I often write “consult your medical team” because of these reasons:
I often mean “do not use snowthrower on roof” or “your brain should be involved here”.
to express that any modification to the treatment is something to take seriously.
to ask the medical team about the specific recommendation I have given. If they turn down my approach I want to read the argumentation of them in the following discussion. Just to give you more and more ammunition until the medical team is on track with your goals. This cyclic approach will tell you something about the value of your medical team for your glucose control.
although I use the term “team” I would never expect or allow any data exchange between different doctors. I want to have control about the information collected about me. A team does not need endless data. It needs the exchange of refined information and I am the messenger.
my diabetologist is a well respected source of information. He will look at my data from a different standpoint. He has seen many patients (thousands) and this gives him the creativity to develop new ideas and approaches. So his value for me is the ability to transfer or adjust the successful treatments of others to my situation.
the medical team is good for consultancy but I am the captain of my ship.
“At some point, we NEED to learn to deal with our Diabetes, and be big boys and girls and learn to take care of our own bodies, and insulin dosing.”
Isnt this what we go to the Dr.s to learn to do? I mean honestly, Id rather learn from a trained professional than something unverified on the internet.
I completely agree regarding research and self involvement in the care of one’s aliments, but I dont pretned to know more than a biologist about human cells nor and Endo about internal medicine. I research, theorize, and verify with a trained professional.
Personally, I think folks should really see a therapist post diagnosis. It would greatly assist in people learning to deal with it mentally. Also, I understanding that Dr.s are exactly like us. Although, I do think they take their work home with them, just like I do. =^)
Do any of us really have Dr.s do our thinking for us all the time? I mean Im all for consulting medical journals for our information (just like your Dr.s should). Heck I was recently going to believe an article written in USA today! However, I think these ideas and findings should be consulted with a trained medical professional. They get paid to research and know these things. Remember, they work for you. If you dont like them, dont pay for them!
At one point, I really did have a team. My former endocrinologist had a large practice that, at one point, focused both on research as well as the purely clinical. Out of necessity, as the grant writer and Primary Investigator in charge of the studies, everything was coordinated out of his office and he had to meet regularly with every specialist to discuss data and progress reports for whatever grant he was working under. As a new diabetic, it was great experience to have that kind of support. He eventually retired and turned his entire practice over to a colleague. Nice guy, but the practice is 100% research based now and I don’t have the opportunity to be involved often enough for regular care.
Now, not so much. I have a new endocrinologist who has a much smaller and intimate, meaning isolated, practice. Yes, I am responsible for 99% of my daily diabetes care and, ultimately, 100% of the decisions I have to make. Still, I am not a doctor and I wouldn’t think about trying to manage my diabetes without sound advice from a physician I have some level of confidence in.
i don’t have a team; don’t want a team. only have myself, which is fine. i’ve never met a CDE, never gone to a support group. what can a dietician offer that you can’t learn from reading the label?
i use my doctor for one thing only: renewing prescriptions and lab requests.
in fact, i’ve never had a single diabetic friend; in 50 years i’ve never had a relationship with another diabetic. (in fact, i’ve never told anyone at school, work, sports, etc i’m diabetic.) it’s the way i prefer to live my life. i know others have a different perspective but it works for me.
I wish I had a team, but I don’t. I basically have a bunch of consultants, rangining in competency from trusted advisor to keystone cop.
Endo. He is his own team, you are either on it or off. Patients are to be seen and not heard. Other doctors need to follow or get off the bus.
PCP, nice, fairly compliant, collects my records from everyone, but not diabetes competent, has thrown up her hands at my D.
Cardiologist, neurologist, opthamologist, dentist, periodontist, recent surgeon, all competent in their specialty and trusted.
CDE, they are nice, they give good listen, but at this point, they don’t offer any medical contribution, I am educated on D, I don’t agree with their dietary advice and they refuse to interact in my “team.”
I have some serious “trust” issues when it comes to my “medical team.” I’ve had to put up with a lot of incompetency. I keep copies of all my important record, I don’t trust any of them to lead my team. I lead my team. My team consists of a bunch of “consultants,” about half of which I have to keep on the rolls because of the “system.”
Ugh my “team” dosen’t seem to talk to each other like your “team” don’t seem to talk to one another. I have 1 dr who just raises cane with me about my A1C while the other dr is happy with it. I know that a “team” consists of the ones dealing with the D but it would be nice if all 4 drs could agree on something!
No… it isn’t what we go to our doctors to learn to do. Most doctors DON’T know how to do that. It’s what most people go buy a book like “Think like a Pancreas,” to go learn to do. I’m sorry, but I really disagree strongly with you… and I do not appreciate your tone, either. It’s very patronizing in that “shouldn’t you know better that you should blindly trust your doctor, sort of way.” I don’t, sorry.
When it comes to chronic illness, we all ought to exercise some care when it comes to our health… we need to go read up on our conditions, and search for second opinions. Not just merely entrust ourselves blindly to people because they went to medical school. I know that that means nothing because I have seen it with my own eyes, and lived it. My own doctor does not know more about Diabetes than I do… and I can’t “fire her” because she’s the only volunteer doctor that works for no insurance and no money that is available in this town. I have “no choice,” unlike people who always complain about their docs, yet have great insurance, and do NOTHING about it. It does NOT mean that I think I know more than a biologist, or whatever other “professional.” It means that I am assertive with my health, that I take time to educate myself so that people aren’t always pulling wool over my eyes, and that I don’t take risks with my body. I know endless ridiculous treatments and statements doctors have said… NO, I would never blindly go with a doctor without knowing anything about my condition! THAT’S what it means. Had I "entrusted’ myself to my doctor, I would still be over 200 lbs, today, on two or three Diabetes medications, and with a high A1C like many people on this site… Instead… I am not on ANY medications, I’ve lost almost 80 lbs… and my A1C is 5.5%. So yeah, I do trust my own understanding a little bit more than most doctors when it comes to D… Sorry, but I am not going along with your reasoning.
I have a team at the Joslin. But I will say that the communication is mostly passive – there isn’t an enormous amount of consultation, mostly just reading what the other wrote/did from the computer. I don’t know if that would be different if I was having problems. It’s fluid though, and they aren’t afraid to call someone else in when they don’t have a great answer to a particular question.
It’s super-convenient that my endo, clinical exercise physiologist, opthamologist, optometrist, pump/cgm cde, and the administrative staff that handles LMN are all in one building and all have access to the same computerized records. The only downside is that Joslin is part of caregroup and my primary is at the Brigham which is part of partners. But they are usually pretty good about interchanging records. Always room for improvement but I’m happy.
Ok, lets begin this by saying, this is a discussion, not personal, nor patronizing. If you feel this side conversation is irrevocably headed in that direction, we should stop. If you think we can still have a debate on methodologies and learn something, lets continue.
I definitely agree with your point about med school meaning nothing. I mean honestly any doctor can generate wild theories and attempt to prove them with less than reputable methods. So, I think essentially we agree about that.
I think where we differ is in how holistic we believe one should self medicate without the aid of a trained professional. This may come from your experiences with sub par doctors (of which Ive had my fair share as well) and my experience with above par doctors. But, then again, we may agree there as well in that Im for self medication, but having the advice or 2nd opinion of a trained physician which you seem to suggest.
I dont think Im arguing to “blindly go with a doctor without knowing anything about my condition,” Im only advocating verification with someone who is able to research beyond most of our capabilities before administering potentially harmful medicinal regiments. But, it seems we agree here as well. Your reference to Gary Scheiner’s “Think like a Pancreas,” is
after all, written by a trained professional.
So in the end, I think what you are saying is correct, sans the hostility towards the medical profession. Even though Ive had some horrible doctors, I kept wading my way through to ones I feel I can trust. I think though, that this falls just as much on our physiological ability to deal with D as much as anything else.
Oh and good luck with the flooding! Hope it clears up soon.
I don’t have a “team.” There is just me and my PCP ( who is also certified in Internal Medicine.) I stopped seeing my endo about 6 years ago when we had a “parting of the ways” about my D treatment. He wasn’t very helpful anyway, just dictated to my former PCP who wasn’t very helpful either. I also see a Podiatrist, Ophthamalogist , & GYN, My current PCP orders my labs & goes over my test result. I read and check the internet to stay up to date on current D related info. I have learned more being a member of TuD than I learned from my endo. I do calibrate my own insulin doses based on what my PCP suggests. My A1c stays around 6.4
What I’m saying is that we need to educate ourselves via all the potential avenues for finding good, sound information about our condition… and not to merely be passive passengers in the vehicle of our disease, while a doctor drives. I don’t think learning to dose our own insulin is “self medicating.” I think this is something that needs to be taught to people because insulin is a moment by moment thing, and doctors are not going to be with us 24/7, and many doctors fail miserably at doing this… I’ve come to understand that is quite frankly dangerous to not know how to dose your insulin for most situations… Some people NEVER learn, and will follow all kinds of outdated insulin dosing schedules/sliding scales, etc, because they are too afraid to look for any information… whether that’s from another professional, or from books written by professionals. I am saying… patients need to do their part, too, and not simply be passive. We need to learn, and think, and question, and research… Understand why things are being done the way they are, etc. In my opinion, too many doctors are uncommunicative, keep distance from patients, patronize patients, or simply don’t invest themselves in what’s going on beyond the 15 minute appointment… So we need to study as much as we can, and find doctors who’ll treat us as people, and not just another $. We need to be assertive in our own care, as we are with everything else in life…
Ugh. What a hassle. I’m sorry your “team” is so out of whack! I just changed endocrinologists for this reason. My old endo operated alone, with no nurses or CDE’s. She had LPN to draw labs, but that was it. So I changed to a new endocrinologist with a CDE and RN in her department. My hope is that because they work together in the same space they will talk! I had a team like this when I was in college and felt it was better. Plus you get to see them all at the same time, instead of multiple appointments. However these kinds of offices are difficult to find. I had to get a recommendation and it’s at an academic center which helps. Good luck!
I utilized the “team approach” when I was pregnanet and when I started on my insulin pump. I received excellent care during those times. I have found that the “Team Approach” is likely to be available in a teaching hospital enviroment.
If and when I need help to fix or avoid a complication, I would most definetly ask for the “team approach”.
My current “Team” is confident that I am able to “self-manage”. That is the “teams” ultimate goal. And the team begins with me.
I made that one of the requirements for putting together my “team”. They had to speak to each other, they had to work together, and they had to have my best interests at heart.
On my team are my PCP; a ortho doc, a therp, a psychiatrist, a CDE, myself, a nutritionist, a podiatrist, an opthamologist, and a optomistrist, and the pharmacist. Now they don’t all get together, but maybe once a year, and talk…but if meds are going to be changed, those that it directly affects get an e-mail of fax about the change. If I am going to have a cortisone shot or surgery, they all meet. Each time I see one of them, I either ask for the records within a week to hand deliver to the people w ho need them, or I make sure that they are shared with the team or people who need them.
My ortho was scheduling surgery for my knee, and didn’t know that my numbers weren’t good, not even close. Had he waited until the day of surgery or my pre surgical phsycial…it would have been too late to change things. So it is vital that they work together. And unfortunately again, YOU have to be the one to bring them together…but that’s part of taking care of you.
I guess I have a decent team. I use the VA for my diabetes care and everyone on my team has access to my records and reports from each other…the endo reads what my CDE notes, my CDE reads my PCP notes and my phyc people read everyone’s notes.
I define a team as a group of health care providers that work together and give me the best care possible. It includes for me my Family Physician - she is the hub of the wheel. I see her every three months and we talk and look at the big picture. She is usually the final word after conferring with everyone. But sometimes,For example, when my gastroparesis was diagnosed, she and the endo gave gastro guy veto on any meds until they sorted that problem out. When I walked into the endo they had conferred and they had already sorted out all my insulin orders. It was awesome. My FP has a nurse practitioner that I also see. They are both excellent and are never afraid to say they don’t have the answer but will find out or send me to a specialist that knows. I respect them. I also have the spokes of the wheel - my endocrinologist, gastro, retina specialist, foot surgeon, gyn. No, they don’t physically meet together - its the 21st century. All labs have everyone’s names on them, they phone conference, they are all linked with computer so they all have my same health history. But they communicate beautifully. They will call each other right then and there while I’m sitting in the exam room with a question and confer on testing, meds, whatever. They each have additional support for me. For example, my endo has a dietitian available to take classes with or meet with. I email every Friday my numbers and the nurse practitioner calls me that afternoon and goes over any changes or questions. He is thorough and the expert and there is NO AMOUNT of research or reading I can do to be more of an expert than this doctor. I keep a list of questions and he is never offended if I ask about a med or a treatment and he answers articulate and with great confidence. Out of respect for all he does I would never take meds or adjust anything without discussing it with him. He prescribes based on testing and exam and gives me options. I never feel like he has his hand on the door nob. And I am totally part of this team. I make decisions, I state preferences, I ask questions and while they PLAN, I LIVE the plan. Without me, there is no team.
I feel very sad when I read about some of you and your struggle to find a physician that will take good care of you. I am very blessed. Every time someone on this site talks about anything from should I take cinnamon or B12 to liver problems I think - gosh, my doctor discussed that with me - Why didn’t theirs??? My first doctor experience was not good. I went about 10 years basically untreated until I fired my doctor (I thought my daughter was going to punch him out) and found my team. It seems very few of you are satisfied and I just think I do have a team and they are great and I wish that for you.
My local hospital puts out a local health care magazine and several of their articles have talked about and praised the idea of a health care team. I think that attitude coming from the hospital makes a difference. Its where my team started. I was untreated, I crashed and ended up in the hospital and my foot surgeon said “honey, you need to make some changes”. With my blessing he put together the team, PERSONALLY called and made all the appointments for me on the spot (got me in quick, too, the little rascal) and its been great ever since. My first appointment at the endo was 2 hours long. If you aren’t happy, keep pushing to find the right fit – it is worth it. And yes, it truly exists out there.
I don’t really have a “team”…I have a group of individuals who make a point to care for certain parts of Me.
1-endo
2-podiatrist & orthopedic surgeon
3-GP
4-massage therapist (energy work rocks!)
5-eye dr.
I’ve been to a nutritionist a couple times but inevitabily she’ll say I need more protien when I’m craving more greens or I need less fruit when my body is screaming for blueberries. We seemed to lock heads too often.
There have been times I think the most important one in that list was the massage therapist.
The only time these people share info about me is when I request that a copy of blood work be sent on to various doctors. It doesn’t help that my endo works out of one hospital and all my other doctors another.
