Visiting the endocrinologist - my PDM


#41

I don’t have a pump but I feel the same way about a doc asking to see these things. I know many people are asked for their logs or their meters, and even though I never have been, I already know those are things I would not give them. I feel the doc can ask questions about what is in those things, and if my answers are not good enough for the doc, the doc is not good enough for me. If he cannot trust me to tell him the truth, then he must not be trustworthy himself, otherwise there would be no reason for him to not trust what someone who has never done anything to not deserve his trust, is telling him. I feel that meters, pumps and logs, are personal and are things docs have no right to see. I test and keep records for my benefit, not the doctors, so he has no right to those things. They have a right to A1c results and to ask questions, but to ask for proof, that is not something they should be doing. Insurance does not require those things and since I am paying the doc along with my insurance, they work for me and since I am not comfortable handing those things over to a doc, they do not have the right to them. Since it is me living with diabetes 24/7 and I am the only one who is available 24/7 to make decisions and adjustments, it is me who I am accountable to, not a doc so if I were to have an appointment with a doc who insisted on me giving him those things, despite me telling him I do not want to give them, it would be the last appointment I would have with that doc.


#42

I guess you aren’t aware that to get more strips than is normally allowed (as an example), one’s doctor has to have documentation to substantiate the quantities. If you don’t provide some sort of log (I just give him reports printed from my computer), you may be denied the additional strips you need. It’s your choice–be secretive and suffer the consequences, or be forthcoming with the proper information to substantiate your Rx request.


#43

I WANT my Endocrinologist to see all of my records, so I gladly give her my PDM from my OmniPod system. (The good thing about the OmniPod is that I never have to give up my basal insulin while she downloads my PDM.) I just started on the G6, so I printed out the Clarity report on that also. Additionally, in my Endo’s office, I always see the “team” of either the RN and the doctor or the RD (registered dietician) and the doctor. To that end, I also take in two weeks’ worth of food records. Why would I want to keep the data from my Endo team that can help me get better control over my diabetes? Yes, I make changes on my own quite often, and my Endo is fine with that. My appointments generally last 90 minutes, and in that time the doctor checks my eyes, my heart, and my feet. We discuss TRENDS which can only be seen through data that my PDM and CGM records provide and discuss any adjustments that might be helpful in my control. She and the dietician answer any questions I have, and after 52 years of T1, I have no serious complications due to my condition. How can a doctor assess what one is doing if she/he does not have the records to show the trends and reactions to things like exercise, food, medications, stress, or travel? Data gives us power, so I have no problem giving her all that I can to help me lead a healthy diabetic life.


#44

Wow, 90 minute visits! I see my endo every 90 days, but the visits are MAYBE 25 minutes long, at most. I’m impressed with yours.


#45

I don’t have an endo. My GP and I manage my diabetes effectively and efficiently. I do share printed reports with her and we review them together, especially if something jumps out at her but that’s quite rare.

When I was pregnant with my little one I had the rudest OB who was young and just a couple years out of medical school. He told me he had ordered tests X,Y,Z for me. I politely informed him that I would not be doing test Y as it was invasive and unnecessary and the results would not alter any decision of mine regarding the pregnancy or alter course of current care regimen. He told me that if wasn’t going to do Y that I might as well not do X & Z as there was no point. I angrily informed him that there was such a thing as bodily autonomy and I was exercising the right to mine and that the patient was an integral part of the care team and deserves to be consulted and involved about testing and treatment options.

To the original poster, if you don’t want to hand over your PDM then don’t. It’s your right. If the doctor has labs and other reports that allow for adequate data to determine whether something is working or if improvement is needed then it shouldn’t be a problem.


#46

It appears that some of you have some serious issues with your doctor/patient relationships. WOW!


#47

Dave, it is not about being secretive, it is about my right to only give what I feel is necessary and am willing to spend my time with my doc on. There is no need for me to waste the precious appointment time with a doc having him go over logs when there is just no reason for it as I make my own dosage adjustments and manage my diabetes just fine on my own. I am not a child and my logs and meter results are not homework assignments to be graded or gone over.

You have no idea what I am aware of or what I need to do to get what I need and obviously I do not need to provide any of those things. I have never had a problem getting the amount of test strips or anything else I have ever needed. When I needed this many, I got 10 strips a day with no problem for quite some time. After a while I didn’t need quite that many but my doc still wrote my script as “test more than 8 times a day” and I have never had a problem getting them. Since using Libre, I told the doc I went to after the one who wrote the 10 a day and more than 8 a day scripts retired that I only need 5 a day and he wrote the script for 6 a day. If a doc is going to hold supplies you need hostage unless you comply with giving info you don’t want to give that he has no legit reason to have, he is not a good doc and is not one for me. Luckily, I have never encountered a doc who was that kind of bully, and that is what a doc who would do such a thing is.


#48

Yes, her office is great. They use the “team” approach to care, so while the visits have to be scheduled ahead of time if I want to get in, I know that every aspect of diabetes – exercise, food, and medication – all will be thoroughly covered. I am soon to go on Medicare (March 2019), and for the first post-Medicare visit, I actually am flying back from Florida to Wisconsin just so I can see her for that visit. I know that I will have to find a “winter” Endocrinologist in Florida, but I still will base the majority of my care through my original doctor. If I had needed help while I was in Florida, I knew that she was only a phone call or an e-mail away. I actually dread the every-three-month visits since I have been doing fine with every six months for many years now. My Endo is an angel. I wish I could take her with me to Florida in the winter time.


#49

I’m in Canada, so it’s different. Only endos have a say in pump application or renewal. I’ve been seeing a new GP for a year and we still haven’t discussed all my issues. I like her, but she is always rushed and I need to prioritize what I bring up each visit. I don’t know if I would trust her with my diabetes care.

Which is ok, because I have a great endo. She takes a look at my pump numbers and writes down her recommendations. She’ll add “if this, then that” scenarios. Sometimes I change things right there in the office. Sometimes I just hang onto her notes for reference until I see her again. I don’t hold anything back because she needs to see the real thing, not just 3 perfect days, like what I used to shoot for when seeing a dietician and nurse at the clinic. (provincial health insurance also covers this which is awesome)

It’s great to have that piece of paper and know that she trusts me to make the appropriate adjustments where necessary.


#50

The worst part is going to the lab for blood work every 90 days. I worry that some of the people in the TINY, CROWDED waiting room have air-borne communicative diseases. I make an appointment so that I don’t have to wait long, but the close quarters with possible sickos is unnerving.


#51

I have never handed my PDM to my Endo. I always provide reports from Glooko downloads.
He might ask me about basal rates and wants to make some adjustments. I tell him what they are currently via Glooko or he can look at the sheet and we do tweaking.
However why go see him if you don’t want the input on the data that he or she is looking at?
Any Dr can’t fully assist you with only limited info. It is a team effort


#52

I only go so I can get my prescriptions renewed. If I didn’t have to go for scripts, I wouldn’t go.


#53

I think it’s in the best interests of you that the doctor knows all the records, and there’s nothing to worry about.


#54

I agree with everything you wrote. Yesterday when I went to my wonderful GP to ask for a prescription for 10mgs of Crestor to be taken twice a week, he thought it was a great idea.

What really troubled me about the appt though, is that the nurse, who I have known for years, demanded to see my feet. Throughout my 60 yrs living with Type 1 diabetes, I have had my feet checked a handful of times. When I saw my GP last month to get the results of a breakdown of my cholesterol, he checked my feet. I have never had a sore on my feet, don’t have trouble with dry feet, and can feel all the pins when the doc tests for sensitivity.

I told the nurse that I had just had that done 4 weeks previously. She said that she realized that, but I needed to have it done again. I flately refused. I refuse to be treated like a child or a statistic. I told her that it would be a complete waste of time for her and me. Turns out that that info is required now for when they are audited. I assume that now anytime I am in the office, they will ask to see my feet. I will continue to refuse unless many months have gone by. I can look at my own damn feet and contact the doctor if I have a problem.

I know I am the healthiest diabetic that they have ever seen, and I refuse to jump through hoops even though I love my GP.


#55

Goodness!! My endo checks my feet every visit, which is every 90 days. I don’t think of it as a thing to get upset over. He asks if I can feel the pin pricks, which mostly I can’t, depending on where he is checking. It’s quite eye opening to read so much vitriol about one’s doctor for them doing what is customary. As I said earlier some of you have “issues” with your docs, and one even claimed they were being “attacked” somehow, due to a request for reports. I hope that you all are simply coming across more angrily in print than you are in “real life”.


#56

Hi Dave,

Actually I am thought of as a very kind intelligent woman with strong feelings. Somewhere here I wrote about my history with physicians. I wrote about finding help for my severely ill son and my husband who has had 3 cancers. I have had to have a lot of knowledge about all of their illnesses in order to fight for the treatment that might have saved their lives or at least their quality of life. It is hard to let that go.

As I said I love my GP, but since I have full feeling in my feet, there is no reason to check them often. I will agree to twice a year, and more often if it is found I have lost feeling in them at some time in the future. I refuse to be a statistic for a form though.

My GP really likes me and respects me which is one of the reasons we get along so well. He likes the fact that I question everything.


#57

Hi Marilyn, we (any of us) can be misunderstood (as far as intent and feelings go) when communicating in writing. Face to face is a far more effective method of being understood correctly.


#58

Same here Eddie, that is all I need the docs I see for diabetes to do too. If it were not for needing scripts, I wouldn’t see anyone at all for it.


#59

I don’t see a problem with that at all. When I go every 90 days I do hand over my pump (and or CGM) and let the Endo/Diabetologist office run their nice colored print out. Which we (Dr.& I) then use to discuss trends (highs/Lows) and possible adjustments.
that is the reason I see this particular Dr. and together with the Lab report we as a team make the decision how to treat my diabetes (Type 1)
Now I do have a problem with the duration they have my pump for, as they take it when I check in and if they don’t see me in a reasonable time (15 minutes or so) I’m losing basal inputs.
A Dr. office has a lot more personal info then my quarterly pump info.


#60

Not that I like doctor’s staff taking my pump out of the room for a while, but you can safely go at least an hour w/o basal. I give my doc printed reports which he is happy with, and Medicare blesses all of the scripts he writes for me covering pump and CGM supplies. The reports I give him obviate the need for staff to take my pump from me.