You know, Zoe, I totally agree. I like to see the docs only when I really need to. And as consumers, I often wonder why doctors (a service industry!)are not open hours that are condusive to their consumers, like after 4:00 and Saturday?
I am VERY expensive for the health care plan. I work in HR and understand that ONE employee(in a small employee environment) with excessive medical bills can raise the cost of health insurance for all employees. In 2010, we had three employees (out of 140) who had major healthcare events. In 2011, everyone's health insurance costs (including co-pays) were increased.
I don't use the plan at work, as my husband works for the federal government. I have a much smaller impact on a plan with hundreds of thousands of participants.
However, I feel we all need to be congnizant of what our choices cost.
I have never seen an endo in my life. I work with one every day though. I suppose if I NEEDED and endo if I were in the hopital etc I am certain he would come see me :-)
I haven't had anyone tell me to change my DM management since High School. I suppose my PCP's always figured I know more about MY diabetes than they do. PCP's tend to get the deer in the headlight look when you tell them you have a pump. I then rattle my basal rates etc off to them and they just kind of let it drop from there. When I need scripts for infusion sets I write it for them and have them sign. I am reasonably certain none of them have really even known exactly what they are.
I'm so glad I'm not alone in my non-attendance or as the docs might say...non-compliance (god I hate that phrase!). If I could have a white coat who was knowledgeable and also a Type 1 like you, MD, I'd go just for the pleasure of sharing ideas!
I see my Endo every six months. Of course I have to travel 350 miles to see him, but he takes that into account. He won't do phone calls or internet appointments, but he wants to see me to see if there are adjustments that need to be made to my pump. He also wants to check to see what if anything else is going on with me. I really believe if you want an effective doctor, you have to have a relationship with them, they have to know you and your situation. And you have to trust them, I think that's built over time. Not every doctor is a good doctor as I am sure ALL of you know.
I see my endo twice a year. We both agree that there is no reason for me to be seen more often than that. I haven’t suggested that I just go once a year because I am glad to get the labwork twice a year. I am one of her easier patients in that I take diabetes seriously.
350 miles!! And I was complaining that if medicare makes me see an endo when I turn 65 I will have to drive an hour over the mountain! I hope it's somewhere you enjoy going anyway!
I was diagnosed in December and on Insulin in February (I was misdiagnosed by my PCP for the first few months). I started going to the Endo in February and I am in love with the education and the support so I go about every month, sometimes more for the education. I'm in the process of getting my pump right now so I am in constant contact with them through email about lows, highs, and illness, I think that I will be going about 3-4 months regularly for a while.
Can I ask why the Endo assists with the low bone density? I recently hurt my foot and the Doc said that I had low bone density and I am at a lost for what to do about it. I'm lactose intolerant and have been for 6 years so I think that may have something to do with it. I started taking Calcium supplements on my own recommendation, but I don't know who to discuss it with.
I found a very supportive and knowledgable Endo, so he's worth the trip. I feel completely at ease when I leave there and so does my husband, which is also important. We feel like he really knows his stuff and are encouraged by his support even when my A1c isn't always where we would like to see it. The one that was in our town made me feel so bad about about having diabetes I wanted to just give up, I felt like what's the use it's going to kill me anyway. Come to find out I wasn't the only one, but I didn't see a doctor at all for over a year because I just couldn't bring myself to go back to that one. Live and learn!
Unfortunately the doctors have the power of the prescription pad. None of us here have the ability to obtain our meds without doctors unless we want to use the older insulins. They hold it over our heads to force us to comply with their wishes. Sometimes it's for our own good and sometimes it's for their bottom line. But to hear them tell it's always for our best interest. I wish I was in a business where I could dictate to my customers how much business we will do together.
We can push back against their demands but unfortunately we can only push so far because they hold the trump card in this game. I can see myself telling my Doc that I will only come once a year. I can hear him saying... Well big boy let me know how things are going for you after your insulin runs out. So I grit my teeth and keep going in just often enough to keep him off my case. I just wish my doctor would stick to managing my disease and not try managing me.
I have a lot of bone loss brought on like a house afire from some of the drugs I took post-cancer. I did a 2 year course of a daily injectable parathyroid hormone rx'd by the endo. My oncologist referred me to him both for the bone density issues and the flood of D symptoms I was having.
Just make sure that the endo you sees is familiar with issues other than D.
Well, osteoporosis can actually be a hormone problem. Vitamin D turns out to have a big role in calcium metabolism and in the loss of bone density. My endo always tests and adjusts my vitamin D supplementation.
While I agree that much of the medical system is "broken," operating as a fee for service business. I have to defer to my endo and her negotiations with insurance on the choice of whether I come in every 3 or 6 months. I have specifically asked about a 6 month schedule and been turned down. And while my skipping an appointment may save "some" money, another patient might skip an appointment and end up in the ER, wasting many years of accumulated savings for skipped appointment. I try to to be wise about the choices I make, but I also realize that some things are set for an average or to "cover" the patients, not for me who is not a typical patient.
I find this whole line of conversation very enlightening! I never saw an endo until we moved to another town 12 years ago. For 22 years, before we moved, I visited my internist every 3 months. He was a wonderful doctor, very caring and knowledgeable because of being diabetic himself. Also, his rate was very reasonable. The doctor I have now is very expensive. I was seeing him every 3 months until the economic downturn and rising cost of insurance made it difficult to see him that often, so now I see him every 4 months. It is a revelation to me that diabetics can actually see the doctor less often than that and still do all right. Good to know!
I should add that I want to stay accountable. Now at 17 years with Type 1 diabetes, I am doing lots of things to stay motivated for the long haul. I want to keep learning, keep tweaking, and as I said to my endo several weeks ago, "this old dog is learning new tricks." That said, I am fortunate to have an excellent endo and GP, both of whom are 100% on my team/my side.
