Both my endo (of over 20 years) and my ophthalmologist (of at least 15 years) have retired unexpectedly within 6 months of each other. I was taking it in stride; an eye doc from the same office took over my care. As for a new endo, I was told that a new one would be assigned to me from the same group of doctors as my previous endo.
Well, I’ve found that I will be meeting with a nurse practitioner from now on; one of the endos will “oversee” my care, but who knows if I’ll ever even meet the guy. This scares me because I always met with my previous endo and he took the time to discuss any concerns or issues. At least he knew who I was! Maybe the nurse will be great–I won’t know until my next appointment in the Fall–but as I age I feel like things could go wrong fast and there won’t be a doctor truly familiar with my care to help me if I’m hospitalized.
As for the new ophthalmologist, he seems to be a good dr, but I think I spent maybe 3 minutes with him at my last appointment. They did a visual fields test, as usual, and he did a quick look at my eyes without dilating them, then he rushed on to the next patient. This worries me because I have had elevated eye pressure for the last 10 years or so which my previous endo has watched closely. It’s not glaucoma yet, but it likely will be at some point. My previous dr. also took the time to discuss my care with me, as well as get to know me a bit as a person.
I suspect I don’t have a safety net with my diabetes care somehow, and it scares me. I will admit I’m not good with change, but the care I’m getting now doesn’t seem as focused as it once was. Is this just how things are going to be now? Is it this way for everyone?
I have seen the Eye clinic’s retinal specialists for years. They took excellent care of me and had triage nurses on call if I had any urgent situation. Now the practice makes us see an optometrist with a retinal specialty. The guy was quirky fast and rude. Imnot pleased. Having cataract surgery at this clinic in two weeks. I hope it goes well.
Ugh. I had a retina dr (from the same practice I go to now) do lasers on one eye when it had a bleed about 30 years ago. I refused to go back to him, he was such an a***ole. Yes, I want good care, but I’m not paying them to emotionally abuse me.
I had a lot of pan retinal laser and then about three eye injections over many years. My doctor called me at home to make sure I was ok. One time she called and said not to come to my appointment because the roads were too icy. A gem. A rare gem.
My experience hasn’t been the same but it has been bad in different ways. You have to be ready to advocate for yourself. With your endo that might be asking the practice for appointments with a doctor. They’ll resist, keep asking till you get a yes or no. I look at changing doctors like I’m hiring a new employee to be on my care team. It is great when the first person you interview checks all the boxes but sometimes it takes longer.
For the eye doc, I had a retinal surgeon that was doing a great job keeping track of changes when I was having problems. I ran into a coworker in the waiting room, after two visits he came to me and said his pervious doc was way better. I’ve moved since and the two retinal specialists I’ve seen can’t take notes to save their lives and its very much a get it, get imaged by some machines and get out experience. The first guy wasn’t even looking at my retinas and was clearly just trying to sell the services he offered regardless if they were the best option, the second one looks but without notes there isn’t much point.
The barely good enough endo I had been seeing left last year and I had to find a new one. Since I have a HMO plan I went back to my PCP for a referral and when discussing the terrible list of in network endos I had to choose from he said “you are fine now, if you need a good endo in the future we’ll find one then.” His advice isn’t working out well for me but is another way of looking at the problem.
Your doctor does not see you in hospital anyway. My understanding is that pretty much all hospitals hire rotating hospitaleers (not sure this terminology is correct) who deal with hospitalized patients. I found this out when my husband was hospitalized over 10 years ago and I received a bill from a doctor from a state nowhere near here. As I tracked this down, I ended up speaking to the hospital manager who explained it to me. I was outraged that at one of the most traumatic times in life, the doctor who had a long time relationship with him was not taking care of him. It makes no sense to me at all.
I have always promoted, look for a doctor you get along with and like. It doesn’t always change how you are cared for, but it could, if you feel you have a doctor you can talk to and is on your side, instead of just being one of his/her patients.
That being said, nowadays when there is such a shortage of doctors and specialists, it’s not always as easy.
Agreed! Sadly, I liked both of my previous doctors and felt like they were on my side. Things seem to have changed so much since I first started going to either of them. It’s scary and frustrating.
My family dealt with that when my dad was hospitalized in 2014 for gall bladder issues. His family doctor had no involvement whatsoever; it was all hospitalists. It makes no sense to me, either.
I will tell you that back in 2000, I was hospitalized for a burst appendix. I had been on an insulin pump for a few months by then, but the hospital wanted to put me on an IV insulin drip. I put up a fuss because I was closely monitoring my glucose levels and they were in normal range despite the infection. Finally I actually called my endo’s office, told them the situation, and they got involved. My husband said the endo put up a fight with the hospital staff out in the hallway to keep me on the pump. In the end, they kept me on the pump but warned that as soon as my blood glucose went up they were going to yank it off and do the IV. Also, this was a teaching hospital, and the med students had no idea what an insulin pump was at that time. Fun days.
That is worrisome. I see a retinologist yearly and he gives a very estensive exam. The camera work is done by assistants, but he does a hands on exam where he is looking into my eyes and checking every bit of my retinas. He wll pull the pictures up on the monitor and explain what it shows.
My 1st ophthalmologist was sthe same, but our insurance threw him/us under the bus. The 2nd waws much like you described I knew of Dr Kuhl because of bicycling and asked my endo to refer me.
As to an endo nurse practitioner. I have no experience, but I have great resspect for the 2 NPs, oncology and cardiology. They are fully qualified in my opinion and are more personable than the doctors. The docs are good, but the NPs make me feel like family,
Of course your experience may differ. Just give the NP an honest chance.
Yes, this IS how it’s going to be from now on for most of us. Lost having a CDE from my Doctor’s office many years ago. Last time changed Endo’s, over 10 years ago, only saw the Endo on 1st visit. After that, was Nurse Practitioner. However, it is even better for me. The NP specializes in Diabetes, and is very good and knowledgeable about it. Handles my Rx’s, insurance auth for pump, sensors, etc. Still occasionally see the Endo, but not usually Diabetes related issues.
I myself will be getting a new endo this fall but at least it stays within the practice so I don’t have to do the whole search/wait 6 months for an appointment thing again.
I have been with my current opthalmologist for 15+ years. While the office has all the fancy cameras and scanners run by his staff, he makes it perfectly clear that the dilated eye exam with the slit lamp (which only takes a couple minutes after being dilated) remains the best tool to detect retinopathy.
When I was diagnosed at age 15 I quickly found my way to my state’s research hospital where endos and opthamologists and other specialties were all under the same roof. I struggled a lot when I left college and had to try to piece together all my health care myself. I’m just “OK” at it today.
@Lisa_H1 I can appreciate your concerns as I have similar feelings about docs once in a while. My recommendation, not knowing your insurance etc., is to give the NP a chance. He/she may be better than your previous Endo. Have a discussion with her/him, layout your expectations and see what he/she says. If it doesn’t pan out, then ask around your area, get recommendations about Endos with a positive reputation. You may want to check the LoopandLearn website (https://www.loopandlearn.org) as they have a spreadsheet listing of recognized good Endos around the world that work with DIY systems (Loop, Trio, etc.) but the same list of docs don’t require DIY use, they’re just good Endos. Regarding your Opthmalogist, you may not be comfortable doing it, but try having a discussion with the doc about your expectations and perceptions. If that doesn’t bring about change and info to your liking, then look at other eye docs in your area, request an interview appt, layout your expectations, and get their perspectives, pick one and try them on for size; if they’re not supportive of the interview, they probably don’t deserve your consideration. And do what research you can about the docs on-line; it isn’t easy, but you may get a clue whether they rushed to get to see as many patients as possible or take their time. Of course you’ll have to make it thru the front office staff first and that can be challenging (my wife and I currently see an eye doc that is very good, but her front office staff are terrible). It isn’t a short process, but it’s the only way I know how to work.
This may be a blessing in disguise. Endos have historically had such tunnel vision that their near entire focus has been on blood sugar control, with a stab at controlling cholesterol. With all the great blood sugar control technologies that have been developed in the past few decades, endos need to focus more on what kills a diabetic. Most diabetics now die of heart-related issues, and very little time and effort go into controlling cholesterol and the leading killer, atherosclerosis.
Even the best of endos tend to think “not my problem” if blood sugar is in control.
Hi Lisa: I think that this is the direction healthcare is going in. My first endo, way back in the 1980s checked my injection sites, my feet, my eyes and my reflexes. Those days are long gone. I still see an endo, but he never really does anything, except go over my labs, tell me my H1C is great, or I need to improve it, tells me I’m mostly in target and that he could go down to seeing me once a year if I wanted. I said no, I’m better being monitored more closely. End of discussion. I leave. It’s the pump nurse (dietician and nurse) who suggests pump changes and who really talks to me about that’s going on with my diabetes. She’s the 4th one I’ve had over my time in that office and they’ll all been great. As for ophthalmologists, my newest one (7 years) is quick and brusque, but all the tests are done and he’s keeping an eye on my cataracts. I can’t complain about him either, since he clearly knows what he’s doing. Just make sure you always mention your elevated eye pressure when you talk to him (her). I do this all the time with mine regarding my dry eyes. Also, as someone else pointed out, you don’t usually see your own doctor in the hospital. You generally see the hospitalist. My own family doctor did that job before he took over my retiring doctor’s practice. Best of luck going forward.
My endo who is fairly young does a thorough examination. He doesn’t check my eyes leaving that to my retinologist and ophthalmologist. He looks at me thyroid and if it looks odd Will palpate it.
I’m lucky to have him as endos are quite rare here anyway. I was referred to him shortly after he opened his practice. He now has a full plate of patients with various endocrine diseases, not just diabetes.
I wish he would add a NP certified in diabetes education to the practice.
Thank you all for your replies! They’ve given me much to think about, and they’ve helped me calm down a bit (I’m a natural worrier.) I will take a deep breath and see what happens.
My first endo, way back in the 1980s checked my injection sites, my feet, my eyes and my reflexes. Those days are long gone.
I was also diagnosed in early 80’s and at the time if you were an endo you were a doctor of internal medicine and that meant you spent a lot of time poking and prodding your patient’s internal organs. And if like me your endo was also the state university hospital training young doctors that meant that a dozen students got to poke and prod your internal organs too.
This was before A1C’s and the big slate of blood tests. In fact my endo diagnosed me with hypothyroidism based on poking and prodding of my thyroid and a follow up blood test confirmed that.
Those days are long gone. I still see an endo, but he never really does anything, except go over my labs
Indeed that seems to be the modern way. I sometimes ask my docs (now all younger than me) if they want to poke or prod me like in the good old days and I may as well be Grampa Simpson talking about how nickels had bees on them and I wore an onion on my belt because that was the style at the time.
I’m more or less happy with my various doctors. One thing I’ve found is that whenever I have an ophthalmologist appointment, it’s almost always a long wait — first a long wait to get dilated, then another long wait after being dilated and having the various tests and yet another long wait to see the doctor. Sometimes, it’s like two hours and rarely less than one. This has been true (with possibly one exception) over decades and across different practices.
I’m just curious. Is this an ophthalmologist thing? A New York ophthalmologist thing? Or, as I suspect, was I put on a list many years ago and singled out to spend, at this point, several days of my life sitting in ophthalmologist waiting rooms half blind from dilating drops?
My first endo, Dr Henderson, was a T1 in Huntingdon (I lived in Cambridge, so his diabetic endocrinology practice was the one I could go to). He didn’t have much time. GPs handled diabetics so it took an effort (by my first wife) to get me there; there’s probably some appropriate historical analogy.
He was great. He understood. He didn’t have much time and I didn’t understand (at that time.) Still, despite years of highs and lows running riot through my brain cells I remember him.
He had a lot of people helping him. A lot, a whole ward of a hospital. As a fellow T1 I have never ever managed to manage that many people at once. My limit is three and even then I’m out of my depth.
It is the guy in charge that matters. I think Dr Henderson saw every patient but maybe it was just the irritating ones.
My current endo rotates, once me then once his NP. I don’t know why, maybe I should ask him. I do like them both but, what’s to like? Someone who will sweet talk me, exploit me or someone who will heal me? Difficult to tell, sometimes I’m difficult to communicate to.
