Some of you have followed my adventures with my last Endocrinologist. I had originally selected him because of his technical merits, he was active in AACE, his capabilities were respected by peers, and he published. I thought that he would be able to properly diagnose and treat me. Instead, I rudely discovered that a “Perfect” endo was so much more than technical competency. So after I stopped seeing my last endo nearly a year ago (I actually fired him, but he thinks he fired me and I have the letter to prove it), I queue up my search for a new endo. Thus started my quest.
This time I took my time, but in the early summer, my GP suggested that I needed one, so the search took a new priority. I live in a large metropolitan area, so there are lots of choices. I know a bunch of diabetics in the area, but none had really good recommendations. In the end, I searched through the roles of in-network endos and I looked up each of the candidates and did my homework. I went through the rating sites, RateMds, Vitals and others. I checked the comments. If patients reported poor bedside manner or other serious problems, I ditched those options. In hindsight, I made a huge mistake with my last endo, he is apparently famous (and not in a good way). I then checked out the background of the doctor, where they practice, where they were educated, all the papers they have written, etc. For some of you, this may not matter, for me it does. And then I got down to the real dirt.
You can look up your candidate doctors background and license status. First you can go to a site like DoctorsScoreCard to find the link to your state’s government licensing records, in my case I could look up the records for Virginia Doctors here and get the status of their license, background and a list of any actions against the doctor and claims paid. And finally, you can look up in certain circumstances where your doctor has accepted payments from industry. Propublica runs a site that lets you look up your doctor and see if they are “Feeding at the Big Pharma Trough.” The health care reform enacted in 2010 will also bring a new transparency to the industry payments to doctor and AstraZeneca just announced that they are disclosing all their payments. Exact this year to be able to fully identify how much feeding your doctor has actually done.
So after all this I found a candidate. She was foreign educated, not an industry leader, but she had great feedback and she was “clean.” Her patients liked her and said she “listened” and made time for patients. So I made an appointment and I waited three months to see her and now that I’ve seen her I “THINK I HAVE A WINNER.” She spend an hour with me. She listened to what I said. She accepted and encouraged patient centered care. She accepted my goal of tight control. She was fine with my insulin use (even if my NPH/Humalog is not mainstream). And most surprising she is low carb friendly. I see her again in six weeks.
I feel really lucky. I hope it works out like it seemed to in our first meeting. And perhaps this will restore my faith in the endo profession.
So what did you do to find a good doctor? Is it just luck or can you really “shop” for a doctor that meets your needs?
When I got to this sentence, “where they were educated, all the papers they have written, etc. For some of you, this may not matter, for me it does,” I planned on saying that I used to be like until I found a really good doctor and he was none of those things! But I see you found someone that might not have been on that original list and you like them. I am still looking for the perfect endo and not sure that I will ever find one of those, but one of the other doctors I see went to a foreign medical school. I am ashamed to say if I had read his profile before I saw him, I probably would have chosen not to pick him as a doctor. I met him when I was doing HBO so he was a non-chosen doctor. I had the opportunity to talk to both him and his other patients and see what kind of a doctor he was – that was in 2006 and I now see him at his office. He is very intelligent. If you have a different opinion than he does, he doesn’t belittle you because you think differently. He listens and he will explain something if you don’t understand or have a question. I can talk to him about stuff that he is not my doctor for. If he doesn’t know something, he will look it up or call one of his buddies and ask them. He actually cares about his patients.
I am glad that you found a keeper BSC! I know what that search is like, not just with endos but with other doctors.
Yeah, I am so happy for you, BSC! That’s a really good approach to getting a good endo. I have only had two endos. The first was the on-call endo when I was hospitalized. I stuck with him for 5 years. Then my insurance changed to Kaiser, so I just asked my then-current endo about the Kaiser endos, and of the two local ones he recommended my current endo but said I should avoid the other one. I have been seeing my current endo for 11 years. It’s a good relationship.
So actually, this new endo was originally educated as a podiatrist in Iraq. She then attended medical school in the US a decade later. It mattered less to me that they were an expert and more that I understood where they came from.
I think finding an endo can be really hard. For a regular doctor, there are tons, you can “shop.” You could five appointments in the next week and choose the best one. But an endo is different. There are not that many. And you can have a real wait to see them. Three months is not uncommon. I can’t imagine what it would be like navigating Kaiser. That would seem to be even more constraints.
Wow! It’s obvious that you’ve done your research. However I think the key to this discussion is in the title. “Mythical” I’m not sure the “Perfect” Endo exsists. While there are some that are obviously better than others and some who I think shouldn’t be practicing at all I think the “Perfect Endo” is someone who fits your style and personality. If you’re inclined to take your diabetes seriously, you do your homework and all that stuff I’m of the opinion that as long as your the one “In Control” you’re going to be fine. Having a "better, “the best”, “most educated”, “most published”, “most whatever” won’t in the end make you a better diabetic. As you’ve indicated from your experiance with your first Endo, I feel, at the end of the day, that I can’t stand talking to (or rather, being talked down to) by one of these types of people, rather I want and Endo that can talk WITH me.
Case in point, I’m T1 and have been for about 30 years, For most of that time I’ve lived in practical denial of my condition. I"ve done enough to “feel good” and “stay alive” but I won’t bore you with that story here. Anyway I live near a Diabetes clinic, the main Endo has been practicing since 1968 and the clinic has been there for almost 33 years. He has been one of the forerunners of diabetic research, regularly works with all the major players in DB managment, conducts clinical trials, publishes his findings, and consults with the FDA. In other words he is arguably the BEST endocrinologist within 500 miles. He has been MY endo for the last 10 years never developing a real relationship with this guy more then… “I see your A1C is blah blah blah, you really should test more often, blah blah blah” you get the picture. So fast forward and one DKA later I wake in the hospital to find my Endo’s newest associate at my bedside. He’s very young, (like mid 20’s young) but this guy “Gets it!” Meaning, talking with him is more like reading the posts here on Tu. He understands not just the technological and phyisical aspects of the condition but the human componant as well
Now, while my new Endo is great (I’ve been officially “reassigned” or “fired” as you put it to this new young Endo) The change I’ve really seen in my life has come from my commitment to not wake up in a Hospital again. My Endo supports me, encourages, we talk through managment options, he celebrates my succsess with me and so forth but at the end of the day it’s on me. I think the better question is how to find an Endo that will help YOU become a better diabetic! For some, that may be talking with the “Smartest”, “Most Published”, and so forth but for ME, it was talking with one who could treat me like a human and understand what emotional or psycological issues were also keeping me from proper managment.
In conclustion (geeze I didn’t mean to write a book!) I really do think you need to “SHOP” but I’m not sure that there’s a “List” or anything that can narrow it down. I think it comes down to an interview, unfortunatly you usually have to pay for that first appointment so If I were in the market I would talk candidly with my regular Doctor with whom I have the type of relationship that I would want to duplicate with my Endo. I would tell them that I was looking for a referral to an Endo that shares his/her approach to patient relationships & care. Then when talking with your “new” endo. I would work to “define the relationship” have a list and share it with the Endo about what you expect and would like, ask if this is how he/she works. And hold them to it!
Good luck on breaking in your new Endo! And when all else fails, We can always complain about it here right?
Decaff
I used most of the same techniques you discussed but really ended up finding a good endo through pure luck. I had been shopping for an endo and had to make an appointment with someone quickly so that I could get prescription refills and get my DMV paperwork signed. I basically made an appointment with the office that could get me in the quickest. It ended up that my endo was the newest and youngest doc there and she ended up spending 45 minutes with me discussing my history and about the same amount of time for every appointment. She listened to my complaints of suspected thyroid dysfunction and ordered appropriate bloodwork. She understood the extreme stress I had been underneath with school and family issues and didn’t treat me like I was a failure for not having a great A1c. And SHE DIDN’T PUSH PARTICULAR DRUGS ON ME! Very important (by the way that Propublica website is great!).
Of course, she’s leaving the practice, and now I have to do this process all over again and it is just so time consuming!!! I’ve called up various offices and they have told me they have a 6 month waiting list! The endocrinologist does not have to be “perfect”, I would much rather have a doctor that treats me like a human and acknowledges that I am an intelligent and informed patient that knows more about my body more than anyone else. The problem with shopping for an endocrinologist based on merits alone is that you don’t really know how much of a fit they are for you until you actually interact with them. Finding a good doctor seems to be a mixture of pure luck, ability to get an appointment, lots of patience, and having SOME requirements that they have to meet in order to properly help you.
Anyways, good luck to you! The new endo sounds great!
When we moved to Frederick, MD I was shocked to find that there were only 2 endocrine practices and my insurance wasn’t accepted at one of them. It forced my hand. However - I LOVE my endo! She is intelligent, current on new technology, not pushy about one “method” over another as long as my results are good, and respected by her peers. She encourages me and reminds me that I do not have a functioning pancreas and in spite of that, I’m doing very well. She keeps in contact with my other doctors and they tell me that she continually has positive things to say. She is not afraid to “jump ship” from regiment if it is not working. She didn’t give me any flack for low-carb. Her staff is also awesome!
The downside is that it is a busy and slow office. But if THAT’S my only point of contention - I’ll take it!
Hope this endo works out for you, BSC! A good one is worth their weight in gold 
I wonder if the endos ever search for the mythical perfect patient?
Glad you found one BSC!
My GF gave a gift card to her gynecologist and it worked wonders for her future visits. It took her a long time to find a Dr she liked too. When she finally found one that she did something extra. Just thought I would mention it . Pauly
I was wondering the exact same thing Kim!!!
I network a lot with CDEs and happened to sit next to a CDE who was also T1. I quized her and BINGO! I found an endo I am very happy with.
I found it difficult to find an endo… First endo I saw i was shoveled to from the hospital… Too laid back and really didnt help matters… And NPH!..(Did I mention I was the only young adult in the practice, it was mostly geriactric patients… It was very uncomfortable .But at least I started off with insulin pens… and a sliding scale…So it was suggested I go to the Joslin… Not a good fit… tried not to answer my questions and always sorta poo poohed my A1c… Saw them for awhile… Lost insurance, ended up seeing a great Dr at a nearby hospital… Didnt do pumps but got me playing with insulin to carb and lantus… answered my emails promptly,. worked with my side issues that went along with the diabetes and other endocrine stuff…also tried some off-label stuff which worked but my body didnt like it (Metformin) and Actos (trying to work on the insulin sensitivity thing) but could not seem to get lantus to split right, and always thought I should be on a pump… Got me an appt with a very well known endo at joslin who does pumps… got into some red tape at Joslin… he got it resolved… Now I have an endo team at Joslin I like… I still don’t like the place, but will go back to see this person and the particular CDE I work with … Not stacking insulin like before I was on a pump, and they don’t talk down to me, and give me suggestions, and dont force my hand… No prescription extortion either…Its hard to endo shop but you really have to to get someone who will work with you, not against you, or in place of you…
I think many endo’s have chronic problems with schedules. I’ve not decided whether that is a good thing or bad thing. I certainly don’t like to wait. But lots of us come to our endos and we really could use more time than a simple 15 minute slot and I’d like to have a doctor who will take the time to help me. And then there is the whole crisis thing. I would like to have a doctor that if I call and am having some sort of crisis, they will help even if it does inconvenience others.
So I’m trying to be flexible and that is why I always try to schedule first thing in the morning.
I have to admit, I am a “difficult” patient. That is perhaps part of my problem. I have my own ideas about my health goals. I’ve gone off and read about stuff and ask too many questions and have high expectations of my health care providers.
Ding, Ding, Ding. We have another WINNER!!
Your endo sounds great!
I have had 2x recent endos and maybe 4 during my “career”, although for a long time, I blew them off and went to GP for a while, which also included quite a few years in student “health” where I could get supplies w/o bothering with a doctor and then about a 5 year run where I was able to get supplies w/o seeing the doctor because Walgreens pwned @ getting rx’es refilled while I was non-compliant with appointments!! Then I went to a GP for a while who was pretty good, provided useful information about “curves” however during the R/ NPH/ mainlining years, I didn’t keep any records and pretty much was sort of “carb-guesstimating” rather than counting. Eventually, I launched my long campaign to get healthier and, after a couple of years of that, decided to follow a friend’s recommendation to try a pump so he said “you need an endo”. There were two @ the insurance-friendly clinic, the old white guy and the young, Indian lady. I was pretty gung-ho w/ the TKD/ testosterone/etc. and figured (correctly) that I’d be able to see the young doctor much more quickly (Champaign, while fairly diverse community, also served as the “metropolis” for the surrounding non-diverse farm towns who I reasoned would overselect the old, white guy…perhaps I am guilty of reverse racisim in some manner, oh well…). This was pretty correct and I liked her, she seemed intrigued by my regimen but perhaps a bit astounded at my just using insulin like something I’d have bought in the parking lot of a Grateful Dead show, instead of calculating anything. That was also when I started hanging aound message boards but the doc was helpful and supportive during the pump process although, when I got it she said “I want to go to the installation because I’ve never done one” which made me wonder about her experience but I also thought that she would be open-minded. The pump trainer was very experienced (a buddy of mine used to work for Medtronics and gave her the thumbs up too…) and the doc and her did some discussions about ratios in front of me and I was impressed with both of them turning my extremely messy logs into very close to the correct settings. A couple of adjustments and I was off to the races, literally as it turned out. I am probably not the best patient because I make changes all the time and rarely bother discussing any of them with the doctor or her nurse.
The current endo is also pretty good, I like her demeanor and she is helpful. The wierd heart thing caused some annoyance as I felt that it was just an insulin OD/ being whacked out but the recommendation was to get more tests and I was burnt out on appointments by that time. She was pleasant about the whole thing which is what I was looking for.
Then, at my last appointment, I had to drag the 12 year-old as we had back-to-back apppointments and she remarked “you are still losing weight, is that on purpose” and I said “well, the charts suggest I could drop another 5-15 lbs” and she said, in front of junior “oh, you don’t need to worry about the charts, you have a lot of muscle” which was a huge boost to my already inflated ego. Obviously nothing to do w/ diabetes but well, it cracked me and junior up!
What is your doc doing differently GinaY? Always curious about new angles to work!
My guess that most of finding the best Endo is just luck. My first and only Endo is great; he acknowledged all the work and studying I do; he gives me a wide range of things I can do wot wokr with my numbers and doses. I even experimemted on my own one time and he accepted it and said that if anyone else had done that he would not have stood for it. Back in March I asked to go from Lantus to Levemir and it supprosed him but when I explained my reasoning he was all for it. He dod not know that I have split from 2 shots a day to 3 shots aday but will my next visit. I guess I was lucky coming ot of the gate.