Spend Time Listening
It’s been awhile since I posted anything significant about diabetes. I still have diabetes. It still creeps into every aspect of my life, it especially horns in on my sleeping as of late.
I started writing this post then the DSMA Blog Carnival topic for October was posted as: What can diabetes educators/HCP learn from the DOC? and I thought this kind of relates, continue reading for some reflections on my last endocrinologist appointment.
Most of the time I don’t have a problem with the fact that my endo sees only adults making me one of her few Type 1 patients or that I’m treated at a teaching hospital and spend most of my appointments with doctors in training*. But at my last appointment I did.
The doctor in training that I saw seriously lacked patient communication skills. She did all of the things that people with diabetes hate. She picked out a particularly high number on my log and asked what happened. I explained to her that I had an infusion site failure, I took the proper steps to fix it and pointed out where my number stabilized (in reasonably short order). She practically disregarded my explanation and fixated on that number and how to fix it for that time of day until I stopped her and said that I did everything right to fix it and that one number didn’t represent my general diabetes status during the afternoons. Then she said, three different times, “Your A1c went up.”
“Your A1c went up.” “Your A1c is up by .2.” Yes, yes I realize that my A1c increased by .2. It’s 6.1 from a 5.9, please move on. That’s only an average glucose increase from 123 to 128. And the goal on my chart is under 7% and my personal goal is under 6.5% so I think I’m doing ok. Clearly, my doctor in training had no idea what it’s like to live with diabetes. She asked about complications (I have none), she asked about any other issues that I was having and I explained my frustration with massive after lunch spikes, which she couldn’t find on my log to be a problem and said, “We’re okay with the 160s after you eat.” That’s when I said, “but I’m not.”
I see these doctors in training for chart updates and basic reviews of my logs since my last appointment, then I see my endo and they go quiet. Hopefully she learned something when Dr. O was unfazed by my A1c jump and was attentive to my after lunch frustration (that was when she switched me to Apidra).
The two positive things that this doctor in training did were to ask me about my pump since she wasn’t familiar with OmniPod and to talk about my kidney function improvement. She answered my questions about what I could do to continue reducing my nephrology risk (continue keeping my blood sugar in range and keep doing what I’m doing with my blood pressure).
This appointment was awhile ago, and I’ve been thinking about it off and on and been bothered by the communication/customer patient service aspect of it. I know that I’m not alone in feeling frustrated when healthcare professionals don’t acknowledge the day-to-day life that affects diabetes and that things happen beyond our control. The logs that they chose to look at were all of my test results from painting and moving into our new house, a situation that is not my regular and will throw my numbers into strange patterns. Situations that need prepared for and addressed, but not treated the same way as my typical routine.
How the DOC fits in
The healthcare field has a wonderful opportunity to peek into our daily lives through social media and blogs like this one. I feel that if my Dr. In Training had spent a little time as a fly on the wall on Twitter, she would have not been concerned by the .2 jump on the A1c, but more interested in the patterns I was seeing. I didn’t go to medical school and my college eduction was in communication and business, but I have received training from a CDE and dietician and I live with my particular case of diabetes so I would like my opinions heard and considered.
There are enough patient tales of doctors who refuse to download meters, ignore patient input, pinpoint crazy numbers out there to help people in the medical field understand the type of communication that we need. There are enough patient stories of balancing diabetes and family, work, school and life in general to let them know how we live and what they can do to make it easier.
Maybe it’s the field that I work in or maybe it’s common sense, but I think good communication is incredibly important in our medical care. And good communication doesn’t start with the words we say but with the listening that we do.
This post is my October entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2012/october-dsma-blog-carnival-2/
Does your doctor have diabetes, too? Mine doesn’t, but I’m always amazed at how he seems to “get it”. In fact, in my next-to-last visit, he noted that my A1C was “about the same as last time” (though in my mind, it wasn’t the same, it was .2 higher [and above my target] and I was really upset about it).
Then again, I’m reminded of an earlier Doc-in-training who declared, and this has replayed itself in my mind for over 20 years, that “this [diabetes] is a part of your life now”. He didn’t care that it had already been a part of my life, or what I was doing with it, he was just laying down the law, so to speak. It completely disgusted me.
Having people that listen, and are willing to talk WITH you rather than AT you, makes a tremendous difference!
No, mine does not have diabetes. She’s made reference to other endocrinologists who have type 1 and what they’ve noticed (what I noticed that caused the switch to Apidra).
I have no question about the doctors I’ve seen getting the science of diabetes, but there are so many that don’t get the patients who have diabetes. I think that’s part of what makes the “non-compliant patients” that we hear about.
Ugh, I hate that you had such a frustrating time with that doctor in training. I agree, she could learn a lot from the DOC. I hope she also learned a lot from you and from what she observed from your endo during the rest of the appointment. I sounds like you have a really good doctor!
Hi, Rachel – I just found your blog. I love to read about others’ experiences with diabetes. There are no support groups in my area so it’s very helpful. I wish I could see an endo with Type 1. Or even a nurse with Type 1. What a difference that would make. Anyway … I, too, have after lunch highs (on MDI) and am curious about the Apidra. Has it helped?
Kudos to you for keeping your cool during that appointment and explaining your frustration to the doctor. I’m grateful that this seems to be atypical of your experience at that office. Your BP would suddenly become a new factor to consider. 🙂