appointment but who knows about next year, the one after or 10 years on.

One thought on “Endos and Don’ts

  1. Exceptionally happy with my current endo, who comes free with the local hospital and is full of awesomeness and tons of information about the latest studies. I see him about every 6 months. If I need a new pump or have a problem, I have the CDE attached to my endo, who is awesome, and who I almost never see. He has T1 too – major benefit. I can email either of them if I have a problem. There’s also a dietician who, lovely as she is, will make me end up looking like a beached whale with her food recommendations. I’ve opted out. Gluten free, dairy free… not much left other than the fresh food I want to eat. My GP generally leaves me alone. He looks at my A1C (6.0 last time) and says… hmmm, very good, very good. This is all exactly where I want it and where I want to be after 35 years. Oh sure, I’d like more funding for Pumps and CGMs, but that’s another story. No horror stories, just the very fabulous luck of the draw with getting this particular endo and his team. Yes, it continuity, it’s access and it’s information, not always diabetes related – same as you Melinda. It’s a good place to be.

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