Visiting the endocrinologist - my PDM


#61

I am really in the minority here. I see my endocrinologist every 3-4 months and I have a wonderful nurse, certified diabetic educator, who works at my internal medicine office. Whenever I have concerns I upload my data (tandem t:connect), let the nurse know, she reviews it, gives advice, and then I change settings according to her recommendations. When I go to the endocrinologist, I print 2-3 weeks of data (current settings, logbook, CGM and BG trends, and whatever else I think is important). She reviews it, discusses recommendations, and she does like to change the settings while I am there. She does not take any of my equipment out of the room. I then followup any changes with CDE because I like that she can review my data through t:connect. Even though in different offices, they communicate via EMR. This works great for me. Jane


#62

I don’t pump so the only thing I have to share is my Dexcom. My Endo is on my shared list of people so the nurse just downloads the reports from Clarity. I am managing my numbers very well so my Endo never tried to meddle with my choices. He’s very trusting in me and I so appreciate that.
Sorry, some of you guys have issues. It makes the disease so much more difficult to control when you and your doc are not on the same trust level.
Stay well.


#63

Just a thought. I have Medicare advantage with Kaiser. Which means all my history is posted in their system. All my visits test, falls and fails. Actually I like that.


#64

Yea it is part of the COMPLETE management and if you can’t trust your diabetic Dr. (Endo, Edu, PA, or whatever) just watch the national news each evening and YOU can determine what medication is good for you based on advertisements shown and not learned knowledge from the health professionals you should be dealing with.
I’m more worried that the office wants my drivers license and SS# which they store in a not so protected way. (hence that isn’t info I give out likely, and therefore sometimes had to find a different provider)


#65

Are you saying that you have been able to see a doctor (in the US) without providing identification such as a driver’s license or SSN?


#66

There is no reason a medical office needs your SSN or drivers license. I have never given my SSN to any medical office and have only showed driver license so they can verify that it is me.

As far as handing over devices to staff, I agree that I am am uncomfortable doing that. But I now can share a clarity report from Dexcom clarity app and keep device with me.


#67

Dave
That is correct. I will show my license while holding it in my hand but I refuse to have them take it and copy it. My insurance card & information and home address is all they need and I have never not paid a bill in my life.
I trust them to give me good service which I in return will pay for so they can trust me. If not, I won’t do business with them.
I had my identity stolen thru a doctors office, hence my reluctance.
I did notice one of my doctors now takes a picture of you at the front desk which goes with your file so everybody knows who you are when at that office.


#68

I’ve had my Amex card compromised twice online, but not any issues with identity stolen via the medical establishment. Thank you for sharing your issues with that.

oh, and I’ve also had my pic taken at a couple of offices. It’s a small percentage of the offices that I’ve been at.


#69

There was one Endo in the practice I have to use that took my pump (supposedly to upload the data) and gave it back to me 35 minutes later. I couldn’t get my bg below 150 for the next two days! I looked at the settings and they had all been changed - without telling me. I am proud that I thought to look. And pissed that I had to look.


#70

That is an endo that doesn’t have a clue! That could have really messed you up!


#71

The reality is the reports give far better information then just eyeballing through the pump.

We use online reporting so we don’t print out the reports on paper but the same concept. We use Dexcom Clarity, Diasend and Tandem t:connect. We have given the Endo online access as a Medical Provider to the Dexcom Clarity and Diasend. The Endo is very familiar with these and can click and scroll through the online data pretty fast.

It would be ludicrous to change a pump setting based on some particular historical entry found in the pump. Who knows what might have caused that.

On the other hand if the reports show a particular trend over a number of days at a particular time of the day then it may be helpful to make a change to address that trend.

There is no reason for us to hand over the pump to the Endo.

We spend about an hour with the Endo. Every 3 months. We really like our Endo.

I am perfectly fine with Identification. That is necessary to prevent rampant fraud. The Doctor has zero need of our SS# and they do not get it. They can ask but it is not happening. There is zero legitimate need for such.

Yeah - online is certainly high risk. But I figured - not my problem. Something happens, I report it to the credit card company and it is their problem. I have one credit card that I use for online shopping. I consider that my “high risk” card.


#72

That’s just crazy!

The doc my wife goes to always asks first to make any changes and all changes are noted on the documentation my wife gets after the visit.


#73

The worst part is going to the lab for blood work every 90 days.
I have to go to hospital every week for bloodwork due to DVT/warfarin use.


#74

Tried to quote didn’t work


#75

Follow up!
I had the second visit with my endo and she never asked for my pump this time. She must have made a note! I gave her the reports and she looked at them and said that she sees I change my own pump as needed as the basals are different than last time.

Side note, I was wearing the Libre and the Dexcom and showed her and her nurse the different readings from both, which they were excited to see. If anyone cares I made a few notes about what I found of wearing both and the differences for me under the Freestyle Libre vs Dexom 6 category.


#76

I assume you don’t see that Endo any longer.


#77

@Marie20 Good for you! My endo completely understood me and even mentioned that the results are what matter the most. When I have some concerns or vice-versa, I freely share my PDM. Stick with your doctor if you are satisfied with how you are being treated. :slightly_smiling_face:


#78

Well, I saw my endo today. Actually a member of his team. I gave up the goods.
I told her about “Tudiabetes” and the discussion we had about giving up the PDM and the cgm for data pull. She was amused but was sure to ask me how I felt about it. I was glad to share with her how some may feel. I am waiting for my lab numbers. She made a few changes that we discussed and made sense to me.


#79

I don’t know where their “auditing” comes from (if they are “owned” by an organization like a hospital and it is that hospital’s criteria or if it is from the insurance directly) and it may be different from state to state but in my neck of the words they there are typically at least two different audits. I’m not sure the name of the one but the other is called HEDIS. For HEDIS measurements they can be looking at a couple of different measures: “Comprehensive Diabetic Care”; “Statin use in Diabeties”; “Controlling High Blood Pressure”; “Statin Therapy for Patients With Cardiovascular Disease”. I’m not quite sure how they determine what they are going to list you as.

The “Comprehensive DIabetic Care” is looking for:

  • Evidence of A1c testing
  • Yearly Diabetic Eye exam
  • BP Control
  • Evidence of medical attention to nephropathy
    (kidney disease)- basically that you are being
    monitored for it.
    They also look at the A1c results and evidence of “control”. (Though their definition of “control” is extremely broad). A1c of Less than 8.0% is “controlled” or less than 7% in "selection populations).
    They don’t what to too tightly define control so that the don’t have doctors out there trying to achieve things that may not be safe for the individual.

HEDIS does NOT ask about diabetic foot exams. I know sometimes other plans will but not as a part of HEDIS reporting.


#80

I have an exam with my GP next week, so the foot examination is on my mind. I am going to ask the nurse more about why they need the info if I am pressed for another exam. My sister who lives on the other side of the nation says that there is a sign in her doctor’s office which asks people with diabetes to take off their shoes and socks.

I don’t want to have my feet examined more that once a year, because it makes me feel like a child. As a diabetic of 60 yrs duration with no neuropathies, I have complete feeling in my feet. I also take very good care of my feet, so that they don’t become dry just like everybody should. I don’t need a nurse demanding to look at my feet. I find it insulting. If there was a rule that all folks over 65 needed their feet examined that would be one thing, but as an excellently controlled diabetic, I don’t like being singled out.