My type 1 diabetes is managed on a day-to-day basis by me. I do my blood sugar checks, I make insulin decisions that correlate with the food I’m eating or the exercise I’m doing. I have decided to make an insulin pump, a glucose meter, and a continuous glucose monitor part of my diabetes technology arsenal.
My endocrinologist helps manage my diabetes from a distance, but her input is important in the decision-making process I fumble through every day. Her recommendations, education, and advice color my choices in debating things like Symlin, having children, clinical trials, etc. She prescribes the drugs and devices I need/want/should have. My endocrinologist went to medical school and, in any given week, sees dozens of patients living with diabetes (all types). She’s (sorry for going full Rhode Island’er on you here) wicked smart. And she helps put her more global perspective on diabetes in play with my myopic view of this disease, giving me a slate of smart options to think about.
Last night’s #dsma chat was a tough one because it seemed to inadvertently set up healthcare professionals as the “bad guys” and people with diabetes as the “wicked smart” ones.
Q1. How do you let your doctor know (s)he does not know what (s)he is talking about? #dsma
— DiabetesSocMedAdvoca (@DiabetesSocMed) November 21, 2013
Whoa, what? I’d like to assume (and I think correctly so) that the question was more poorly phrased than poorly intentioned. The discussion should have been about gaps between HCP and PWD communication and about building better HCP/patient relationships, not pitting one side against the other. But, like it or not, it did open up a heated discussion with Tweets and emails and texts flying. Paraphrased examples:
“They doesn’t listen to me.”
“They dismiss the things that I say.”
” They judge me.”
“They don’t care about me.”
“I know more about diabetes than they do.”
Funny thing is, I’ve heard doctors and patients ALIKE say these same phrases.
I have had my share of excellent doctors in my life. Compassionate, smart, reasonable healthcare professionals who have helped me maintain good health. Ones who have encouraged my patient empowerment and who have celebrated with me the health I’ve achieved and have maintained. I’ve also had my share of crummy doctors – apathetic, arrogant, uneducated healthcare professionals who didn’t do anything to move the needle on my well-being (except to potentially push it back). It’s frustrating as fuck to be under the care of a medical professional who doesn’t seem to care, or who make you question the depth of their diabetes knowledge.
And I’ve been an excellent patient a lot of the time. I’ve been on time for my appointments and armed with the data my doctor needs to help me make decisions. I’ve had lists of questions and expectations, and my current medication list handy, and my goals outlined. I’ve also been a crummy patient plenty of times, one who fuddles through the creation a logbook in the waiting room, with a chip on my shoulder already about the A1C result I know won’t be in-range, frustrated by the fact that my insurance company only covers therapies I don’t like, hating on diabetes and the fact that it makes me sit in more doctor’s office’s than I’d like, and arrogantly viewing my perspectives and needs on diabetes as the only one that’s “right” in that moment.
People are people, doctors and patients alike. And, like all people, there are good days and bad days and good people and bad people and all the in-between people and moments not carefully structured in this sentence but you know what I mean.
Q1. However, I haven't had this relationship w/every endo. Endo/pt relationships are delicate. It's like dating. Only w/needles? #dsma
— Kerri / Diabetes (@sixuntilme) November 21, 2013
The doctor/patient relationship is a delicate one, and isn’t easily housed by 140 characters, or within the confines of one disease state. What seems to be missing, from my admittedly oscillating perspective, is respect for all parties on all sides. I need to be more respectful of my doctor’s time, education, and opinion, and they need to be respectful of the exact same things for me. One doctor doesn’t make or break my perspectives on how healthcare professionals conduct themselves, just as one patient doesn’t speak for us all. I am the expert on MY own diabetes care, but there is no way I can claim to be the expert (or even remotely knowledgeable) on all things diabetes. I have made many mistakes along the way, both in how I manage my diabetes and how I interact with my medical team, but I have to allow myself the chance to learn from those mistakes. Same goes for my doctor.
This is life with diabetes. My healthcare team AND I work together on my health. There’s both an “I” and a “team” in “my diabetes,” and that’s the way I like it.