Diabetes: Why do Doctors Miss the Wood for the Trees?

I find it very strange that when you are hospitalized, the doctors looking after you are concerned only with the problem you have reported at the time of admission and not with anything else.

Back in 1998 when I was hospitalized for “abdominal pain” (my complaint), the doctor’s (correct) prognosis was acute pancreatitis. I went through a battery of tests which confirmed this. However, the CT scan also showed the presence of a number of stones in the gallbladder.

My wife pointed this out to the doctor who dismissed the finding as a “secondary” issue that “could be tackled later. We have to treat the pancreatitis first.”

To cut the long story short, I was soon developing obstructive jaundice periodically. At the same time it was discovered that I had developed Type 2 diabetes and was put on insulin (my choice, since I had researched the problem). And, finally, 3 ERCPs and stentings later, in 2003 it was finally decided that my gall bladder had to be removed surgically (cholecystectomy).

That is not the end of the story. Five years later, I had chronic pancreatitis and developed pancreatic abscess, and as a result, intestinal adhesions that required emergency surgery. Uncontrolled hyperglycemia added to the problems and I was in hospital for 2 months.

My saga does not end here. Fearing that I might develop an infection during the 2008 surgery (it was touch-and-go for me at that stage), the surgeon decided not to place a mesh to strengthen my abdominal wall. So a year later an incisional hernia developed, which required another surgery a few months ago.

My point is that if the gallstones had been removed laparoscopically in 1998, maybe, just maybe, I might not have developed type 2 diabetes.

I have brought this up with many doctors time and again. My argument is: Gallstones are also a cause for pancreatitis (though not necessarily in my case), which means damage to the pancreas that produce insulin. So why weren’t the gallstones attacked earlier? I may have been a healthier individual today. But, alas, I still have to get an honest, in-your-face answer. As with any profession, in the world of medicine, too, dog doesn’t eat dog.

But this just strengthens my belief – and I’ve written about this based on an empirical study – that in the age of ‘superspeciality’, our medical schools are producing graduates who miss the wood for the trees.

I can therefore empathize with a British pensioner who developed diabetes after battling pancreatic cancer and nearly died because medics failed to diagnose the condition.

According to a news report, Raymond Ellerby, 67, lost three stone in four weeks because his diabetes was not spotted. It was only when he slipped into a diabetes-induced coma – a life-threatening condition – that doctors discovered what was wrong with him.

Diabetes is always a risk following pancreatic surgery when part of the pancreas, which produces insulin to regulate the body’s sugar levels, is removed. And Ellerby had an operation to remove part of his pancreas at Castle Hill Hospital at Hull, East Yorkshire, in December 2009. Initially, he seemed to recover well but his health then started to deteriorate late spring, with his weight plummeting and feelings of dizziness, constant nausea and pain.

“It was like being drunk all the time – I didn’t know what I was doing…I was having hallucinations and I knew I didn’t feel like myself. Eventually I was found collapsed on the floor of my lounge by my daughter. If she hadn’t found me, I wouldn’t be here now,” he recalls.

The great-grandfather was taken to Hull Royal Infirmary where doctors told his family he could die within hours. But he came round and was on the Intensive Care Unit for about a week.

Following his recovery, Ellerby complained to the UK Patient Advice and Liaison Service for Hull and East Yorkshire Hospitals NHS Trust. He has now been told procedures to identify diabetes in patients with pancreatic cancer have been “changed completely”.

A letter from Jenny Barker, assistant service manager in digestive diseases at Castle Hill Hospital, dated February 11, contained an apology from Dr Anthony Maraveyas, senior lecturer in oncology. She said: "Dr Maraveyas would like to reassure you that since this incident, the Trust has changed practice completely and all patients with a newly-diagnosed pancreatic cancer, who come to the unit, have a baseline glucose test, which is reviewed at regular intervals. He would like to apologize once again for any distress or anxiety caused due to your diabetic symptoms not being identified initially."

Wow, even a layman would have thought that if damaged pancreas is involved, “a baseline glucose test, which is reviewed at regular intervals,” would be the first thing ANY doctor would order.

In essence, thanks to the doctor’s incompetence, Ellerby had received a death sentence. That he survived to tell the tale is another story. And all he got in return was a letter from the British NHS Trust chief executive Phil Morley, saying, "Please accept my apologies for the distress you and our family have experienced."

So my advice to everyone is: Research your condition and take a second opinion. And DON’T put your faith in just one doctor ‒ he may be clueless about treating diabetes-related problems.

MY ONLY reasoning is that docs only look for what’s on the paper. INHO, House (tv doc) is the ONLY doc I’ve seen who considers the wildest possibilities. Docs really only receive a minimal number of hours of instruction on diseases such as diabetes…very minimal…that’s why most patients know more about their disease than their docs. The only one that I have met that was up on things on my level was a doc who was also a diabetic…so if you have something else besides what you are seeing the doc for…you’d better write it down, and express it to them immediately when they open the door.

Guess it depends on where you are, when I was last in hospital for an emergency hysterectomy they where right on top of things when it came to treating my diabetes (my endo came by to see me twice a day to make sure things where going alright - i was spiking and crashing after surgery and they couldn’t understand why). The doc who did my hysterectomy only came in twice to check me out, I saw more of the dietitian who as assigned to me and my endo then I did of my gyn or any other doc.

if you go to the ER that is what they treat… its meant for that.
I would not be typing if I had not begged and seeked out a Secret Nurse Practioner. No Doctors would listen to me. So she agreed I could have a CT scan, and GUESS what I was right, I had a Andrenal Tumor the size of a Softball.
Doctors don’t listen. I think what they bring with them is there lives, and problems and dump them in a negeltful way on the Patients… I fear them, haven’t much trust in them. They need to change and make a Presense to us that there INTERESTED and CARE…
On Another Note… Doctors can be C students and Pass and get to be Doctors… So do we have more of them around the world and The A students work in Rich cities…

They get mad at us for researching our ILL’s and it wouldn’t happen if they KNEW what we have learned. It seems so many are teaching there Doctors. They know nothing on Nutrition. There is nothing like having a Obese Dr telling a Pt to Lose weight and they will be healthy. The example has been lost…

I Don’t know where we will be in 10 yrs, so many retiring and not enough in med school. Maybe we will have to be are own Doctors.

You are totally correct, Roger. We must always be our own advocates for our health. Especially when it comes to diabetes. When I went to the hospital for a totally different condition, I took my blood glucose meter and test strips and did my own testing. Doctors just want to treat their own specialty, they forget that the human body is an entire unit that operates together. It’s scary !!!

All of you have a point…some doctors are good…but many (most?) are so full of their own superspeciality that they fail to follow one cardinal rule - the human body works as a unit, i.e. a sum total of all parts and, more importantly, that each patient is unique…Textbooks are good at the training stage, but doctors need to go beyond them if they are in the business of saving lives, not repairing, say, automobiles…Med schools must update their curriculum from the present pathetic training being given to graduate students