Last year my insurance changed; I lost my beloved doctor of the last 12 years and switched to a different practice. At this point, I’m extremely frustrated by the doctor’s fixation on having the shiniest toy in the box and refusal to provide any suggestions on how to improve my control.
On my first visit, the doctor disclosed that he owned stock in Dexcom and thinks CGMs are a wonderful tool… Every appointment since, he badgers me about why I’m not on a CGM and how I’m killing myself “by throwing money away on lattes instead of investing in my health.” Yeah… I’m a recent graduate with an entry-level job and crippling student loans. There just isn’t money for the sensors in my budget, no matter how much he insults me. He spends more time during my appointments lecturing me about how “someone in my position” needs to look for jobs that provides top quality health insurance than discussing my medical care.
I have a Medtronic pump - he downloaded my pump once, complained that the charts were too confusing to read, and has refused to download it ever since. I religiously log my 8-9 tests per day in MySugr - again, he doesn’t like the setup and won’t look at the reports. I had to download the CSV sheets and reformat them into the traditional “Breakfast/Lunch/Dinner/Evening” sugar sheet - deleting a third of the data in the process - before he’d even accept a copy to put in my file instead of throwing it in the trash.
We did a 3-day run with a loaner CGM last fall… He came up with one tweak to my basal rates as a result; when I brought it up at my last appointment, he had completely forgotten this happened and has managed to loose the CGM report from my chart. Given how little value we got out of the first attempt, I’m not really interested in repeating the experiment.
OTOH, I’m afraid that if I leave this doctor, the alternatives are even worse. The other practices nearby include (1) the office that cancelled my appointment because the doctor went to a conference, then refused to process refill requests for a month and a half because I hadn’t been in within the last 6 moths; (2) the office that fraudulently billed $400 of services that were not rendered; and (3) the office that claimed there is no difference between T1D and T2D and that T1D could be controlled by diet and exercise.
Do any of you brave forum members have a more polite way to tell this doctor to stop beating a dead horse and work with the materials we already have, or do I need to accept that I’m basically on my own for determining treatment options and relegate this doctor to a prescription/lab test dispenser?
One suggestion while not immediately helpful, you can file a complaint about this provider to your insurance company. Too many complaints, they might drop him as one of their preferred providers. You can also ask your insurance to consider covering your old doctor and state your experiences with their “in-net” options. I’d be concerned about a doctor pushing a device of any kind they have stock options in. That is very unethical. Sorry I don’t have any better suggestions.
“Charts were too confusing . . . has refused to download it ever since.”
“Won’t look at the reports.”
“Had completely forgotten this happened.”
“Managed to lose the CGM report.”
Urges you to do the financially impossible instead of trying to develop a solution that works for you.
This isn’t a pattern—it’s flashing red lights and sirens. This guy may have the correct initials after his name, but he’s not a doctor in any sense that means anything; at least, not while he’s with you.
You have to be responsible for your own health; it’s clear your provider isn’t. So either you need to find someone who will treat you like a partner and not an insubordinate pupil—and yes, I get that may be difficult or even impossible at the present time—or, as you put it so well, determine your own best course “and relegate this doctor to a prescription/lab test dispenser”.
It’s unfortunate but true that many of us here have had to do the latter to one degree or another. But after all, you’re the one with skin in the game, so if that’s what you gotta do . . . you can finish the sentence. BUT: you’ll never be “on your own” as long as this community is here. Whatever wrinkle of diabetes you’re dealing with at a given moment, there is someone among these thousands of members who’s been there, done that, and is willing to share their experience.
You can fashion a reliable solution from the present mess, though it may be a lot more work than it ought to be. Please stay and let us know how you’re doing.
It doesn’t appear your doctor is interested and maybe even not capable of the analysis and insight you seek. No great loss. You need to become the BG trend guru. You have skin in the game and live your blood glucose all day, every day. That kind of time lever puts you light years ahead of most MD’s. And somehow the perspective of the someone with an actual stake in the outcome is better motivated to take notice.
I’m experimenting with a fingerstick app called Vigilant. This company has looked at huge data files on BG and derived some pattern recognition so that it can tell you when you’re apt to go low or high. No CGM needed and I’m finding it’s indications are helpful and legitimate. I use the Roche Aviva Connect meter and Aviva Plus test strips. The meter connects via BlueTooth to the app on my iPhone.
You may use any meter to get the data but then will have to do the data entry.
I was fortunate with the first provider I had when first diagnosed about seven years ago. Their care model (collaboration between doctors, nurses and the patient) gave me the understanding about what I needed to do. I now have a decent endo, but his knowledge of technology is low. So, I ask him to send me to an RN/CDE who also happens to be a Type 1 diabetic. He approves it, because it has improved my A1C and BG stability immensely.
So your endo doesn’t have to know or do everything as long as he/she is willing to get you to the experts who know what he doesn’t. You need to tell that endo, “This is the technology I’m using. It’s your job to treat me. Even if I’m not using a CGM.”
If he still isn’t interested in helping you, I’d report him to whatever Board that certified him to practice Endocrinology . His behavior, attitude and medical professionalism is sorely lacking. No one should have to put up with his B.S…
From a doctors perspective I can understand not wanting to have to wade through dozens of different reporting formats.
I don’t think I’ve ever really had a doctor look in detail at my logs. Instead I provide high level overviews of my blood sugars. In a single page I show my readings like below:
And then I provide averages and standard deviations for my fastings and after meal numbers. That is basically all any doctor has ever been able to tolerate.
But of course some of this could be that my doctors has rarely if every had anything useful to recommend about my day by day control.
That bit about owning stock in Dexcom while pestering you to get one still sticks in my craw. I have to file an annual report with the state Government Ethics Commission detailing my sources of income. In my world, what he’s doing is called a Conflict of Interest.
Agreed, anyone who is a medical professional or works in the medical field knows this is a major issue and yes definitely a conflict of interest. Working for a health insurance company, when our in-net providers get complaints about them it is looked into and investigated, and too many complaints that provider risks remaining a preferred provider. Also as someone else posted, a complaint can be filed against the state board of medicine as well.
Although owning stock in a medical/pharmaceutical company might seem to be a serious conflict of interest, it is only the tip of the iceberg. The biggest problem is that the pharmaceutical/medical device industry directly bribes and coerces doctors to change their prescribing practices and they almost totally own the primary sources of medical information for many doctors. It is pharma reps that go out and train and educate doctors about drugs and medical devices.
pps. My former endo (“He who shall not be named”) has now received a total of $973,000 in “payments” (this is actually only reported payments, it is probably far more).
Oh my, he sounds like a piece of work. The concerns about his Dexcom involvement aside, he just doesn’t sound very bright, and zero bedside manner, which is obviously critical with Type 1. Would he be willing to look at the Minimed Carelink reports if you download them there? Your pump, assuming it’s within the last few years, automatically stores 2 weeks’ worth of BG’s (if you use a linked pump or manually dial them in). They may have sent you a USB connector in the box that came with the pump, so check the box if you still have it, or you can order one but I don’t think they’re very cheap. Carelink is the system most endos use, and if he is still unwilling to read those he is simply not competent and you should seek another, even if it’s in another city 1-2 hours away. I had to do that for several years but it was worth it. In the meantime, is there a Certified Diabetes Educator in your area you could meet with? They often do a better job at reviewing BG reports anyway, and your endo would give you a referral if needed. Good luck!
Thanks Brian, I forgot about that website. My doc who I love looks like he has taken only about $2300 over 3 years, mostly lunches and a couple of hotel nights, which sounds reasonable to me. Your guy sounds like he has made a whole lifestyle out of it.
@Brian_BSC - I didn’t know about that Propublica site. It was disappointing to see my doctors taking significant money from Big Pharma. I suspected as much but to see it in black and white troubles me.
I think the taint of money undermines logical thinking. I’d like to think my physician is only looking out for my health based on sound science and clinical experience. You just can’t conclude that. The need to look out for your own best interest is further supported by the realty of money and influence in medicine.
Wow. I’m just really not sure what to think of what I found. $58K by Bydureon and another $54K by Ivokana for “promotional speaking” in 2014. Sometimes multiple payments a month (or even per day). No wonder it can be so hard to get an appointment. She must never be there!
I’m probably going to regret even wondering about this, but . . . I wonder how much of what we pay for drugs could be eliminated if those payoffs weren’t being made.
