Thursday, October 18, 2012

If it 'aint broke...

I've had quite a difficult time getting in to see my doctor lately.  I usually see my Diabetes Specialist every quarter.  Last time I made my appointment, I scheduled the usual 3-4 months out.  The day was approaching and so I arranged for a babysitter for little brother and for a friend to pick up big brother from school.  The appointment was in the late afternoon.  As the date was getting closer, I realized I was having some major concerns with my weight.  I'd been exercising and training really hard for my triathlon.  Throughout that time, I was also counting my points (weight watchers for calories) and although I was creating a large deficit, I was still GAINING weight.  Oh the troubles of it all!  So entirely frustrating!I was really looking forward to getting to the bottom of some of the issues I was having.  I was prepared with food logs and exercise regimens and some really good questions for her.

When the day of the appointment came around, I got a phone call that morning, at about 9:30 or so.  The receptionist, who knows me by name and is very nice, let me know that my Nurse Practitioner had a family emergency come up and that my appointment would have to be canceled.  She tried to have me come in later that day and meet with another doctor in the office.  The appointment was at an entirely different time that would not work with my previously arranged plans (for picking up, dropping off, and watching my boys).  SO... the closest thing she had was this week, nearly 30 days AFTER my scheduled appointment.  I was so frustrated I believe there were tears.

As I thought about my upcoming appointment, I thought maybe it was time to switch doctors.  I have been seeing the team at the Diabetes Center for almost 10 years and while it was a great experience, they are quite a long ways from my home, they don't allow children to come along for appointments, and it causes quite a bit of pain and planning on my part just to make it down there.  In all, I usually spend about 3 hours for a trip to the doctor.  So, I kept my appointment with my NP but went online to find a new doctor.

I looked for Endocrinologists who practice closer to my home.  I found one who was particularly attractive because of his specialties with thyroid conditions.  It said that he even did ultrasounds on thyroid.  I didn't know if that was something I needed, but I was looking forward to someone who would maybe take a more whole-body approach to my endocrine system.  This particular doctor had an office very close to my house so I called and made an appointment.  I was looking forward to meeting someone new, and having a new doctor who would be so much closer.

I met with my regular NP on October 3.  The appointment went really well.  My A1c was 6.6, I was overjoyed!  We didn't make any changes to my pump settings as they were obviously working quite well.  She sent me home with a full panel of labs to have done at my earliest, fasting convenience.  We briefly discussed my weight, but things have sort of straightened themselves out on their own.  I keep thinking that something has to be wrong, or off, but I don't know.  She mentioned making an appointment to meet with the dietitian who specializes in weight loss.  I may still do that. 

I left thinking, man, that went really well.  The only draw-back really was that I found out my NP was moving to a new office and that I wouldn't get to see her again.  However, I love the main doctor there, so that wasn't really a problem for me.

Which brings me to my next appointment.  The second appointment I made was clearly unnecessary except for the fact that I was looking to switch doctors to a more convenient location.  I felt like it was more of an interview- I was interviewing this new doctor to see if he would be a good one to switch to.
I was really looking forward to seeing a doctor who could better treat my thyroid and whose office was closer to my home. 

The appointment was for October 8th.  So, I walked into the office and there was a woman behind the desk.  She did not greet me so I approached the desk and waited for her to admit me.  I stood there for at least 2 full minutes before she even addressed me.  Hmm...  She then asked me what my name was and gave me the paperwork for admittance   I sat down to fill it out and she she asked me probably 4 more times to come up to the desk while I was trying to fill out my patient profile, complete with a family history and all.  Next the Medical Assistant came up to the front desk.  She starts bad-mouthing a patient.  Right in front of me.  I couldn't t believe it.  Said patient comes up to the desk and is obviously upset.  He tries to handle his business and there is tension.  He leaves.  They continue bad-mouthing him.

I'm called back to the room.

They take my weight, bring me to a room, take my heart-rate and blood pressure (personal pet peeve- I can see my weight on the scale, but I cannot see my blood pressure, if you're going to take it, why not tell me what it is? I finally told the nurse at my OB/GYN that she needed to tell me when she takes it).  Anyway, let me tell you about this medical assistant.  She was gross.  Her hair was unwashed, uncombed and pulled back into a pony-tail (nothing against the pony, I wear it frequently), her teeth were disgusting,  hadn't been brushed in WEEKS, nasty breath too.  She wasn't rude or anything, she asked me a few questions, took my meter and left.

The room was small but I noticed that there wasn't a computer in the room.  I was curious as to how they'd upload my blood sugars.  The doctor came in and we visited for a while.  He pulled out my meter, turned it on, and started scrolling through my blood-sugars.  He never looked at mealtime averages, post meal sugars, or anything like that.  He just glanced through a few of my numbers.  Granted, my A1c was great, but he had no way of really looking at my blood sugars in a constructive way.  

He examined my feet, asked me when my last eye exam was, and told me that I needed to schedule an appointment for an eye exam.  The weirdest thing of all this was, he asked me if I was on a CGM.  Then he mentioned, ever-so-casually, that he "wouldn't advocate for them or anything".  WHAT??? Um, that was the straw that broke the camels back for me.  I couldn't believe a person in his position wouldn't "advocate" for a medical device that helps patients take great care of themselves, manage their diabetes well, improve A1c levels, etc. etc. etc.

Because I had already done all of my labs, he was able to go over those with me.  He mentioned that everything looked to be within normal levels except for my cholesterol   I've never had elevated cholesterol before so I was pretty surprised by this.  He said that because I'm 32, and most of the research on cholesterol meds were performed on patients 35 and older, that he wasn't going to put me on any prescription.  I'm fine with that.  Honestly, I was so put off by this guy that I was just going to wait and see what my other doctor said when they called to tell me about the same results.  But he never mentioned anything else about it.  He never brought up anything about diet, exercise, or anything else related to lowering my cholesterol   This guy was striking out with me.  

I  casually brought up the question about my weight.  I told him that I am counting calories, exercising lots, and not seeing great progress.  He mentioned that I should move more and eat less if I'd like to lose weight.  Um... right.  He then asked me how often I usually visit my other doctor.  I told him that it was about quarterly and he said, okay, I'll see you in three or four months.  Right.

The receptionist asked me how it went, and offered to make an appointment.  I told her that my schedule is really varied (it is) and that I'd call her to make a follow-up appointment.  But I won't.  And I'm pretty sure it's obvious why.

Needless to say, this "interview" didn't go so well.  The doctor was nice enough, but obviously not a great fit for me.  I need someone who is proactive with my care, who uses technology, and who is interested in helping me stay as healthy as possible.  His flippant attitude toward the CGM was one thing, the fact that he didn't look at BG averages was another, the "do nothing" approach to cholesterol was a third.  Not a great fit.  Perhaps he's better with other types of patients but I wont be going back.

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