My endo is pretty good... just wish for more one on one analysis of my bg records and a longer appointment, which he doesn't have time to do I'm sure since he does research as well as a practice. I give them my records printed out at every visit but I'm not sure if they actually look at them, if they do, no one discusses it with me. The first one I gave him he glanced at and said it was good I was circling my hypos, lol. My last appointment was rescheduled- I will try giving them the records ahead of time and see if he discusses them at all. The problem is they don't have email and I can't just email it over from my phone- I will have to drop it off or mail it. I have stopped having blood work done through them and go to a hospital near me with a lab I feel is more accurate. It's kind of a pain to go there but it's worth it. I also try to get the testing before my appointment and have them fax it to me so I can actually discuss it with him at the appointment, ( I know he reads and remembers the blood work because he remembered that my b12 levels were too high on one appointment a few appointments before)and not just have some assistant call me and tell me your a1c is .... and you need to take a statin, even though my cholesterol is fine but not as low as the ada recs.
Otherwise he asks me what questions I have and listens/discusses all of them. And he is knowledgeable about new drugs/treatments. My main problem was initially when I had a dvt after my release from hospital last year, he didn't do anything and told me to follow up with my ortho, I was back in hospital the next day. He should have made the connection with leg pain and dvt and me being in dka etc. Dvt is a complication of dka and being immobilized. I really would have switched docs over this alone but it was impossible at the time since it takes months here to get an endo appointment and I was freshly out of hospital and dka and could not go without close follow up. I remember calling my neighbor's endo before I was hospitalized telling them my symptoms and they still wouldn't give me an appointment for 6 months! crazy!!! All of this made me realize why people just go to an er- which is what I should have done.
Yes, I preach that sermon often too! I completely agree with you. I am a big advocate of nutrition being a main component in my diabetes management. I wish my doctor could see more eye to eye with me on that. I am aware of T1D endocrinologist in my state but his waiting list is extremely long. Looks like I should start talking my T1D friends into going to medschool. haha.
Junior year of college was my hardest too. I joke that finals week is always a blood sugar mess week, it seems to happen regardless of what I do. Cortisol plays such a huge role.
That is a huge time difference on appointments. It seems as though your office was able to work with you on what fit your schedule. That's really nice! :)
That sounds extremely frustrating. I'm sorry that you have to go through that. I have had trouble with my doctor not reading my records or looking at my labs results closely either. I now request a print of them every time so i can go home and google all my levels to make sure that I am in a safe and healthy range. This is sad because I'm paying for these appointments and getting very little out of them.
That's a scary story about your dka and your doctor. I can't believe he could miss that. I sure hope you are to get a new doctor without having to wait too long. Thanks for sharing youre story.
Wow. After reading about all the things people wish they had at a perfect endo appointment, I feel super lucky. I feel like I have the best endo in the world! Here are the things I love about her: 1. She is usually running on time. The longest I've waited is like 5 or 10 minutes past my appointment time.
2. She always spends plenty of time with me, I never feel rushed in and out of an appointment, which is why I don't mind if she's running a few minutes late.
3. My endo and her whole practice utilize the latest technology. They can download any pump/CGM/meter and they do it every time and actually look over your data and analyze it in the office with you.
4. They use electronic medical records, to which I have complete access to from my own home as well.
5. They have a whole on-line contacting system where I can log in and see all my lab results, my medical records, and I can even send and receive e-mails from my doctor and her nurses in between visits.
6. They use Diasend, which right now is a life saver for me. I am currently pregnant, and I upload my pump info to Diasend twice a week. My endo will look it over twice a week, and then e-mail me back any adjustments they think I should make.
7. They trust that after 20 years of having Type 1, I know how to count carbs, and don't make me see a dietitian unless I want to. :)
8. I never feel like I'm being dictated to, I truly feel like they work WITH me to achieve the best diabetes care I can get.
9. I get all my labs done right in their office, and they have the ability to do one of those in-office 5 minute A1C tests, so I don't have to wait for a week to get my results back.
10. Her office is run like a well oiled machine. They are SO helpful and organized and I've never had any problems asking them to help me battle insurance companies, or get new prescriptions filled or anything like that.
I could go on and on! I LOVE my endo. If I ever move, I feel like it will be really hard to find an endo/endo's office that is as great as this one. I've had lots of endos over the years, and I can't believe what a difference it makes to have one that I like!
IDEAL: I don't have (or particularly want) an endo, but if I did I would want one that says "how are you doing and how can I help?" Then we would have a dialogue very similar to when I post a thread on TuD like my current one about DP. Abbreviated sample dialogue:
Zoe: I have been having extreme high numbers when I wake up out of the blue the last two weeks.
Endo: Sounds like maybe DP
Zoe: I've never had DP at all, can you suddenly develop it after 6 years?
Endo: Yes, this can happen
Zoe: Ok, so I need to raise my basals before morning? Can you suggest an approximate time frame and percentage to raise it?
Endo: Everyone is different, of course, so I would suggest testing through the night to see when the rise happens. But a common time is between 1 and 3AM. Ditto the percent to raise, but I have had patients whose increase varies from x to y percent. I would suggest raising it for these time zones by .100 increments until your fastings come into range, testing a few times during the night to see what is happening and make sure you don't go low. E-mail me if you have questions or concerns. DP is difficult, but it can be managed.
Zoe: Thanks, doctor.
REALISTIC/ACTUAL
Zoe tells doctor what prescriptions she needs refilled or what lab tests ordered. Doctor does exactly as Zoe requests and then the appointment ends.
I think he does look at the lab results closely and he remembers them, but I'm not sure about the bg records.. which I really would like more input on. I saw the diabetes/pump educator at their office when I tried a cgm but I only saw her 2-3 times for dietary advice and help with the cgm which I had to stop using. I agree it is frustrating that we have to check our test results so closely, they should really be doing that. - I have been doing that for years now, always read all my blood work etc. and look it up online. I recently called my new gp's office a few times about a cbc I was concerned about and a nurse there spoke with her and discussed it all. She is also going to do a repeat in a month. But it would be better if the doctor called and discussed it all and we didn't have to do all of this! They said it was normal, and I asked for the records to be sent to me, there were lots of highs and lows I didn't comprehend so I questioned it. I really think in 2013 all of this should be online for us to access and everyone should have email capacity.
I think I have forgiven him for missing the dvt, and since he is a good doc overall I don't plan to change as long as I'm managing ok. The office is very good about getting my rx etc. and he is pretty knowledgeable about everything else so far. If I ever have symptoms again, I know what to do. I carry lovenox around with me too just in case, rx by my vascular doc.
Oh and adding to my previous post on this thread: I wouldn't want an endo who thought A1C's in the 7's were fine. I'd want him to support me in getting and staying in the 6's and be over the moon happy for me when I make it into the 5's. (Not, like many tell me I need to raise it to avoid hypos). And of course to be supportive of whatever level of carbs I decide is right for me.
Why is this starting to sound like TuD without the copay??
Zoe, this is great! I've never had a conversation like your 'ideal' with a doctor but if I had they would have immediately earned my complete respect. It's the little things like times and percentiles that can help tremendously. My appointments usually go exactly how your 'realistic' one was written. I occasionally tell my doctor about something I found that helps, from reading a book or researching scientific studies online. I'm no sure if she is actually takes it into account for her other patients or just listens to be courteous, but at least I try. I'm glad this site seems to be helping you get some of the information you need. Thanks for your thought! :)
It's nice to know I'm not the only one that does that. haha. It sounds like your gp was really responsive. I know that some Doctor's offices are moving towards all electronic records. It's a great idea and I think it will really catch on. It's just a transitioning process.
Well that sounds good! It's nice that you have a plan. :)
This is beautiful! I'm so glad there are Doctor's out there like yours. I was eating while reading this and seriously dropped my fork when I read that your endo looks over your pump records twice a week. That's amazing, even when you are pregnant. It really sounds like your office is on top of things! I like to hear that there are great places like that out there. It gives my hope in finding one similar one day. Best of luck with your pregnancy!
Haha yes, I feel your pain about the low A1C being dangerous problem and about the carb intake! I've had that very same conversation with my endo before.
we have to do it because if they know we're paying attention they will be too :) I hope they will all have that asap, it makes life so much easier.. thanks!
My endo does the same thing! He also celebrated when he found out that I was (finally!) diagnosed with something after four years of searching. (He'd tried to help me at some point.)
My father and I usually share a 30 minute appt (15 minutes each). I take up most of the time. He always asks me how I'm handling school and reassures me that med school is better than college, and that I'm almost there and that I'll make a wonderful doctor.
He'll also test me for anything I want, because he's already drawing blood anyway.
