"Now you have Type Oooooone Die-ar-bee-tes. That means that you do not produce any insulin," the doctor said as he reached for his pad and pen to draw me a diagram of this phenomenon with which I am, in fact, intimately familiar - having lived with the condition for Twenty-Seven Years!!! This is not the story of my diagnosis, but a story from last week. I have no idea what the doctor said next because I was in shock. I snuck a look at my husband, who was sneaking a glance at me - and sitting forward on his chair in case he had to restrain me from jumping across the desk. There was, however, no doctor-throttling as I was so shocked that I was simply speechless - for a moment.
I was seeing a specialist for a condition other than diabetes, however as everything is related to diabetes and diabetes is related to everything, one of the treatment options, a drug commonly used for type 2 diabetes, had us talking about my diabetes. My downfall, I determined later in the debrief with my husband, was when I used the phrase: "I have read some research", that this drug has been used in type 1 as well as type 2 diabetes. Later on, debriefing with some nurses who share my cynicism for the odd species that is the doctor, I discovered that perhaps my downfall had been opening my mouth, or rather attempting to engage in a conversation.
It was put to me by the doctor that there were two treatment options for my condition. The most common one was the Type 2 diabetes drug, but in Type 1s it was perhaps not a great option as it may cause hypos and make managing diabetes harder. Sure. The other drug doesn't normally impact upon diabetes at all so is a better option .... and we would try that to see if it worked. "And if it doesn't?," I asked (Wouldn't anyone ask?) and this is where we went down the slippery slope. This scenario - two drugs, one's not great, if one doesn't work, well, I refer you somewhere else - got me asking questions. I wanted to understand the options. How long do I try the drug? Is the diabetes drug an option I could try too? And there were probably more .... I am in the throws of a research thesis - asking questions is what I do! But then the next thing I know I am getting a stern look and a "NO". Followed by the idiot's guide to Type 1 diabetes.
My diabetes management doesn't win any awards but I fail to believe that you can have an Hba1c in single figures and next to no complications after 27 years without understanding the basic tenet that my pancreas doesn't produce insulin. But the issue wasn't so much his inaccurate appraisal of my understanding of diabetes ... I think it was a complete shock and bewilderment that I wanted to (needed to?) engage in a normal, adult conversation. This is the way I learn and grasp information - most adults do - huge amounts were thrown at me by the end of this appointment and I was glad I had been to the brink and back to get the information and understanding of the treatment options that I needed. Even my husband was willing to concede that I wasn't pushy enough to deserve the "you have diabetes" talk. With a bill for $220 on the way out the door, I was sure glad I had got what I wanted.
Subscribe to:
Post Comments (Atom)
Posts
Kate, this is a really valuable message and valuable perspective and it sounds like you had a great opportunity to share some of the reality of how badly doctors (what specialty? endocrinologist? other specialty? this is relevant as basic medical education for licensed MDs in diabetes is really primitive) behave, and manage their authority and relationships with patients, as well as (more essentially) how bad their medical advice can be.
ReplyDeleteBut I really couldn't grasp the take-away message. You lost me in paragraph 3.
I feel like I don't engage in nearly enough interaction with other diabetics or diabetic social networking, I haven't read enough blogs and articles, but I really believe people need to get a reality check on how -- excuse the hyperbole -- fraudulent the affectation of authority by doctors is. As my wife is an endocrinologist (and a rare one, she started as a medical student and in residency studying actual interwebs forums/blogs/discussions of diabetics and how they're managing their conditions etc), I've gotten a privileged look at her licensing study, exams, the content of her education, and a rare behind-the-curtain look at how endocrinologists counsel their patients... and how shockingly badly it's done, seemingly 95% of the time.
All too common, sadly! We've seen an acceptance of the need to tighten training standards for roof insulation installers and for home energy efficiency assessors... how about a requirement that all medicos undergo an independent skills audit and regular training updates, including those all-important courses in effective practitioner communication: "Your patient is not an insect 101", and "Other people can be intelligent too 102"... Grrrrr
ReplyDeleteHello,
ReplyDeleteI must admit I've had similar experiences, thankfully not from doctors as I'm lucky enough to have a type 1 GP and wonderful endocrinologists; but rather from nurses and some few diabetes educators. This is probably the stage where I admit that I'm a medical student as well as type 1. Before I'm lynched let me assure everyone that I'm doing my part in my school to educate fellow students and to complain to the med-school whenever they fail to differentiate between type 1 and 2 in teaching where there ARE differences.
My daughter has been a type 1 Diabetic for over twenty years and the Doctor situation has not improved in that time. My Grandson is also a type 1 Diabetic and his poor mother is having the same problem with condescending Doctors as I have had all these years. What do we do?
ReplyDeleteBeen there, done that. Some 15 years ago or so I moved interstate. I sought out a new endocrinologist in my local area (Wollongong). When I finally saw the endo he gave me he gave me a 45minute lecture on "what I was doing wrong" (note that I'd already had diabetes for 10 years by that point).
ReplyDeleteHe didn't listen (and wasn't even interested in) the fact that I was doing a lot of fieldwork, which made "traditional" management difficult (eat at the same time of day, eat the same amount, etc etc). He essentially seemed to be insisting that I completely change everything. I walked out and never went back. I would have been quite prepared to work with him in finding ways to improve my diabetes management that would work for me. I'm very glad that I never saw that specialist again.
Ugh. It's enough to make us not what to go back. Maybe that's their plan...surely not!
ReplyDelete