Diabetes From a Doctor's Standpoint

Dr. Fran Cogen Health Pro
  • I would like to wish a Happy New Year to our MyDiabetesCentral.com readers. 


    Generally, my posts provide factual information along with tips and advice for people with diabetes. Although I provide my professional opinion on certain subjects, I generally do not deviate from the realm of topics associated with diabetes management such as insulin management, psychosocial support, and research developments. As you know, I often abstract papers from evidence-based literature and provide perspective to understand the significance of the conclusions.


    Today I wish to discuss an essay that was given to me yesterday by one of my physician colleagues at Children's National Medical Center that profoundly resonated in me as both a physician and as a human being.  I consistently review the content (and reader comments) by my fellow bloggers on our website. Recently, my just posted blog Diabetes and Depression in Childhood was unfortunately juxtaposed under a reader's comment entitled "doctors just don't understand" in response to a different post. Not surprisingly, this remark both upset and prompted me to finally write a meaningful commentary on this subject.

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    Doctors are people with the same talents and flaws that are found in all humans. Just as there are fine plumbers, accountants, electricians, attorneys, teachers etc., there are equal numbers that do not live up to expectations. Clearly, however, doctors are often held up to different expectations due to the nature of the their work. I truly understand the significance. However, the key is finding the right doctor and team to suit your needs and allow for collaboration to provide you with the best health care possible.


    Dr. Rachel Sorokin, from Thomas Jefferson University Hospital, published an essay in the January 2011 issue Annals of Internal Medicine (volume 154, number 1, pages 70-71) entitled "In Praise of the Cognitive Specialist." I quote "My father's diabetologist saved his life, although few credit her with the rescue...this wonderful diabetologist orchestrated the 10,000 days that constituted nearly half of my father's lifetime."  Dr. Sorokin wished to "celebrate one physician's ability to inspire the daily discipline that living with diabetes demands."  The article describes the relationship between her most admirable father and his diabetologist from the Joslin Diabetes Center in Boston, Massachusetts that first began in the 1960s when he was diagnosed with type 1 diabetes at age 38. 


    I was transfixed.


    A "cognitive specialist?"  Perhaps a medical professional who thinks and intricately manages medication/diet, etc., to seamlessly integrate with a patient's lifestyle? We occasionally intervene in dramatic crises and rarely perform procedures to save a life.


    We do, however, revolve around the day-to-day activities of our patients and families in the hopes of enabling them to live long productive lives.


    As a member of a Diabetes team, we participate in our patients' everyday adventures. We learn of birthday parties, weddings, marathons, intercurrent illnesses, first days of school, births (and deaths) in the family, broken ankles, college acceptances, first jobs, and finally graduation from our practice and on to the adult world. We help to intricately manage diabetes with the activities of daily living to enable our "person with diabetes" to have the best quality of life possible.  According to Dr.Sorokin, her father's diabetologist helped her patients learn how to manage insulin and how to dose themselves. "Patient education illuminated their diabetes treatment, and patients refined their glucose levels." 


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    I could continue to quote the entire essay which in essence truly defines how I wish (and dearly hope) to practice diabetes care to enable my children/teens and families live the best life possible.


    I understand the comment "doctors just don't understand" is a generalization. However, there are many doctors that DO. They are "out there" ready to participate in the mundane and exciting aspects of your lives. I believe that there are many diabetologists willing to partner and negotiate with you. Much of diabetes care is negotiation and goal setting. It is up to you to find a caregiver (or team) that will work in your best interests and inspire you to fully live the best quality of life possible. 


    Dr. Sorokin's father lived to be nearly 70 years old after 32 years with type 1 diabetes despite primitive means of insulin therapy and blood glucose monitoring from the 1960s-1980s.  2011 is now here with the promises of innovative treatment, further progress towards prevention...and cure.


    And, collaboration with your "cognitive specialist."


Published On: January 18, 2011