I live in Montana and have an awesome doctor. He's the one who convinced me to wear a pump. He's also a research doc and I hold him in the highest esteem.
This Winter we are snowbirding in CA and it's time for my quaterly labs etc. I made an appt with a doc here (not an endo) that was recommended by the MM rep. I'm so impressed with my ultra-thorough super-doc in MT that I know I'm setting a very high bar for this new one.
I need a reality check.
Does anyone want to comment on what reasonabe expectations are to have for a doc as a pump user?
What questions would you ask?
Or should I just sit back and observe her style and decide later whether I want to return?
All viewpoints will be welcome.
And thanks always for being here for me!
Do you have any specific concerns?
IMHO while some endos are real fanatics about bg control there are other aspects of health that a doc has to help us stay on top of, too. We are more than just our bg's. A non-endo doc may not care too much about your pump mechanics but might have some good insight into the rest of your health. No idea if MM only recommends pump fanatic docs or has a broader scope.
If you have a specific problem ask the Doc for help...on the other hand I would
suspect you probably have a pretty good idea how and when to deal with BG
issues. Any Doctor should be fine to order labs..JMHO
My Endo is easy to contact by email he is a teaching Doctor at the University of
Texas it's easy to contact him or his staff . If I'm going to be away from
home for a extended period of time I will always ask my Endo to send a referral
letter before I leave town.
Thanks, John, for pointing me back to my excellent doc/trainer team. Great idea to email them!
I don't understand your question. Do you mean you will be in CA for several months only, or moving there? If Montana will continue to be your residence, I don't understand the anxiety over a one-time visit to an MD to get your lab work and quarterly visit. Especially with a MM rep recommendation. You don't think the rep would send you to a 'bad' doc do you?! If you are looking for a CA dr and keeping the MT dr, I don't think either would be happy being co-primary on your diabetes.
But to answer your question,I can't. For me, I can tell by the way the visit goes and the comments made and responses to me whether the doc is one who works with the client or whether the doc has to be in charge. I don't know your criteria, but that one is mine. If she recommended changing anything major, without getting to know more about you, or asking you about it, then that could be a red flag. Sorry if I sound unhelpful, I don't mean to be.
I think it depends what you are looking for. I'm assuming you'll be in California for a few months and just want somebody to maintain, do labs, write prescriptions (if needed during your stay) and be available for any problems that come up.
I generally don't expect much knowledge about Type 1 from a PCP, and zero knowledge of pump mechanics (although with a MM referral that might be different). But I'm ok with that as it meets my needs and I just manage my own blood sugar.
You don't say what part of California you are in. If you are in the Bay Area, I started a wonderful Type 1 Women's Group which meets monthly and I can direct you to the mailing list. (that list would also be a way to get doctor referrals). There are also groups on here for Northern and Southern California. Enjoy your visit to our sunny state (I say that, but I now live in the mountains where it snows....yes, there is snow in California!)
No, you aren't unhelpful at all. I appreciate your comments! Yes, my MT team is primary as we only stay here for the winter. I appreciate your slant on the fact that maybe 2 distant docs don't want to "share" advice on my care. That thought is valuable to me, and it makes me want to take this appt lightly. Just get labs and rxs and listen attentively. You made me realize that I don't want 2 treatment plans to deal with anyway, especially since I am WAY biased in favor of my guru in MT. I will plan to visit this one each winter if I like her. The one here I had for years doesn't "do" pumps. That's the reason for changing.
BTW, I thought a MM rep recommendation would be a good thing too. (tho I'm not impressed with this rep.) She offered two choices of docs that do pumps. The first didn't have a real person answer the phone and I left a msg. They did not call me back! I drove to the office and peaked in and rejected it anyway. Too seedy. I'll reserve opinion on the other til I meet her. I feel sooooo lucky to have my MT team considering we live in a small town. I digress....
How I wish I could attend your Group! Unfortunately this is So Cal. New to pumping, I had great hopes to connect with others because I had experienced an excellent support group even tho it's small town MT. I figured this place would be teaming with pumpers if for no other reason than it is overpopulated So Cal. My MM rep just sounded like I bothered her and she only had those 2 suggestions for docs and no group suggestions at all. On my own, I found a hospital related support group I'll check out this week, but don't have much hope for T1s.
My biggest thrill this winter is finding you T1ers!
If it was me....I would keep my MT team as my "primary" endo team and see if they would be willing to coordinate with a GP in Cali to order tests and do anything else the Montana team cannot do remotely. For example, your endo in MT should be able to call in refills or any other prescription items you need. They may also be able/willing to provide some email/phone support while you're in CA.
The reason I think this approach is better (GP in Cali and Endo in MT) is because having two endos might result in a butting of heads.
I guess as a pump user myself, I feel like I am my own expert. I have all the tools I need to make adjustments in my basal/bolus rates and deal with most pump-related issues. There's very little my endo can do for me that I can't in that arena.
That's great that you have an excellent support group in Montana! When I started the Type 1 Women's Group in the Bay Area, many of the women said they hadn't found what they were looking for previously: Only "Diabetes Groups" which were oriented to type 2's, or Type 1/Pumpers groups which were mainly education in nature (and pretty basic). It doesn't sound like you will be in So Cal long enough to start a group there, unless you partner with someone (perhaps from the So Cal group here?) who would like to start a group as well and would maintain it after you leave. Now that I'm 5 hours north of the Bay Area, I'm going to consider starting another group in Redding which is a town of 80,000 about an hour over the mountain, so it's nice to hear a group is maintained for type 1's in a small town!
Yes! I love your ideas! I do want MT to be primary! I'm going to keep this appt Friday secretly knowing it's just for a local contact.
And I like your encouragement to feel secure in my own maintenance. Maybe it's good that I left my comfort zone. I did feel like I could make phone calls at the drop of the hat if need be. I've definitely become more independent being a little fish in a big ocean here. Of course, finding Tud has helped enormously! I love it!. Thanks for your comments.
p.s. I can't believe Redding has 80,000 people!! I think of it as rural. My sis lives in Napa, but I haven't been up your way in a while, obviously.
Redding used to be rural, but has grown quite a bit. I wouldn't exactly call it cosmopolitan, though! Now Weaverville in Trinity County where I live, we are definitely rural!
Well if you do go visit your sister while you're out here, let me know and I'll let you know when the Type 1 group meets - they also have periodic potlucks which are great fun!
Propose to them what you want and see what they say. Medicine is (and should be) changing from a location-based experience to something that can be done remotely when the situation warrants.
The good thing about diabetes is that, the vast majority of the time, we KNOW what to do even better than a doctor. Too often in the past, I've called up the doc knowing exactly what I needed to do. Now, I just eliminate that phone call and take care of things myself :-)
Thanks for the invite! I'd love to.
Yes, another vote for taking responsibility for myself!
So this morning at the gym, I mulled over all your replies and wondered why I am even going thru with this? Per all your thoughts, I decided to email my MT team and do a home A1C and call it good. Then I remembered why I need to keep the appt... Medicare requires it every 3 mos.
So I will go, but with no stress. Like most of you said, I'll just play the game, get scripts and labs, and come back home to quilt.
Maybe it's just me, but I would just get the lab results and make my own interpretations. Most of the time I don't need the doc's input - if things a clicking fine. Maybe just worry if your labs are unusual. Then call your doc in MT.
I agreed with you completely and kept the appt with the new endo with just that secret attitude. I thought I'd get my labs and scripts and see her in my rear view mirror.
Here's The End of the Story:
Boy am I eating crow!! She was fabulous! She scrutinized all my pump reports, circled #s, asked me questions, and evaluated the data for a good long time. She was very respectful and included my views into the discussion. She explained her tx plan. I agreed and I let her change my pump settings. After I get my labs she scheduled me to a half hr with the pump trainer followed by a session with her! I can't believe my luck! Of course, my revered doc in MT is still my main guru, but whooda thunk I would find a gem like this doc ?
On the downside, she thinks I should eat more carbs. She couldn't possibly understand how O/C I am about not getting highs. She's concerned about all my lows, but how does she think I get good control?! Thats the hell of T1 for me being so brittle.
I'll see how my new settings work....
Thanks for your comments.