New Doctor/Fresh Slate

Because of a recent health insurance switch, I have found myself for the first time in years without a primary care physician. So I did what many of us do and opened the online directory and blindly picked a physician based on nothing but a name and the proximity to my home.

So this coming Tuesday I have an appointment with a brand new doctor and I have the opportunity to start with a clean slate (of sorts…that a1c don’t lie).

Part of me is excited…part of me is bummed.

I’m sort of excited because I’ve gotten better at being able to articulate my healthcare needs (thank you TuDiabetes for that), and I think that I can use this opportunity with someone new to be very clear about what I want and what I don’t want…instead of doing it the “way it’s always been done.”

On the other hand, my old team has learned some of the things I will and will not do (paper logs? Come on!) and I’ve grown to understand who in that office really loves people and who should be avoided. It’s comfortable and it took a couple of years to get to that point.

If you had the opportunity to “start all over” with a new doctor, anything you’d do differently? I’m a fan of the TV show HOUSE, where the doctor on the show believes that every patient lies. Should I go in and try being 100% honest for once?

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My condolences. I hate starting over with a new doctor.

I had to recently chose a new PCP myself. Much the same process, though I did go through reviews, Healthgrades, etc. rather than simply picking one at random. Still, you can only learn so much.

I was very honest with my new PCP about who I was, what I expected, what medications I would/would not take, etc. etc… I told her that my previous PCP had been very gung-ho on bariatric surgery and statins, and that those two items were not up for discussion, period, and that if that was going to be a problem to let me know.

It really helped to lay down a groundwork right from the beginning with both of us laying out all of our cards on the table. We really respect each other. My new PCP has turned out to be one of the most enthusiastic, supportive doctors I’ve had in a long while.

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Good luck Mike. Hope all goes well.

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FWIW

The last time I had to change doctors (about 3 or 4 years ago), I organized the process. I did some basic vetting in the ways mentioned above, then made an appointment with each suitable candidate. The purpose of the appointment was basically to permit us to interview each other. I was determined to find a doc who was on my wavelength as to philosophy, treatment, etc., and who would treat me as a partner and not a wayward employee. One office refused to even schedule such an appointment; that scratched them from the list. Choosing wisely was especially important to me because I don’t have an endo; the PCP and I would be managing my diabetes ourselves (well, mostly me, but you get what I mean).

When meeting with a doc, I was 100% truthful. “This is where I’m coming from, this is how I expect us to make decisions, these are my treatment requirements, dos and don’ts”, etc., etc. During that part of the conversation one doc actually said, unprompted, “I don’t know everything.” He’s now my PCP and I couldn’t be happier.

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I just saw a new provider yesterday. It was a nurse practictioner in the same office as my former endo who left to go to a different practice. I tried to go in with a completely open mind and it went pretty well. She did note that my basal/bolus split is not what one would expect (30% basal, 70% bolus) and that my I:C was “aggressive,” but then said she supports the approach of allowing people to keep doing what they’re doing if it works for them. It was a relief to hear that, but I did spend the rest of the day questioning whether I could improve my numbers if I try to seek a different basal/bolus balance. Still pondering it and I do think it’s good for me to sometimes question whether what I’m doing is really working or whether I’m making excuses for myself because I don’t want to try and change things.

Good luck!

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I was very fortunate. The first team I had for my diabetes care (Type ? to Type 1) was top notch. So, I know what good care looks like. So when I got coverage through Medicaid, I knew what I was looking for in a team. I felt no need to be anything but honest.

But it didn’t hurt that my new endocrinologist put my apprehension to rest at the first appointment. “If you ever want to get an insulin pump, I’ll support your decision and fight for you.” Then he proved it right away. He found out what BG meter they gave me. “That piece of crap! Let me get you a good one!”

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What is gained by lying?

“House” was a television drama about a mentally ill physician, certifiably so, who bullied and manipulated others. It was fiction. However, perhaps as a result, I have been encountering more assumptions that I must be lying from doctors, nurses, etc., when I attempt to truthfully describe problems. Every now and again, I attempt to weed out the misinformation in my chart. No, I don’t have a son. Yes, I still require insulin.

I’m well aware that House was a fiction. I’m also very aware that being 100% honest for me at a doctor’s appointment is not easy as it requires me to look head-on at some of my imperfections. If this isn’t a problem you have, consider yourself lucky.

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Being judged a liar when I am trying to deal with my problems is my greatest problem. Being told I must be lying and eating more than I say I am makes it harder to calculate insulin doses, but easier for them to dismiss by saying eat less. 12 years and I still can’t figure out how to not go low with exercise, but it’s easier for them to dismiss, figure I’m lying about exercising at all, and tell me to exercise more.

Why does my husband have to be in the room to confirm what I said for me to be believed?

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I was one of those people who felt generally good and never went to the doctor unless “something was wrong,” so. after seeing a somewhat randomly-selected doctor for what turned out to be a staph infection, and who subsequently suggested I be tested for diabetes, I had no PCP to turn to and had to find that first doctor. I suppose I got lucky that I knew of a doctor with a good reputation (whose wife happened to have been a classmate of mine, way back when…), and who happened to have had an opening to take on a new patient in his otherwise overloaded practice. At that point, I knew almost nothing about diabetes and my biggest concern when meeting the doctor was that he not order me to stop drinking coffee! (He did not.)

Like @David_dns’s selected doctor, this guy does is honest that he “does not know everything,” but is willing to do the research necessary to find out what he can, or refer to someone who is better-equipped to help those patients that exceed his experience (as, apparently, was the case with me). He diagnosed me in the office during that first appointment, despite his disbelieve that someone as fit and active as I was at the time could have Type 2 diabetes (which so-far hasn’t been re-Dx’d). I told him that I knew very little about diabetes, but as a technology person with full access to a university library, I planned on becoming as close to an expert on the subject as humanly possible! (He currently often defers to my knowledge on many diabetes-related issues :slight_smile - and, though I clearly don’t know even close “everything,” I am sure I’ve taught him a few things along the way.

It wasn’t too long (in my opinion), that my PCP decided that he couldn’t resolve some of my concerns within his skill set, he referred me to an endocrinologist (I have had worse luck in that department…). I think my biggest criteria for a doctor are: One, that he treat the patient, not the disease, working within the specifics of the individual, including preferences, abilities, and understanding. Second, I want a doctor who is smarter than I am – they don’t need to know everything, but that need to be willing to find out.

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