Talking To Your Doctor About Your Diabetes

Dr. Fran Cogen Health Pro
  • I routinely review the comments associated with my blogs as well as those of my fellow bloggers on this site. I have noted a persistent theme in regard to the lack of satisfaction with diabetes healthcare providers and the pharmaceutical industry. Many of the comments are truly appropriate given the current state of health care and insurance companies, hence the need for reform. However, until reform is actually underway, a call to action must be directed to people with diabetes and those given the responsibility to help care for them. This responsibility is a joint one. It is essential that the person with diabetes work in conjunction with the healthcare team to direct the appropriate management. As a physician working with children, teens, and their families, I will readily admit that each person with diabetes (and their family members) knows himself or herself intimately. They are uniquely cognizant of how they personally respond to insulin, carbohydrate loads, exercise, illness, stress, happiness, anger, sadness, etc. As such, the person with diabetes has a great responsibility to help care for themselves and provide this important information to his or her diabetes team. It is impossible for the physician and healthcare team to know everything there is to know about how diabetes treatment and evidenced-based research will affect the individual with diabetes. However, at the minimum, the healthcare team has a foundation with which to provide objective information and guidance for individual patients and families.

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    Just as all people with diabetes are not the same; neither are all physicians and healthcare teams. Some are adequate, not so good, and even dangerous. And some are really good and actually care about their patients and eventual outcomes. The difficulty lies in choosing the right diabetes healthcare provider that meets your needs. I know this is difficult. Even I have a hard time discarding my personal healthcare providers when I actually know that they have not updated their medical arsenal. Or when a physician does not treat me like a patient; but rather as a medical colleague and does not give me what I need at the time. So, when is it time to change diabetes or other healthcare providers? When is time to realize that the match between you and your team is not acceptable and is not working? When is time to realize that you care about yourself or family member to search for a more appropriate match? Change is difficult, but it is good if you get what you need. So what are your responsibilities in pursing the appropriate necessary care for your diabetes?

    1. Trust - if you do not trust your doctor or healthcare team, find someone else to care for you. Don't wait.
    2. Knowledge - it is important that your doctor and health care team be "up" on the latest treatment of diabetes. A reasonable understanding of insulin regimes, oral medications, nutritional guidelines, etc., is essential. If you know more about diabetes care, find someone else. (I also am aware that there are not enough pediatric endocrinologists or even adult endocrinologists available to everyone who has diabetes. If that is the case near you, it is your job to find a pediatrician, general practitioner, internist, etc., who will go the extra mile to learn about diabetes via phone consultation with an endocrinologist, diabetes evidence-based literature, or continuing medical education conferences. I will discuss later about what tools need to be in the "toolkit"). There has to be an interest in caring for you and thus learning about diabetes treatment.
    3. Information exchange - you need to be able to provide your healthcare provider with information particular to you so that your team can make the appropriate suggestions for improvement or even say "stay the course." If you do not check blood sugars, adhere to a mutually agreeable nutritional program, or follow-up with your team, how can anything change for the better? Having said that, the team has the responsibility to follow-up. 
    4. Speak up! If you do not feel that you are getting what you need from the healthcare team, be assertive and say so. If 10 minutes is all you are getting to share only superficial information with your team, it is time to change and find another team or doctor. Clearly, a 5-10 minute discussion is unacceptable to both the person with diabetes and the team. We both become frustrated. And yes, I know, many doctors are stuck seeing too many patients for financial reasons. But, if you do not persist in getting your questions answered at the visit, you will leave very unsatisfied. You also may have to wait in the waiting room for a considerable amount of time because the doctor and team are spending time with patients. Be understanding that they will then spend the needed time with YOU.
    5. Get the lab work requested by your healthcare team. If you do not follow-through, how can they guide you to make changes or diagnose other associated conditions?
    6. Collaborate with your team!
    7. Change your doctor or team if you do not feel that you are getting what you need to care for your diabetes. No one likes to feel that their healthcare team is not hearing them. Ask around for suggestions by other people with diabetes and determine who might be right for you.

    Part 2: What are the healthcare team responsibilities in your diabetes care?


Published On: November 03, 2009