The doctors we criticize


#21

Like a doctors waiting room, No one is there because it makes them happy to be there.


#22

A very interesting issue to ponder. I think the majority of doctors are well informed, have good intentions, and truly assist their patients. I think the majority of patients are happy doing whatever their doctor tells them to do. Things get a little more difficult, however, when you get the combination of perhaps a less well informed doctor and a patient who wants to be more involved in their own care than the average patient, so he or she learns about it and questions the doctor’s methods. Add to that the fact that this second type of patient is more likely to be participating in forums like this and, therefore, more likely to be griping about “bad doctors.” I think it definitely gives a very unbalanced appearance to the patient/doctor relationship.

My initial diagnosis went very smoothly because I was lucky enough to see a nurse practitioner who immediately knew I should be tested for antibodies. Then the fun began. I went to what is supposed to be one of the best diabetes centers in the country and was told as a T1/LADA on bolus insulin (no need for basal in my early stages), that I should only test my BG once or twice a day. It sort of shook my confidence in my doctor and I definitely griped online.

All of that being said, I have the greatest respect for the vast majority of doctors who are trying to do the best they can within a system that makes that more difficult for them every day.


#23

There’s no question that the system as presently constituted is more about putting obstacles in doctors’ and patients’ way than it is about promoting and encouraging a high standard of care. It really has become an obstacle course in many respects.

This observation is anything but original, but it is a tragedy and a flaming outrage that in a country with the finest technology and research engine in the world, one that includes institutions like Joslin, Mayo, St. Jude’s, Johns Hopkins and a dozen others, we are well on our way down the path to having the least access to quality medical care in the developed world.


#24

I really, really like both doctors I currently see. My GP (or PCP, whatever) is a wonderful guy who has been really great to me for years. Unfortunately, he knows about as much about diabetes management as he does about plant microbiology. Which isn’t a whole lot. Although I will continue to see him for other issues, my diabetes is no longer on the table with him. He has given me too much seriously suspect and wrongheaded advice, including:

  1. You test too much, you should cut back (I test 3x per day)

  2. You should stop exercising (since I occasionally go lower than 65 while exercising)

  3. You should not consume fats (since my LDL is higher than he’d like)

  4. You should stop taking Metformin, since you are going low during exercise (yeah, that’s not likely the reason)

  5. You don’t need to consult an endocrinologist, since your BG is well-controlled

  6. You shouldn’t control your BG so well, you’ll get depressed and make yourself susceptible to lows because you’re being too strict

I started paying out of pocket for a Metabolic Specialist after I was diagnosed with Type 2. She’s been great, but is pretty well convinced I’m not actually a Type 2. She ordered antibody tests, and confirmed that I do not have classic Type 1 either, since I have no ICA or GAD antibodies. She is suggesting I keep an eye on things (my BG is very well controlled now) and see an endo when I can afford to or when my BG gets out of whack while my lifestyle hasn’t changed.

The problem is, we expect doctors to know everything about health. I have a PhD, but that doesn’t mean I know everything (or even very much) about ecology. Why would I expect my Primary Care Physician to know everything (or even very much) about diabetes, other than how to know I have it? I find some of his direction to be irritating, and have found I have to be my own advocate. And I have to be willing to pay out of pocket for some things he just doesn’t support (like seeing a Metabolic specialist, or eventually seeing an endocrinologist). I still like and respect him.


#25

I was disappointed and angry with my doctors when I discovered that a lot of my BG problems that drove me into crisis were solved when I started limiting carbohydrates in my diet. I learned several breakthrough tactics from other people with diabetes by participating here.

I had expected that my doctors would know this stuff. My expectations were due to ignorance of what the doctors did and did not know. I accept responsibility for this snafu and see where I went wrong.

I now have a more limited expectation of my doctors. On the other hand, I will not let them exceed their knowledge when they advise me. When it comes to insulin dosing, I expect no expertise from my docs and will keep my own counsel. I can only hope that they will recognize the depth of my knowledge and skill and respect the extensive real life experience I have. To me it’s a more realistic expectation on my part.


#26

That is almost identical to my experience. I had to find the suggestion to look into low-carb, higher-fat diets elsewhere (largely here and on /r/diabetes). It, along with intense exercise (not that namby-pamby “30 mins of walking three times a week” from the ADA), dropped my a1c by a huge amount in the first three months after diagnosis.

I respect my doctor and listen, but I’ll check everything against the experience of other, older, and wiser diabetics. I’m new to this, while some of you have been living with diabetes for years! And my doctor has never lived with it at all.

But I still know where to go to get my kiddo immunized :slight_smile:


#27

By the time I was ready to start using insulin, I had done pretty exhaustive research, both online and off. By coincidence, my PCP was preparing for retirement right about then, so I was going to have to find a new one anyway. Consequently I decided to choose a new doctor based in large part on our compatibility of outlook vis-a-vis managing my diabetes. I wanted someone who would work with me as a team member, not direct me like a wayward employee, and who would recognize that no one is in as good a position to manage my diabetes as I am.

So I approached it like you would a hiring situation; I sat down for a conversation (an interview, if you like) with each potential doctor. During the course of our conversation, one of them said, unprompted, “I don’t know everything.” He’s now my PCP and we have exactly the working relationship I was looking for. I manage the diabetes, which I know the most about, and he manages everything else, which he knows the most about. It’s as perfect a partnership as I could wish for.


#28

[quote=“Dave26, post:12, topic:56472, full:true”]

The first insulin insulin injected into a human in 1922 was actually canine (dog) insulin. There were lots of purification problems! It wasn’t that they knew they were biosimilar beforehand, they just didn’t have any other way to test, but despite the allergic reactions to the contaminants, they were able to see the effect of bg lowering. Later that year as Lilly geared up for mass production they switched to porcine sources because it turned out to be a lot more potent.

Much less than 100 years ago: 25 years ago I was in grad school at a famous research institution and my roommates were working on the first sequencing of the human genome. It was a huge multinational scientific endeavor that took years at the time. And today … junior high kids do DNA sequencing as well as recombinant DNA stuff! Amazing!


#29

Doctors can be amazing! Having sold to doctors in a different specialty for years, I would say the good ones outnumber the ones that appear to be there for the wrong reasons 8:2. With that said, I have noticed that great doctors are at higher risk of burnout. I have seen too many great doctors leave the profession because they got tired of advocating for patients and trying to do the right thing. Before everyone picks their favorite punching bag, hospitals, administrators, insurance providers, and other physicians have all been the source of their frustration. Being a doctor today is difficult. But thank you to all of those that fight the good fight.


#30

Hence they have more than double the suicide rate of the US population as a whole. That ought to tell us something.


#31

Whenever I have a crap day at work (which unfortunately happens over 50% of the time these days, thanks to my needing to beg and grovel with health insurers to cover the care my patients need and deserve), I will come here and read the posts in this thread. This will keep me going. Thank you, everyone, from the entirety of my heart! :heart:

Rose


#32

[quote=“Chris72, post:29, topic:56472, full:true”]
Doctors can be amazing! Having sold to doctors in a different specialty for years, I would say the good ones outnumber the ones that appear to be there for the wrong reasons 8:2.[/quote]I think that’s a bit on the high side.

The actual ratio is closer to 4:1.

:grin:


#33

[quote=“rgcainmd, post:31, topic:56472, full:true”]
Whenever I have a crap day at work (which unfortunately happens over 50% of the time these days, thanks to my needing to beg and grovel with health insurers to cover the care my patients need and deserve), I will come here and read the posts in this thread. This will keep me going. Thank you, everyone, from the entirety of my heart! :heart:
[/quote]Rose, never forget the squeaky wheel law of the universe, and it’s corollary that most wheels don’t squeak…


#34

True, but I was thinking of actual doctors I know, and then I would have had to cut them in half. The horror of it all. :slight_smile:


#35

So long as you get the half that knows how to manage diabetes, what’s the problem? :grinning:


#36

Cutting a doctor in half is a serious felony. Cutting anybody in half, for that matter.


#37

There’s a law on the books forbidding cutting anybody in half? :astonished: :stuck_out_tongue_closed_eyes: :slight_smile: :grinning: :grin:


#38

Back on topic for a moment, speaking of bell curves…

Keep in mind that while doctors fall on a bell curve (a.k.a. Gaussian Distribution) in terms of “quality”, patients too fall on a bell curve in terms of temperament, irritability, cordiality, interest in following treatment instructions, and on and on.

The average PCP has more than 2000 patients in their active practice. So, while the vast majority may be quite happy and satisfied with their physician, there will be a “tail” on the curve at one end with people that aren’t ever happy, no matter the doctor.

And it is those that tend to make the most noise.

Now for balance, understand I don’t mean to imply that anyone complaining is just a whiner, nor that their complaints are illegitimate. Just want to provide a complete perspective.


#39

I have a lot of respect for the medical professionals. I don’t mind that they do not know everything, but I do mind when they ACT like they know everything. Overstepping that edge of knowledge and giving advice past that edge, to me, is more dangerous than a doctor that is humble enough to say, “I don’t know enough, but I can research that for you”, or even saying “the symptoms don’t fit the exact criteria for XXX, but I leave open possibility that it could be XXX”.

I don’t know whether it’s the training, the practice guidelines, the insurance rules, or what, but there are definitely flaws in the ways medicine is practice in this country(US).


#40

You know, this is an interesting point. I know that there are many, many doctors who have empathy for their patients and truly just want to help, and there are many, many doctors who have vast stores of current, in depth knowledge. I have a very deep seated fear of doctors - I don’t know what started it, but every time I see a new doctor, I have terrible anxiety. I have to really like the doctor to go back, unless I feel like I have no choice.