Wednesday, June 18, 2008

Dr. Who

When I was diagnosed with diabetes, I didn’t have a regular doctor. I didn’t have health insurance, so I never went. I was pretty healthy. Until I wasn’t.

When I knew something was terribly wrong, I called the medical center right near where I work and got a doctor referral, based on who was available to see me as soon as possible. He diagnosed me with Type 1 Diabetes and gave me Lantus. It was 4th of July weekend, and he was about to go out of town, so he had a nurse show me how to do a shot, made an appointment to see me on Monday (three days away) and told me if I started throwing up, I should go to the emergency room.

Less than 36 hours later, I was throwing up and drove myself to the ER near my house. The doctor who was in the emergency room became my doctor, at least for the time I was in the hospital.

When I got out, I realized I needed a real doctor. I chose a good hospital/medical center near my house, read doctor’s bios online and picked one. My first doctor was perfect. I was already overwhelmed and I couldn’t handle being anymore overwhelmed, so I just wanted her to keep me alive. As it turns out, she diagnosed me with Graves disease and sent me to an endocrinologist—not for the diabetes, but for the thyroid.

Since I was new, and didn’t want information, I told my endo I was fine with the diabetes part, and that I just wanted him to deal with the thyroid. He was wise. He said okay, but to let him know if I had questions. My regular doctor just made sure my HbA1c was okay and didn’t ask any other questions or give me any other information.

About a year or so later, I wanted a doctor who wouldn’t just push me off on the nurse practitioner, and who would actually take an active role in my diabetes, so I got a referral and tried a different doctor. He asked more questions, did a little more delving, but I always got the impression he didn’t really know a whole lot about diabetes, and that I was teaching him more than he was teaching me.

Flash forward and I get married, get health insurance and have to pick a doctor in my HMO plan. The only doctor’s name I recognize is my endocrinologist, who I actually like. So I e-mail him and ask him which doctor I should go with. He gives me three names and I pick one.

She’s my current doctor and she’s very nice. She seems to know a little bit about diabetes, but since my numbers are generally under control, there’s no big discussions or plans of action. The time before last when I went to see her, I didn’t like some of my readings and asked for a referral to my endo.

I documented everything I ate, every drop of insulin, every blood test and every minute of exercise for a week so I could show him what was going on. After checking a few things, he basically told me if it wasn’t broke, we weren’t going to fix it. He said I was doing really well on the program I was on, and he was hesitant to change it. He did put me on Lipitor—my cholesterol was a little higher than he thought it should be for a diabetic and he wanted the number to come down.

My big question that I’m struggling with now is, what kind of doctor do I want? What kind of doctor do I need? What kind of diabetes health care system do I want in place? I do really well on my own, but sometimes I feel like I want a second opinion. My endo will give that to me, but my visits to him are yearly at best—should I be seeing him more often, even if I’m under control? Should I get a diabetes educator? Will they have information and ideas I can use? Do I just need a sounding board? Do I just need to do more research on my own and find out how everybody else is handling it?

I want someone who knows what needs to be known about diabetes, who knows how I play into that information and who will keep me doing my best to control it. I don’t want someone who’s too over-active, though—I don’t want to be put on medications I may not need to be on or have a zillion tests done “just in case.” I want a doctor who tells me what’s best for me, not me telling them. Does one exist? Does one exist on an HMO?

I realized a long time ago, nearly from the start, that I would have to be the lead person on my diabetes management, and I’m okay with that. But shouldn’t I have a few other people on board with me? Not even Horatio in Miami does everything all by himself…

As always, more to come…

1 comment:

Contemporary Troubadour said...

I have so many of the same questions. I found your blog while looking around on the web for information on diabetes management. I'm prediabetic (or at least, this is what my glucose tolerance test and some other factors suggest), and I like to say that my primary care physician is in denial about it -- he says a finger stick once or twice a week is all I need to worry about. I actually test six times a day (before and after meals at my peak time), which has helped me keep my sugar readings down since I'm controlling them with diet and exercise only at this time. Fortunately, I'm moving in a few months and will get started with an endocrinologist -- hope he's more proactive about management than this PCP!