People who don’t have a chronic illness might not be able to understand how important some doctor-patient relationships can be — or how much of a role it can play in emotional well-being as well as physical health. Recently during a discussion about health care plans where I work, one person was giving an example of someone going to the doctor a lot in a year as being as many as 5 or 6 times. She said it as if 6 doctor visits (ie: co-pays) per year was the extreme. When I mentioned that for the Bear and I it is regularly more like 18 visits per year, she was shocked.
When I was diagnosed (at age 29) my endo was a T1 who was probably only about 15 years older than I was. When I was interested in the Omnipod, he was totally supportive and I only found out later that he used that pump himself. This endocrinologist fit my needs to a T: he challenged me to really take charge of my life with diabetes, to make my diabetes fit my life more than making my life fit my diabetes, and he had high expectations for tight control. No matter what we discussed or what he suggested, I knew that he struggled with the same things and really understood what it takes to manage diabetes on a daily (hourly) basis.
When he left to go to a practice in another state, I was heartbroken. But, I still had a great CDE and felt that I was well-prepared to manage my own diabetes. I already made adjustments whenever needed and my A1cs were good. So, even though the endo I switched to wasn’t very challenging, engaging, or helpful – it was worth staying put just to make things easy. Not to mention that by that point I was the mother of a young child and really had enough on my plate without adding anything additional in the diabetes arena. Of course, over time the great CDE also left and I’ve been just treading water.
Well, that endo just left to go to another practice. The new place is only about 25 minutes away, but I just wasn’t connected enough to her to want to drive any further than I do now (which is about 5 minutes away from my house). When I saw her in September, she told me she was leaving, we chatted about some other endos somewhat in the area and at the end of the appointment I decided to make my next appt with the one endo left in the practice (2 leaving at the same time) so that I would have the appt but also fairly sure I would be trying to find someone else.
Long story, short (I know, it’s already long!): Anyplace else I would go would be at least 30 minutes away, and I couldn’t get a good recommendation on anyone. Time slipped by and today was the appointment with the endo that I made back in September. I went with very low expectations — I had only ever spoken to him once on the phone when he was the doc on call and maybe seen him once in the hallway at the practice. My impression from these very brief encounters was that he was kind of dour, old (maybe close to retiring?), and passive. Not what I was looking for.
Well, I’m glad to be able to say that I was very pleasantly surprised! He was personable, efficient, good with the EMR, an active listener, knowledgeable, maybe in his late 50s (though I’m bad at guessing age), and easy to talk to. We had a bit of a disagreement about whether my A1c was proof that my body still makes some insulin (despite the c-peptide test about 2 years post dx that said otherwise, and the fact that a pump malfunction shoots my bgs into the 400/500 range very quickly), and he highly recommends some kind of kidney-protective meds that I’m just not sure about. But in both instances we were able to talk about it and he was very upfront about what is not known that might be a factor in my experience.
He didn’t really have anything to offer me that I didn’t already know about my past few months of management (the CDE said “looks like your breakfast i:c ratio is a bit too aggressive, but I just changed that 2 days ago so I think I have that covered), and I always believe that there’s something that could be done differently to achieve a better result – but in general, I liked him. I would have appreciated it if he had asked me how I was feeling about my diabetes management, or if there were things I was hoping to change, but that could happen at a future appointment since this one did involve a lot of family history, and he seemed thrown off by my A1c (that conversation about whether or not I still produce insulin).* I felt at ease and like the relationship will be more positive than with my last endo, even if my first will always be my favorite 🙂 For a few years now I’ve tried to convince myself that my lackluster relationship with my endo wasn’t a big deal, that I didn’t need more than what I was getting. After this morning, I’m remembering that it can be a big deal, and I’m glad to have gotten that reminder.
*I’m trying to write about this without getting into particulars. A1cs aren’t there to compare one person with diabetes to another.