thank you everyone for your replies–i feel better knowing that this has happened to others (if that makes sense!)
if anyone wouldn’t mind reading this, i would be grateful for any comments–as i said, i’ve never been in this sort of situation before. (i think i deleted each mention of her name, if i missed one, i do apologize)
On June 17, 2009, I saw Dr. — in the division of Rheumatology for an ongoing joint problem. My appointment with her was humiliating and degrading. When Dr. ---- saw in my chart that I have type 1 diabetes, she asked when I had been diagnosed. I am currently 29 years old and was diagnosed 3 years ago at the age of 26. She asked whether my doctor had found this diagnosis strange and when I replied that I was obviously surprised to be diagnosed with diabetes, she said that it is almost unheard of for anyone to be diagnosed with type 1 diabetes at such a late age. I attempted to inform her that this is in fact a misconception, but she disagreed. From that point on, my appointment was solely focused on my diabetes management. In the winter of 2008 I was hospitalized twice for DKA resulting from a steroidal injection, which resulted in extremely high blood sugars for several weeks. My hemoglobin A1C level was elevated as a result of this, and when Dr. ---- saw the number in my lab results, she claimed she was “horrified.” She then stated that DKA does not happen accidentally and could only have resulted from poor control. (Numerous studies have shown that high doses of steroid drugs can in fact have a severe impact upon blood glucose levels.) She continued by saying that I clearly did not understand the ramifications of such blood glucose levels and that I needed to understand that unless I become more responsible in my healthcare, I will “die within the next 10 years, and at the very least, have a leg amputated, along with blindness.” Upon learning that my husband is a physician, she stated that she did not understand why my husband had not been able to impress upon me the dangerous situation that I was in. Furthermore, she did not understand why I was unable to listen to him regarding this matter. My husband is not an endocrinologist, and while he is extremely supportive and knowledgeable, I am a highly educated person who is in fact able to understand the nature of my illness without needing someone else in my family to explain it to me. Dr. ---- then stated that diabetes is a very easily managed disease, if the patient is cooperative, implying that I had until this point been uncooperative and non-compliant. Most patients with type 1 diabetes will tell you that while the disease is manageable, it is certainly not easy and involves constant battles with insurance companies and long waits between appointments. I am currently on an insulin pump and a continuous glucose monitoring system, and several other chronic illnesses which had previously been affecting my glucose levels are now better managed, but she did not take the time to do a detailed history to ask about this. While it was very difficult for me to speak during this appointment due to my anger, I did state that it is very easy to judge something strictly by a number on a piece of paper, and that chronic illness is not always either perfectly managed or easy to do so. Dr.----- replied that she does understand, because she also suffers from a chronic illness and must take a pill everyday for the rest of her life. I do not know the nature of her illness, nor do I care to, because I found her remark extremely inappropriate and unprofessional. While as a compassionate person I am sorry that she suffers from some sort of illness, I cannot compare her healthcare regimen with my own, which prior to starting on an insulin pump involved 8-10 injections daily. This was compounded for me by extreme anxiety with needles. I am not at my appointment to hear my doctor state, “You should deal with this better because I am also very sick and I’m managing.”
Dr. ----- then continued to tell me that it is clear that I am an otherwise very responsible person, but that I seemed to have been unable until this point to manage my diabetes treatment appropriately. She repeated several times that I was going to die, and probably very soon. My appointment was spent defending myself to a doctor who does not have a good grasp of type 1 diabetes beyond appropriate lab work ranges. None of my rheumatoid problems were addressed during the office visit, and while she did order lab work (none of which was explained to me), x-rays and a follow-up appointment, I will not be returning as her patient. I wanted to walk out of the appointment before it was finished because I felt it was such a threatening environment, but was too angry and shocked to do so. This appointment was the worst experience I have ever had with anyone in a professional capacity. I was lectured for 20 minutes about my impending death, my lack of caring about my medical situation, possibly amputation and blindness, the inability to have children, and my lack of responsibility. While I agree that there are instances in which a patient, for whatever reason, is non-compliant with treatment, and needs to be informed of the potential consequences, I also firmly believe that this needs to be done in a non-threatening environment and by a physician who is involved in the treatment of the problem. Similarly, a physician should not make a patient feel embarrassed or ashamed of a medical condition for which the patient is actively taking steps to treat. My diabetes is much more than a lab result from December of 2008. Dr. ----- closed by stating that she could tell she had offended me and that she was sorry for that, but that it was clear no one else up to this point had been upfront with me about the true nature of my illness and all of the complications I will undoubtedly experience, and that she felt a strong responsibility to tell me this, particularly since my husband had been unable to do so. She then concluded that she is “just a very upfront person,” and that she did not mean to be rude.
I would appreciate a written apology from Dr. ---- as well as a follow-up appointment with a different doctor in the division of Rheumatology. I also advise that information regarding the late-onset of type 1 diabetes be distributed to physicians within the department who may be unsure or unaware of the specifics of the illness, and further suggest a discussion held on the manner in which chronic illness is addressed in the future, particularly if the lab work being reviewed is not current or the physician does not have the patient’s detailed medical history.