How can I be assertive with doctors without backlash?

Type 1 and LADA
1

Evening! :sunglasses:

After a horrid week of fighting for renewal of my CGM and hoping to get on a pump, Iā€™m beginning to think Iā€™m not beingā€¦demanding enough. And, I mean that in a professional, adult manner. Not the shrewish get escorted from the building type of demanding. Although my hubby thinks I should try that method since it seems to work for most of the people we know. :neutral_face:

I have to find a new Endo before yearā€™s end, after yesterday, or I loose my deductible window, which will pay for my Dex supplies and a pump and supplies. Not to mention strips, etc. Iā€™ve been footing the bulk of all my supplies because the doctors office canā€™t seem to write the scripts out correctly no matter how many times I take it up with them.

So, what should I say to the next Endo I see soon? Hey, I want/need a pump because of blah blah blah. Hereā€™s my logs, my insurance company authorization, etc. Gosh, I envy people that have more ā€˜assertivenessā€™ than me. I can be assertive with everyoneā€™s needs but my own. :frowning:

Thanks a bunch folks!

Irish

2

Can you get a copy of the letter someone wrote in the past that allowed you to get covered and show the new endo? They can just copy and paste, and sign their name to it? Might speed things up.

3

Yes! Sheepdogs! :smiley: I have those very documents! I have the contact and direct numbers for the insurance agent that is working my case, also. Itā€™s my insurance that has been pushing for the pump with the CGM for a year now!

(insert hair pulling!) Itā€™s just maddening. People keep telling me Iā€™m too nice and polite. That I need to free up the tiger I save for the school board when battling for my special needs kids education. I just canā€™t seem to pull it out for myself! :smiley: Maybe I have nadda left for me! :expressionless:

Iā€™m thinking I might have to defer the ASSERTIVE to my hubby. Heā€™s my legal medical proxy so he has the right to be a tad mouthy on my behalf. I was just curious how others here went about ā€˜demandingā€™ what they need to have some quality of life. I really fear being seen taking insulin in public since it sorta resembles a drug dealer! :slight_smile: And, given my sensitivity I donā€™t dare bolus more than a few minutes before a meal hits the table in a restaurant.

Have a super Friday everyone! Thanks Sheepdogs! :smiley:
Irish

4

Believe it or not, talk to Dexcom. Both they and Medtronic helped me get their devices. They may also know the buttons to push and the secret handshake of the Order of the Water Buffalo that will grant you entrance into the secret society of technology.

2 Likes
5

I called the pump company & Dexcom first & let them do the work.

1 Like
6

Flintstones reference? Nice!

7

I had my first ever endo appointment almost 2 months ago. When I called the Drā€™s office and they asked me the reason for the visit I simply said ā€œto get a CGM to better manage my Type 1 Diabetes and to discuss other Autoimmune issues (Hypothyroidism and Anemia)ā€.

The appointment started with a review of my medical history, she asked to download the history from my meter, explained the tests she was ordering, and then said ā€œI see you would like a CGM, here are the various types and manufacturesā€¦ which one interests youā€? I asked a few questions and she handed me the name of the Dexcom rep for the area and she said give her a call, Iā€™ll have the Rx to her his afternoon. She then suggested a few adjustments to my current I:C ratio and that was about it.

8

Just let the sun shine inā€¦

orā€¦Thereā€™s a town I know where the hipsters called Bedrock-- Twitch Twitch!

2 Likes
9

Hey tiaE! :smiley:

I did that to get my Dex last year. But, my PCP decided this year he didnā€™t want to be involved with ā€˜keeping tract of it and meā€™ as his office now turfs people for chronic stuffs. :frowning: If a band aid or just 30 day script canā€™t fix it theyā€™ve been weeding you out.

10

Thank you for much for the laugh and the reference! :smiley: I so love The Flintstones! Dex got me started last year and I contacted Animas directly two weeks ago. They went to my Endo, chatted with the Asst. Nurse Prac and we assumed everything was good. Especially since they moved up my appointment two days. Iā€™m fat, dumb and oblivious to whatā€™s coming!

Get there and head Nurse Prac comes in and levels her Salvoā€™s at me. I reported this back the Animas Rep and she was dumbfound, also.

11

Wow! Thatā€™s amazing! :slight_smile: I wish I could have that kind of luck. Iā€™ve had three Endoā€™s in the past five years. They either downplay me as not being a real diabetic because my TDD is 3-10 units, depending of course on my Lupus, the season, etc. I
Or, they see that low TDD and say when Iā€™m a serious diabetic weā€™ll discuss yadda, yadda. I donā€™t know if they donā€™t see many T1ā€™s, LADAā€™s or what. I wish my PCP would change his mind and sign off. He actually told me two weeks ago Iā€™m perfect for a pump because of this! :open_mouth: AND, he didnā€™t want the headache of following me or it or my CGM. :wink: Thank Doc!

Iā€™m glad youā€™re Endo is working out for you and you have what you need. Need a few more like you have!

12

It sounds like the problem is that the Endo isnā€™t familiar with pumps and CGMā€™s (or any technology?) To avoid getting a Dr Luddite, find out if a new endo under your consideration has a large T1 patient base, and also bring whatever documentation you can that shoes your expertise using these devices, and that they are a big part of any success you have. I would also go to the American Society of Clinical Endo;s (or some such) and bring copies of their statements regarding D tech as standards of care.Maybe that will appeal to their sense of pride (being up to date etc).

OI had to tell one Endo that my standards for my D management were higher than his, and I wasnā€™t going to lower them (to paraphrase Michelle Obama, when his performance went low, mine decisions went high =- interms of standards not bg!)

1 Like
13

Another reply. Check out TCOYD.org (taking care of your diabetes) They just launched a enw program to heal iwth the CGM-Medicare appeals process. There may be statements etc that you can use in your own quest. Also, check out Dr Nick Argento, and Endo who has T1. He has written many great articles on the value of tech/devices in T1 management. He also includeds references from the Americanā€¦Endoā€™s that can help. Keep us posted

1 Like
14

I got my pump and cgm last year. My first appointment with my ends was amazing. I told her what I wanted and she said okay. I had to do the pump education class and provide a months worth of blood sugar and food logs, but really had no hoops to jump through. I think it widely depends on your specific endo. I have since stopped seeing her because our standards didnā€™t match. She once told me I should never correct at bedtime (I understand where she was coming from, but come on!). I now see my PCP for my diabetic needs and he pretty much does what I ask. I told him I wanted to try Metformin and got a prescription with no hassle. Itā€™s our responsibility to find a doctor that fits our needs, and they are out there.

1 Like
15

Thank you artwoman for the site and advice. Iā€™m certainly collecting a lot of this week. As for an update, this sad tale that is my health care just gets better.

After seeing the Endoā€™s Nurse Prac last week and her agreeing to call DexCom to approve my supplies, I check back with her office today only to be told she hasnā€™t gotten around to it. Tomorrow will be a week since I was in her office. Iā€™ve done all the legwork to get my refills. All she needs to do is call Dex. Easy Peasy you would think.

Like most folks Iā€™m inside my deductible and want to (need to) capitalize on the cost reduction for what I need for my D. There are approixmately 30 plus working days left in this year. So, you can kinda understand my anxiety. And, THEYā€™VE been pushing for the pump for a year!

My carrier just needs a doctor-any doctor at this point-to sign the Medical Necessity letter for Animas and thatā€™s a go. Just sign the dang paper. Iā€™ve gotten the logs, the labs, etc. on my own. Iā€™ve called several Endoā€™s Friday and Today. All of them require a referral from my previous ENDO. Like thatā€™s going to happen. :tired_face: Or, they only treat peds TD1ā€™s. The Endo world is kinda clique-ish. (sorry, that was tacky. Iā€™m stressed)

In desperation, my husband made an appt with our PCP and weā€™re hoping to convince him to just sign off on the Medical Neccesity letter for the pump and after the holidays I establish continued care with an Endo. He supports the pump idea but doesnā€™t want to mess with the follow up care. He approved my initial DEX script, but, left itā€™s care up to whatever Endo I sought out.

Iā€™m still going down the phone book. Iā€™m discovering Endoā€™s donā€™t know what to do with LADAā€™s or mid lifers that get TD1. And, I live near a very large metro area with one of the nations top hospitals. (Their Endo DPT has a six month wait list for new patients that donā€™t come from direct admit. :frowning:

I agree with Artwoman: my standards for my D care are much higher than the doctors Iā€™m seeing. I donā€™t think Iā€™ll ever forget the med student that took a red pen to my log last week and marked them up like a bad spelling test then scolded me for being out of range. Knowing full well I need MICRO dosing and the over/under shooting is the reason.

Hereā€™s the messed up part: Iā€™ve used a pump for both pregnacies in the early 90ā€™s. I used one when I was in the hospital for over a month with Lupus induced heart failure. I OWN an out of warranty pump. Iā€™m to the point of using my old pump and getting supplies for it on the gray market and family.

Yes, I know thatā€™s wrong, but, my pump still works perfectly. I stopped using it due to a long honeymoon. (long story). Right now, I need better dosing. Iā€™m drifting too far out of range and with my insulin sensitivity factor at 50-60, under/over shooting is starting to wreck havoc on my lifestyle.

Thanks for listening as always. You folks have been a blessing to me. Please know I take your advice and suggestions to heart. Your humor keeps me going!

Irish

16

Yay for you MIssMargie! :smiley: I donā€™t mind having to do whatever they want me to do to get my Dex or a pump. Iā€™ve been at this for 17 years. I keep up with the latest on meds, research, etc. Iā€™m not a ding bat wanting a toy.

My Endo told me she wanted my A1C to come up to 6.5 (currently Iā€™m just under 5). I told her that was a little nutty considering the other conditions I have. She told me it would make dosing easier to let it ride over 150 or 160. I should have caught that subtle sign that she wasnā€™t too receptive to free thinkers!

17

Mine wanted me at 6.5, then I went to my retina specialist who point blank told me that wasnā€™t good enough. Itā€™s hard enough having different standards than your doctor, it really sucks when two (or more) doctors have different standards for you.

18

Iā€™m beginning to wonder if standards exist anymore. :confused: I either have a doctor that ignores me or wants to be my parent. Just havenā€™t had much luck finding that middle ground kind guy/gal. :wink:

19

I have to be honest, if your A1c is less than 5% it isnā€™t surprising you are getting pushback. Most everyone here would find achieving an A1c of less than 5% nearly impossible (with or without a pump). If you are using only 3-10 units/day and are on MDI and getting an A1c of less than 5% then this throws up a huge red flag that maybe you donā€™t have much insulin deficiency. Please realize that if you really only need 3-10 units a day and have no insulin production you would be extremely insulin sensitive. A single unit would drop you like a rocket to the floor. You probably would have to skip most mealtime dosing. And yet somehow you have an A1c of less than 5%. This suggests you donā€™t need much insulin support and having a pump wonā€™t make any improvement in your control.

If you really are having trouble controlling your blood sugar you need to document this. Going into see the doctor with an A1c of less than 5% and virtually no insulin use isnā€™t going to convince them. You need to document excursions. When you eat, do you have trouble getting accurate dosing when you need much less than one unit? Does your blood sugar shoot up to 200 mg/dl after eating? Do you have frequent lows? Iā€™m not saying you donā€™t need or deserve a pump, but trying to help you understand the other side of why you may have been getting pushback.

1 Like
20

Hiya Brian_BSC :blush: That was a typo on my A1C. I meant to say an A1C under 6. (probably shouldnā€™t type while a passenger in a moving truck). My new A1C from last week was 5.8.

I do keep detailed records, both meter and Dex records. I bring these to each visit with my doctors. I still make a little insulin but itā€™s erratic and unpredictable. My exact problem is with dosing. A unit can drop me 50-60 pts in the early part of the day and about 40-45 pt in the later part.

I need 1 to 1 1/4 units with meals. Iā€™m hitting and missing with my current method. A half or quarter unit in either direction has unpredictable results. If I let it ride high to see where it will settle, then my body SOMETIMES kicks in and spills too much sending me crashing. I do top 200 mg/dL after a 25-30 carb meal if I donā€™t do help things.

I do see ā€˜the other sidesā€™ point of view. And, thank you Brian_BSC for sound boarding me. Itā€™s easy to get lost in the subjective point of view. I think Iā€™m TRYING to make three different entities happy when all I needed was to figure out the Dex Com refill. It should have been a simple refill of supplies, nothing more. Itā€™s turned into a mess because DexCom had to third party me out because they stopped dealing directly with my state.

The insurance company is pressing for the pump because they like ā€˜comboā€™sā€™ā€¦TD1ā€™s on CGM should also have a pump. Since I donā€™t, theyā€™re demanding WHY NOT. Iā€™ve told them why but they want to hear it from the docs and the docā€™s apparently arenā€™t answering right. :confused:

I donā€™t fit the typical TD1. My insulin needs are weird and I have two other auto immunes playing ball too. My D is much harder to make happy when my Lupus is flared up (which it does in the colder months) or when my auto immune meds are increased. In a nutshell, I donā€™t respond ā€˜normallyā€™ to anything medically-not just D.

Since time is growing short on the insurance window Iā€™m considering just telling them to forget it, forget the Dex refills and pump. The stress and bickering between companies and doctors is too much. Iā€™m upset that Iā€™ve paid a nice chunk for my Dex and itā€™ll be useless by years end. Itā€™s gave me and my family a years worth of peace of mind when Iā€™m alone or on the road.

But, this mess Iā€™ve been in the past month is not worth it. :expressionless: