Last week we discussed the difficulties surrounding the transition from the pediatric diabetes team to the adult world of endocrinology. Several weeks ago I talked about the responsibilities of both the person with diabetes and those of the healthcare providers. Today, I would like to provide tips to choose the right diabetes team for young and older adults as well. I am often pained (and somewhat embarrassed) reading the comments of fellow participants on this site about their experiences with physicians and other ancillary healthcare providers. I sometimes start to feel somewhat defensive (I never behave in that manner) and want to rebut some of the more vitriolic remarks. However, I restrain myself because, as always, there is some kernel of truth in nearly all of the responses. Choosing the diabetes specialist and associated staff that is right for you is like picking teammates in a sport: who will be the best offensive specialist? Who will defend the goal? Who will hit a homerun? Who is a team player? You have to shop around for the best fit. I am aware of the limitations in choosing specialists due to insurance issues. It is a big obstacle. Perhaps the eventual healthcare reform will help in this regard...perhaps.
In terms of transitioning to adult endocrinology, the pediatric diabetes team should gather a list of adult practices in the geographic area and attempt to match the young adult with a particular group, if at all possible. As I mentioned last week, I will be speaking to adult endocrinologists about the need to work together in caring for this at-risk population (with the support of an educational grant from industry). It is hoped that we will have a meaningful dialog and develop a means to decrease barriers for this transition. After speaking with these groups, I will then hopefully develop relationships in my geographical area in association with the involved pediatric diabetes teams in other parts of the country.
What should you be looking for?
- Review The Diabetes Toolkit and determine:
- Education and knowledge of your chosen healthcare team
- Ease of communication of the diabetes team
- Appropriate follow-up
- Patient specific treatment
- Cost consciousness
- Appropriate laboratory evaluation
- Continuing medical education by the healthcare team
- Check up on the diabetes team affiliations: Are they ADA recognized? (Look it up on the American Diabetes Association's web site.) This is not absolutely essential, however, at least you know that the team has the ADA stamp of approval
- If you are a young adult, ensure that they have room in the practice to care for you. Ask if they have relationships with pediatric healthcare providers. Are they initially willing to communicate with your pediatric team? Indeed, upon beginning a therapeutic relationship with our former patients, some of the adult practices often send letters to update medical status.
- Does the practice ask you to provide a detailed past medical history:
- Insulin regimes and medications
- Previous hb A1c and other labs
- Previous hospitalizations (DKA, etc.)
- Frequency of hypoglycemia, hypoglycemic unawareness
- Do they give you the necessary information about referrals, prescription protocol, etc.?
- Does the practice have established relationships with diabetes educators (hopefully certified, but many educators who are not certified are still excellent and helpful), dieticians, exercise physiologists, podiatrists, social workers, and psychologists?
- Will the practice be able to support you after hours? What are the arrangements if you have problems at night or on weekends?
- Does the practice have admitting privileges in qualified hospitals that are near to your home? Is your doctor able to care for you if you get admitted to the hospital (at the very least, is there an arrangement for the admitting physician to contact your diabetes team for information?) You do not want to be in a position where you know more than the hospital personnel. Unfortunately, I know this is often the case, based on some harrowing experiences that have been related to me by my own patients admitted to outside hospitals.
- If you live in an area without a diabetes specialist (and I know this is true throughout parts of the United States and other countries), ensure that your future physician is willing to educate himself/herself about the latest in diabetes management and that he/she is willing to contact a diabetes specialist if necessary.
- Most importantly, are they willing to work with you to achieve your goals? This concept is very important. Some adult specialists (and some pediatric people, as well) can be absolutely rigid about meeting the ADA or ACE goal of a specific hb A1C, blood glucose range or nutritional guideline. In summary, are they flexible?
- Review The Diabetes Toolkit and determine:
If many of these qualities are missing in your search for the appropriate diabetes specialist and healthcare team, keep looking. They are out there.
Published On: November 24, 2009