Searching for the Mythical "Perfect" Endo (My Quest for a New Endo)

aren’t we lucky that we live in a country where we can “shop” for doctors?! (but we pay for it in the end!!)

I am thinking about switching endos. Problem is, with things like this, I always feel bad about firing someone. It’s had me end up with some pretty bad care in the past.

A little off topic as this is not about finding an endo but finding a family doctor/GP. I have found that younger doctors, just fresh out of med school tend to be my favorite as they are still “curious” and don’t know it all and seem to be more willing to find answers, work with you and learn with you…they have not practiced long enough to let arrogance cloud their diagnosing and advice.

It does seem that having a younger Dr. ups the odds of getting one who will work with you. From the other posts on this thread foreign educated also seems to be a plus.

I wonder if our Dr. training has changed or if arrogance just develops over time? I would think Dr.s run into more patients who are educated about their conditions in the age of the internet. I could see this annoying an older Dr. who was used to his opinions about treatment being more readily accepted by a less knowledgeable patient in the pre internet days. It could also be just plain burnout.

I use a GP for my T2 diabetes care. He is youngish and was a random choice as I had no physician when I wound up in the hospital on diagnosis. I quickly figured out the Exchange Diet given me by the hospital dietician wasn’t going to cut it. Through reading and the internet I soon decided to try low carb and saw immediate positive results. But from reading various forums I was leery of what reaction I would get from my new Doc when I told him what I was doing. He could already see from my logs, that I was getting good results, and was fully supportive. I was able to lower my A1C from 13.1 to 5.6 in 6 months time. I got the impression he was a bit surprised by my success. In subsequent visits he expressed surprise at my frequent testing and I explained that it was one of the keys to my improved numbers along with a low carb diet.

Fast forward 2 years and suddenly my fasting jumped 30 points. Metformin, diet and exercise had suddenly ceased working. Because I continued the diet my spikes remained the same as before. From reading many posts on this forum, including bsc’s about moving to insulin, I decided to ask to be put on a basal insulin instead of the usual protocol of more oral medicines. He wasn’t too keen on that and we finally settled on Victoza. I have just started, but so far the Victoza has been very successful in helping me regain control.

In the course of my discussion concerning what to do next he made a couple of statements that confirmed I had found a keeper. First he said we were a team, implying to me, that if I insisted he would have agreed to the insulin route. Second he said he had learned some things about diabetes treatment from me! I don’t know how I got so lucky but I thank my lucky stars every day.

You’ve given a marvelous guide to searching, bsc. Thank you for the job you did. It takes work. We’ll all profit.

I just had good luck: someone who listens, said “decrease your food” under his breath (2-3years ago) even tho he knew I had already decreased carbs - and he was suggesting to decrease carbs even more, let me know I could go on as I was going and he would not interfere.

Endos are like dalmatians.
I think it’s important to know that older endos are from the time when there were no testing meters and “compliance” (of patients) was what they thought was all wrong - and in fact, it was a major focus of research. So when the older ones sound arrogant, it’s time to find a younger one. Arrogance comes from not knowing what to do, being overwhelmed. It’s a defense tactic. IMHO

Hi Leo2. I’ll bite – so how/why are Endos like Dalmatians?

For me, the perfect endo is the one who listens to me, more or less lets me do what I want, and respects my opinions about my health. My current endo pretty much meets those requirements. She doesn’t overdo the medical tests (something I hate because I really don’t have the time for unnecessary bloodwork). She respects my opinion when I tell her what I want to do, even if she doesn’t agree (and she tells me when she doesn’t!). For example, when I need a basal insulin, I too prefer NPH. I know how to use it and it doesn’t have the side effects lantus and levemir have for me. She doesn’t agree with my choice, but respects it. She doesn’t totally agree with my low-carb eating, but respects it because she has seen that it has given me better control (and she is coming around on this issue, as she’s admitted that many of her other T1D patients have had similar experiences).

Nothing in life is perfect. I am not always the perfect patient. I often go too long between appointments, I don’t always do what is recommended (sometimes because I don’t think it’s necessary, and sometimes because I’m just busy and can only deal with so many things at any given time). But listening and respecting my opinion as someone who is living with this disease 24/7 is probably the most important thing for me. I could care less where someone is educated or what research they have done.

Quite frankly, I could manage D just fine on my own by this point. Pretty much all my questions are answered on this forum anyway, long before I can get an appt at my endo’s office :slight_smile:

I’m so glad to hear it, bsc! Now that you have a “real” endo, you might even consider Lantus or Levemir instead of NPH!
As for my own story, it’s a sad one. I was sent to him by the PCP who diagnosed me, because “he knows so much!”. Well, maybe he did when he graduated medical school, and maybe he knows a lot about obese Type 2’s, but he absolutely didn’t know how to handle ME, and basically left me alone to do whatever I wanted. I attended a diabetes education class that was geared to uneducated, unintelligent Type 2’s, and that didn’t do the job. So I got my first real diabetes education from a sweet CDE on, and have gotten the vast bulk of my information from the DOC over the years. The endo really didn’t provide me with anything except prescriptions and lab orders. I was the one who decided that with fastings above 180 and PPs above 250, that 5 months of Glucotrol weren’t working, and asked for insulin. I was the one who decided that NPH at night only was not working for PPs during the day, and I decided that 70/30 caused too many lows, and wasn’t handling the highs – none of my high or low BGs ever bothered him, because my A1c was good. I learned to mix NPH + R, and asked for Humalog when it came out, and asked for the pump when I decided I wanted one. He refused at first, I think because he knew squat about pumps, and only consented when I got an old pump from a friend and was determined to put myself on it. He never ever had anything to say about all the stuff you need to know about pumping, and I figured out my own ratios from Pumping Insulin, by John Walsh and Ruth Roberts. The final straw was when I was depressed last year and sent myself into a coma – I saw him 6 days before the lights went out, and he SAW the terrible lab results, and didn’t even acknowledge that an A1c of 10.7 is HORRIBLY high for ME, or that when liver tests and fasting BG are WAY out of range, there is something wrong. So, way too late, I fired him.

Then I went to a new endo, himself a Type 1, but after seeing him once, he left the practice, and because of ins. coverage, there are only 2 endos in town that I’m eligible to see – one of whom being his former partner. So I’ve been seeing the APN who stayed – I’ve seen her twice. She’s been pretty good – looks at my eyes, feet, and downloads my pump and talks with me about what I’m doing diet-wise – she is encouraging about low-carb. I don’t yet have a “good” relationship with her, because it takes me time to get to know and trust someone, but I’m willing to give her the chance – it seems like it could work out OK. I’ve been forced to be independent for so long, that I don’t really put much trust in medical professionals – I’ve learned so much from other diabetics, and I feel very strongly that I’M the one responsible for my body. On the other hand, the ER staff saved my life, so I guess they’re good for something after all! :slight_smile:

Has an endo ever give you any useful advice that was unobtainable elsewhere ? Mine suggested Lantus instead of NPH which may be better certainly easier to take 2 shots/ 24 hours instead of 6. But more more expensive is the lantus. He also suggested indapamide for BP control which works well except for more uric acid in the system.

Most of them WANT to ride bright red trucks - which STOP TRAFFIC, and end up SAVING THE DAY at really exciting FIRE-FIGHTS.

But instead, they have to listen to a parade of people come in and lie about how complaint they’ve been: “I haven’t eaten SINGLE DOUGHNUT since you told me to stop! I have NO IDEA why my blood test came back so bad…”

They’re stuck, snoozing through the day, with nothing EXCITING.

BTW, Trudy, your offer to “bite” was unfortunate. When I visit an MD without a clue, my Dear Wife puts on my muzzle first. :))

Interesting post. Even though I live in a rather large city, there unfortunately are only a few endo’s in the area. Haven’t been happy with mine since I started seeing her about 3 years ago, but have searched a lot and have not found anyone worth trying. Every few months when a new frustrating issue/visit arrises, I begin my search for a new endo all over again, only to research the same doctors as last time.

Am still waiting to discover the semi-perfect, or just better than average endo. Living in a rural area, there’s no luxury of comparison shopping. There are three. Been to them all. First was a young arrogant twit. He wasn’t interested in me because I wasn’t interested in a pump. He told me “all my patients pump.” Second was older doc who wasn’t current. Third endo never once looked at me. Typed notes in his lap top & then dismissed me. Endo #3 cancelled my insulin & thyroid Rx when I informed his office I wasn’t coming back.

Took three months to get an appointment with each of them.

Since there are no other options, my internist handles my diabetic needs. I love him, but he’s not an endo. While I’m doing fine on my diabetic own, I need someone knowledgeable to get my thyroid levels right & one willing to test adrenal function. Thyroid seems to be trickier than diabetes. So, all I want for Christmas is a good, competent endo.

Not right that local residents have to wait while patients from elsewhere are ushered in. Politics, politics, it’s always politics.

The obstacle with a long distance endo is that she/he won’t be in my insurance provider’s network. I’d have to pay for this myself. It may come to this. If I’m going to pay & drive far (many hours to a city), I’d better pick a good one!

I don’t celebrate Christmas, but worth a shot if I’m a good girl. Dear Santa, Please enjoy the low carb cookies & unsweetened almond milk. I don’t want a pony or any high tech toys. If you have a good endo to send my way, I’ll be your best friend forever. Love, Gerri"

Thanks for caring, sweetie.

This is an old discussion but I just discovered it. Sooooo . . .

Yes, shopping is exactly what I did do. Sparing you the chapter and verse, I prepared a "short list" of the ones in my area and then interviewed them personally. I told them my history, my present circumstances, and the course of treatment I wanted, i.e., insulin. I found one who gave off good vibes, expressed willingness to work with me to find the most effective treatment regime, and said (direct quote) "I don't know everything."

He's now my doc. Couldn't be happier.

My diabetic educator/dietitian talks to me like like I'm a disobedient 5th grader--and I'm an educated professional and T1 for 28 years. Even though she is half my age, she is rude, critical of my diet and other things, highly critical of Bernstein's low carb approach, does not listen, and arrogant. She very much has a know-it-all attitude. Has threatened several times to send me to another educator.

Yes, I may be a "difficult" patient since I have questions, do independent research, and try different things. But it's my life.

It's very strange. I can't believe that medical professionals can act like this.

The frustrating thing is that I HAVE gotten some good advice from her, things that my endo, who is in the same practice, never mentioned in 28 years.

I don’t want to start another topic…

Yesterday I interviewed a new Endo. Along with the new patient paperwork, her office had actually sent me someone else’s test results ( which is a Hippa violation ). I of course mailed it back. That was my first sense that her office was uncomfortably chaotic.

When I got to the office, I was a “new patient” and yet her staff wanted to give me to a Nurse Practitioner. I had never met the doctor. Before coming, I had asked the Receptionist to see the actual doctor, but yesterday it became a squabble with the Nurse, I insisted on seeing the doctor.

The doctor finally made a place in her schedule and finally saw me. To match the disheveled office atmosphere, I noticed that her hair was disheveled too. I did not tell her about the Hippa thing. She was very interested in all my other doctors and very solicitous of all my heart tests. She thought my cardiologist, whom she knew, “never smiled”.

I assured her that I had my diabetes under control. I just wanted an Endo. I have used my Primary as my endo for years.

Almost at once she wanted me to start taking Lipitor, without looking at any blood test results or discussing anything with me. She quickly denied that she was pushing that medicine because of a drug company’s pressure.

She said she only works three days a week because she teaches at the local med school.

There was mention of a sensor that could monitor my glucose level recording results every 45 seconds, she said. This was something for next time, she told me. Now I just needed to take care of my heart, etc.

First impressions are what they are. At least she was taking new patients. The Hippa violation thing worries me because the people who sent me some else’s paperwork now have my social security number. I had tried to make an appointment with another endo, but they were booked for four months in advance.

I had not seen this discussion so I’m grateful it has been been brought back. My daughter has aged out of pediatric care & were searching for an adult endo. It’s anything but a simple task. Our local PCP doesn’t recommend any of the endos in nearby cities (within 100 miles). After using the links in the original post, I can see why. None of the endos have consistently good reviews, & the comments are very negative in the areas were concerned with (knowledge of T1D & technology, supportive & good listening skills, timely Rx refills & lab results). I guess I shouldn’t be surprised. We’ve driven across the state for 8 yrs to see her ped endo because the ones nearby were so bad. I had hoped she wouldn’t have to travel so far. We’re not looking for perfection, but decent care shouldn’t be so hard to find.

I had gone for a long time without an Endo. Then I PMed someone on TUdiabetes who lived in my area and asked if they could recommend an Endo. They did and now I feel very luck to have a great endo.

I like him because he listens, he is up on all the latest diabetes tech and treatments (not stuck in the past) , he belives in the YDMV concept and does not have a one size fits all solution, and most of all he is there to help you with your diabetes and not to lecture you on what you are doing wrong. Only minor complaint is he is busy but that has not really been a problem. It may also help that he has Type 1 too so understands.

I do feel slightly guitly that the TUD member I refer to may now have more difficulty getting and appointment :grinning:

For mme, the key factor is respect - respect for me on the part of the HCP. I am smart, I’ve been dealing with T1 for 40 years, and am thriving. I had a great Endo when I was first Dx’d, I stayed with him for close to 25 years (until we moved). His approach was that I have to be my own PCP and his job was to teach me how to do that, and to be a resource for consultation, ideas and of course Rx’s. After moving the biggest challenge was finding a new Endo who listened to me long enough to learn that I know what I am doing. First off he grabbed my pump, changed the settings, and wasn’t upset at all that I couldn’t get my bg under 160! I told him that was unacceptable. I made good use of my pump features, had a CGM that helped in my decision making (paid for out of pocket because he didn’t see the value of CGM), He also said that because I was 60 years old, I should aim for an A1C of 8! Why? He also said it was impossible for “someone like me” to have the good labs I have. When I asked what it was “about me” that made it impossible, I offered to bring my Mensa membership card with me to the next appt. Needless to say, he brought out the Snark in me - and I do have a mouth on me and I use it. That experience really made me appreciate my former Endo, and I realized that the former Endo relished and enjoyed his patients who did well. Indeed he saw that their success was a reflection on him - not a threat. Still "auditioning Endos. Too bad the health plan network mess gets in the way. You find someone you’d like to meet, but it is strictly out of pocket because of networks and their changing membership

My goodness! I am sure in a mood.

I agree with @artwoman; I highly value mutual respect. I want a doctor who looks at all the data (pump, CGM, fingersticks, labs) and then talks about my unique case of diabetes. When a doctor asks, after looking at my blood sugar data, “I see you went down to 65 mg/dL last Tuesday morning, what happened there?” I am frustrated by that. Unless it is a major hypo (< 54 mg/dL) that lasts more than 10 or 20 minutes, then it is not a memorable event for me. Next time that happens, I think I’ll respond with, “What did you eat for lunch last Tuesday?”

I know most practitioners are trying to be helpful but they do need to realize that I’m making dozens of decisions every day that help steer my BG. The overall good data that I bring to them should speak loudly that my BG control shows clear intention and effort. But I do have diabetes and sometimes my BGs exceed the limits.

I may hold too much respect for my blood glucose control abilities, but I sincerely believe that any clinician who deals with me could learn some useful lessons but they are not often curious about it. I guess they are mired in the whole dysfunctional system (US) where they need to see too many patients and it wears them down.

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