An endocrinologist is a specialist in hormonal disorders. I'm a "gland doctor" as my sister so eloquently put it. I see a lot of diabetics in my clinic.
Usually, when you require insulin, you have to give yourself anywhere from one to four or more shots a day. It's a pain, literally and figuratively. Some patients require insulin for the rest of their life. A few will qualify for an insulin pump.
The pump is the size of a deck of cards and delivers a continuous stream of insulin. You put a new site in every 3 days. One "shot" every three days instead of 3-4 times a day.
Sounds great, right? Really easy?
Well, it's actually a lot of work. You have to check your blood sugars 6-7 times a day. You have to accurately judge how many carbs you are going to eat and tell the machine accordingly so you can receive an accurate dose of insulin. And if there's a problem with any part of the pump, your blood sugar can skyrocket really fast and make you seriously ill. If you aren't on top of this, things will go south fast.
But patients don't want to hear that part. They hear one "stick" every 3 days instead of several times a day and want one now like Veruca from Willie Wonka and the Chocolate Factory. And woe be unto you if you're the endocrinologist who dares to say no.
One patient who wants a pump won't take her insulin on a regular basis. Her blood sugar hasn't been below 300 in months (normal is around 100). She won't check her blood sugars and doesn't follow her diet.
But I'm suppose to approve a $5000 piece of equipment on the basis that you want it because you can't "remember" to take your shots. Sorry if your buddies in your same situation got a pump. No, I don't know how their doctor managed it. Let's focus on getting your diabetes under control now instead of several months down the road when your pump may or may not come.
Unfortuately there are no quick fixes in diabetes. Diet, exercise, and taking your medications regularly are the best treatments. An insulin pump isn't always the answer.
Wednesday, September 29, 2010
Friday, September 24, 2010
How to Be a Better Patient
Now I've seen several things in the media about how to be a more empowered patient, how to get the most out of your doctor, and how to read the signs that you need a new doctor. And don't get me wrong, it's important to have a good relationship with your doctor. If that relationship isn't there, then the two of you won't accomplish much no matter how empowered you are.
Yet I haven't found much expounding on how to be a better patient. And given my three years of working in two continuity of care clinics, I have encountered some patterns of behavior that tend to drive doctors up the wall. Which really works against that whole doctor-patient relationship thing.
So here's my guide on how you can get along better with your doctor and be a better patient.
#1. Bring all of your medications to each doctor's visit.
#2. Bring all of your medications to each doctor's visit.
#3. Bring all of your medications to each doctor's visit.
I can't stress this enough and for a lot of reasons. One it allows me to know what meds you actually have and I can judge if you actually taking it. If I gave a month's supply with five refills six months ago and your blood pressure medicine bottle is still nearly full and still boasts five refills, I'm pretty sure that you haven't been taking it. Therefore I would stress actually taking the medication instead of cranking up your dose.
Also, I can see what your other doctors have been giving you and they can see what I have you on. Some medications, like people, don't play well together. The consequences could be range from one or both not working to something very serious like renal failure.
And sometimes a change in your medical condition will make a once safe medication not so safe. So, while your kidney doctor will likely not treat your diabetes, he or she may note that your diabetes pill isn't such a good idea in someone whose kidneys are failing and tell you that you may need to stop it. Or that a medication you're on may be causing your kidneys to fail. They wouldn't be able to do this if they don't know what all you are taking.
#4. Have some idea of what you medical problems are.
Know the game “Twenty Questions”? Yeah, it's fun on road trips. It's not fun if I have to play it with you to figure out what's wrong with you. For example:
Me: Do you have any medical problems or conditions?
Patient: Nope.
Me: Nothing that you should take medication for?
Patient: No.
Me: You have a big scar running down your chest like you had heart surgery.
Patient: Oh, that's from my second quintuple heart bypass surgery last year. I only take aspirin, a cholesterol pill and three blood pressure medicines.
Me (still trying to be civil): Any thing else?
Patient: No.
Me: But you asked for a refill on insulin. How long have you been a diabetic?
Patient: Only for twenty years.
Sadly, this is very close to an actual conversation with a patient in clinic. Consider this a corollary to #1-3.
#5. Lists are good.
No matter how good your memory is, there is something about a doctor's office that makes you forget everything you wanted to discuss, mention, or ask me about. And you will not remember until about 2 am that night when you suddenly wake up remembering it. So bring a list. I will actually thank you for it.
#6. Be polite.
Especially if this is our first interaction. The old saying is true: you will get more flies with honey than vinegar. Doctors are only human and if you are nice, your doctor is more likely to work with you than if you are difficult.
#7. And be polite to everyone.
During my receptionist days, I was amazed at the number of people were incredibly rude to me or the nurses but were as sweet as they can be to the doctors. This is a bad idea in general. Word of your behavior will make its way to the higher ups eventually and I have seen patients fired for continuing this type of behavior.
#8. Remember that I'm here to try to help you.
I'm not running behind to deliberately piss you off. I'm not increasing the dose of your blood pressure medicine because I don't like you. Nor is the blood work some form of punishment.
Unless you violate #6 or #7. (Just kidding).
#9. Not everything you read on the Internet is true or applies to you.
If there have only been 6 recorded cases of French Fainting Fever since the beginning of time, chances are that you don't have it. While the Internet is a great tool and can provide some great information, you have to be careful of your sources and how you apply it to yourself. And remember, in general, reading WebMD for ten minutes doesn't trump years of medical training.
10. Remember that this is YOUR health.
And nothing can replace your health. It is important that you take your health seriously. Because it's true that if you don't have your health, you don't have anything.
So take ownership of your health and your healthcare.
If I said that I was going to send you to a specialist at your last appointment and you've haven't heard anything about it a month later, pick up the phone and call the clinic. Or write a letter. Or send smoke signals. Something other than waiting until your next appointment two months later to yell at me about it. Generally they send the patient the appointment notice, not the referring physician.
You will not be bothering your doctor. I thanked a patient who noticed that I didn't rewrite one of his blood pressure medications and didn't talk to him about stopping it. It was an oversight and he should have been continued on the medication. By taking responsibility for his own health, his blood pressure remained controlled instead of sky high for the next few months. And all it took was one phone call.
The End
Yet I haven't found much expounding on how to be a better patient. And given my three years of working in two continuity of care clinics, I have encountered some patterns of behavior that tend to drive doctors up the wall. Which really works against that whole doctor-patient relationship thing.
So here's my guide on how you can get along better with your doctor and be a better patient.
#1. Bring all of your medications to each doctor's visit.
#2. Bring all of your medications to each doctor's visit.
#3. Bring all of your medications to each doctor's visit.
I can't stress this enough and for a lot of reasons. One it allows me to know what meds you actually have and I can judge if you actually taking it. If I gave a month's supply with five refills six months ago and your blood pressure medicine bottle is still nearly full and still boasts five refills, I'm pretty sure that you haven't been taking it. Therefore I would stress actually taking the medication instead of cranking up your dose.
Also, I can see what your other doctors have been giving you and they can see what I have you on. Some medications, like people, don't play well together. The consequences could be range from one or both not working to something very serious like renal failure.
And sometimes a change in your medical condition will make a once safe medication not so safe. So, while your kidney doctor will likely not treat your diabetes, he or she may note that your diabetes pill isn't such a good idea in someone whose kidneys are failing and tell you that you may need to stop it. Or that a medication you're on may be causing your kidneys to fail. They wouldn't be able to do this if they don't know what all you are taking.
#4. Have some idea of what you medical problems are.
Know the game “Twenty Questions”? Yeah, it's fun on road trips. It's not fun if I have to play it with you to figure out what's wrong with you. For example:
Me: Do you have any medical problems or conditions?
Patient: Nope.
Me: Nothing that you should take medication for?
Patient: No.
Me: You have a big scar running down your chest like you had heart surgery.
Patient: Oh, that's from my second quintuple heart bypass surgery last year. I only take aspirin, a cholesterol pill and three blood pressure medicines.
Me (still trying to be civil): Any thing else?
Patient: No.
Me: But you asked for a refill on insulin. How long have you been a diabetic?
Patient: Only for twenty years.
Sadly, this is very close to an actual conversation with a patient in clinic. Consider this a corollary to #1-3.
#5. Lists are good.
No matter how good your memory is, there is something about a doctor's office that makes you forget everything you wanted to discuss, mention, or ask me about. And you will not remember until about 2 am that night when you suddenly wake up remembering it. So bring a list. I will actually thank you for it.
#6. Be polite.
Especially if this is our first interaction. The old saying is true: you will get more flies with honey than vinegar. Doctors are only human and if you are nice, your doctor is more likely to work with you than if you are difficult.
#7. And be polite to everyone.
During my receptionist days, I was amazed at the number of people were incredibly rude to me or the nurses but were as sweet as they can be to the doctors. This is a bad idea in general. Word of your behavior will make its way to the higher ups eventually and I have seen patients fired for continuing this type of behavior.
#8. Remember that I'm here to try to help you.
I'm not running behind to deliberately piss you off. I'm not increasing the dose of your blood pressure medicine because I don't like you. Nor is the blood work some form of punishment.
Unless you violate #6 or #7. (Just kidding).
#9. Not everything you read on the Internet is true or applies to you.
If there have only been 6 recorded cases of French Fainting Fever since the beginning of time, chances are that you don't have it. While the Internet is a great tool and can provide some great information, you have to be careful of your sources and how you apply it to yourself. And remember, in general, reading WebMD for ten minutes doesn't trump years of medical training.
10. Remember that this is YOUR health.
And nothing can replace your health. It is important that you take your health seriously. Because it's true that if you don't have your health, you don't have anything.
So take ownership of your health and your healthcare.
If I said that I was going to send you to a specialist at your last appointment and you've haven't heard anything about it a month later, pick up the phone and call the clinic. Or write a letter. Or send smoke signals. Something other than waiting until your next appointment two months later to yell at me about it. Generally they send the patient the appointment notice, not the referring physician.
You will not be bothering your doctor. I thanked a patient who noticed that I didn't rewrite one of his blood pressure medications and didn't talk to him about stopping it. It was an oversight and he should have been continued on the medication. By taking responsibility for his own health, his blood pressure remained controlled instead of sky high for the next few months. And all it took was one phone call.
The End
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