Another newbie with questions

[Guest guest]

Hi. My name is Barb and I live up in the northwoods of NE Wisc. I

was diagnosed with T2 about 3 weeks ago. My fasting was 134 (my

chol. 286, my trigl 271, my ldl 166 and my hdl was 46; also thyroid

down to 1.23; I also have Syndrome X and a fatty liver). I have

gotten no support from my doctor whatsoever. When I didn't hear on

test results I called and was told by a nurse that the doctor said

to get diabetic ed., buy a monitor and come back in 3 months. I am

attending diab. ed. and have an appt. with a dietician tomorrow. I

don't know what to expect and was wondering what type of questions I

should be asking him and what I should bring. I'm also looking for

a new doctor. Is there a listing anywhere of competent drs. that

know something about diab. The closest endo is 125 miles away. I'm

not on any meds and would prefer to keep it that way. I don't react

well to drugs. I know I might have to go on some eventually but I

want to stave it off as long as possible. I have already lost about

14 pounds and my bp has returned to normal. I take supplements for

the insulin resistance and for the liver. Since I've started

reading a lot on R2, counting carbs and taking the supplements I've

seen a good decrease in daily figures (teens or less to under 140

two hours after meals) but my fasting has remained high (130-145)

except for one morning and I'm not sure what I did differently

then. Any suggestions on how to bring that down. I need to keep a

better journal and I'm starting that now. I'm wondering if the

lower thyroid figure, well still within the lower limits, could be

playing a part. I've been execising more (riding my bike most days

but can't currently do much walking due to foot problems-heel pain

on one foot and an encapsulated something or other on the other;

seeing a podiatrist). Any help with the dietician and my other

questions would surely be appreciated. Thanks. Barb

[Guest guest]

> gotten no support from my doctor whatsoever. When I didn't hear on

> test results I called and was told by a nurse that the doctor said

> to get diabetic ed., buy a monitor and come back in 3 months. I am

> attending diab. ed. and have an appt. with a dietician tomorrow.

It sounds like your doctor wants you to see a dietitian (part of the

diabetes education process) and follow the diet recommendations so he can

test you again in 3 months and see if there has been any improvement. Not

an entirely unusual approach to take on a Type 2.

You said you were not on any meds and preferred to keep it that way. I

guess I'm curious about what additional things you would want your doctor to

do?

If you are just unhappy with him for general purposes, by all means find

someone else. If there are limited resources for physicians in your area,

try looking for a Internal Medicine instead of a GP or Family Practice

specality.

Mike

[Guest guest]

>

> Sent: Monday, May 29, 2006 5:20:00 PM

>

>

> Hi. My name is Barb and I live up in the northwoods of NE Wisc. I

> was diagnosed with T2 about 3 weeks ago. My fasting was 134 (my

> chol. 286, my trigl 271, my ldl 166 and my hdl was 46;

>

Well Big Bad Baba 1, you got serious health issues. All those readings

are big and bad! Run, and I mean run to your nearest dietitian and learn

how to control your diet.

And arrange a stress test ASAP before you die of a heart attack!

Drew,

Cold Spring, Putnam Co., NY

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Modeling the New York Central in N Scale and Trainz

Backyard Birding & Gardening in the New York Hudson Valley

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Homepage: http://drucifer.net/index.html

[Guest guest]

Hi and Mike,

I did ask the diab. ed. gal and the dietician about referrals and

neither were any help. I did ask a nurse in the office who gave me

one. As to my diab. ed. classes, they're individual. I wish it

were a class. I was hoping to find help at the diab. support group

but the meetings are suspended for the summer. :-(( I know from

past experience that my ins. won't be of any help. All they do is

send out a booklet with all the doctors in it but it doesn't give

the particulars. I have a lead on one woman dr. and I'm going to

see if she's taking new patients.

Mike, you asked what I expected from a dr. I expect them to give

some support and info. I had (have) lots of questions and I've

gotten the answers from the internet and books and a few from the

diab. ed. classes (so far I have already found out most of the info

in the classes on my own) but none from the dr. I figure if he's

making $185 from the ins. co. for a couple minutes work, the least

he can do is return my call and answer my questions.

Barb

[Guest guest]

> Mike, you asked what I expected from a dr. I expect them to give

> some support and info. I had (have) lots of questions and I've

> gotten the answers from the internet and books and a few from the

> diab. ed. classes (so far I have already found out most of the info

> in the classes on my own) but none from the dr. I figure if he's

> making $185 from the ins. co. for a couple minutes work, the least

> he can do is return my call and answer my questions.

Barb, hopefully the doctor you are checking on will take new patients.

Have you expressed to your doctor what you want from him? " Support and

info " is a very broad request. The 'info' side can probably be handled with

some amount of ease.. but it will probably be based upon publications that

the office gets from drug companies or from the ADA. 'Support' is a very

broad and undefined idea. They are supporting you by providing the typical

services you receive during a visit, and of course, handling Rx refill

requests etc. Now, if you are thinking more of emotional support... a

doctor is quite limited in what can happen during an office call.

I'd ask him the next time you are there why you don't get your calls

returned. Is it possible you leave the message for the physician, and you

might get better results if you tried to get hold of the nurse instead? I

know at my doctors office, I will only get to talk to the nurse. However,

they find out and get me answers. It may take a bit of time, since they

have a primary responsibility to the patients that are there, in person, who

are waiting their turn for an appointment they made in advance. (Calling

and expecting an answer right away almost feels like butting in line...)

I know it's frustrating to have something wrong and I think we all want

instant gratification, especially when it comes to health issues.

If I'm not understanding what you are expecting, I'm sorry. But this is

what I'm hearing. Please feel free to clarify (or ignore this) if you like.

I'll assure you that your doctor isn't seeing $185 from your visit. In many

cases $185 is billed to the insurance, but the physicians office gets paid a

contracted rate, maybe 20-30% less. There is overhead to be covered,

malpractice and other insurance and costs of office equipment and medical

equipment (for all of those things we expect to be done in an office, like

X-Rays, EKG, Ultrasound, etc). When you go into the office, you don't just

deal with the doctor. There is the office staff to schedule appointments,

billing and coding staff you never see, the nurse, and maybe a lab tech.

This doesn't count bad debts, Medicare and Medicaid payments (which are even

lower than private insurance companies pay) and the normal office bills of

phone, lights, heat, water, gas... etc. It's easy to be bitter when you see

this billed charges (I know it's easy for me to feel bitter)... but all in

all, I believe most physicians work quite hard for the money they make.

Mike

[Guest guest]

>

>

> I'd ask him the next time you are there why you don't get your calls

> returned. Is it possible you leave the message for the physician, and you

> might get better results if you tried to get hold of the nurse instead? I

> know at my doctors office, I will only get to talk to the nurse. However,

> they find out and get me answers. It may take a bit of time, since they

> have a primary responsibility to the patients that are there, in person,

> who

> are waiting their turn for an appointment they made in advance. (Calling

> and expecting an answer right away almost feels like butting in line...)

>

>

Just to share a little personal experience here... I actually switched

endocrinologists because of this issue. My previous endo only had office

hours one day per week, and I think she was switching her focus to doing

more research, rather than doing patient care. I also think she was heavily

overbooked. She'd always been a little difficult to get in touch with, but

the last straw was when I started Metformin. She told me to fax her my

blood sugar numbers after two weeks so she could review whether we needed to

change my dosage. I did so. I waited a week and had no response from her.

I called her office and left a message with the receptionist that I had

recently started a new medication and would like some input about whether I

needed to increase the dosage or not. I waited a week, and got no

response. I called her office again and left a message on the doctor's

personal voice mail. Waited three days. Called back and left another

message with the receptionist.

That was two months ago. I never heard back from my endo. Either she was

swallowed by a black hole, or she decided for whatever reason that she

wasn't going to return my calls. I guess maybe I was expected to make

another appointment if I wanted to talk to her, although it would have been

nice if someone had told me that at any point in the process. Anyway, I

found another endo practicing out of the same hospital who seems to have a

less heavy patient overload, and am reasonably happy with her.

You reach a point where you don't really care what the reason for the lack

of communication is; you just want a doctor who isn't going to have that

problem. (Or not as severely, anyway.)

Molly

[Guest guest]

I have serveral medical issues requiring different specialists who are

supposed to work together to be a team for me. Mainly I guess they are if

they can find time to speak to each other when necessary but mainly they

leave it to me to take messages to each other and supply them with

responses. That means I have to spend hours on the phone with their staff

or make unnecessary expensive appointments to see them.

I understand that they have to deal with the patients in their office per

appointments as do the nurses etc, but as a patient who pays bills on time I

don't think calling on the phone shouldn't require a reasonable response. I

never expect a dr or nurse to drop a patient mid visit to speak to me on the

phone but waiting days or even until they've seen the last patient when I am

in need of info as to what to do THAT DAY is to me unreasonable. That is

why there are 'in between appointment' moments.

Drs are overbooking, double and triple booking so that a patient is sitting

in one or two examining rooms just waiting for the dr to breeze in. Well,

ok, business is business and I fully understand that they are entitled to

make a living, but if money is their primary goal being a doctor isn't the

profession they should be in - or should they????

In our litigious society today, what can they do? What can we do? They

have to make money, but then when I see signs that say if you need an rx or

an ins form filled out in between appointments it will cost $10 or whatever,

I begin to wonder just what the 'h' is going on.

Thankfully I have found totally by accident a good endo team and I am

greatful, but even they don't know the answers to why what is now happening

to me is happening. It gets very frustrating. Dr says 2 BS checks a day is

all that is necessary, and call him before appt if BS goes up to 170 and

doesn't come down (I'm not on meds). Nutritionist supervisor (I got lucky!)

says need to test both new foods and combinations of foods to know what I

can eat and then when we finish if we ever do(?) this phase of education for

me, then we test to work in exercise and times to eat.... Then nurse

educator follows up with 'my numbers are fine I'm doing a great job, etc etc

etc. " .

yeah right. Morning BS is supposed to be under 100 for me. Today's was 120.

fine? i guess that means I won't die and we'll see if I am one of the ones

who gets damage on low numbers. What a way to wake up.

oh well.... not every day starts off great. Now i can wonder all day what

to eat and when because I am just plain tired of all this and stress isn't

great either.

If it weren't for this list I doubt I'd have learned much at all. So that

is one good thing that already happened this a.m. Sorry tho' that a PC has

to provide me with something good. So how do 'you' look at being happy for

little miracles? greatfully or begrudgingly? sigh..... as usual.

Maybe I should just go on yet another med and eat what the heck I want when

I want??? Nonsense to take more meds but this new eating thing is ruining

my life and soon I will be alone without my husband who is sick to death of

eating by himself for the past 4 months so that i can keep my numbers down.

Which is the priority? I simply can't tell anymore.

JUDITH

==

Just to share a little personal experience here... I actually switched

endocrinologists because of this issue. My previous endo only had office

hours one day per week, and I think she was switching her focus to doing

more research, rather than doing patient care. I also think she was heavily

overbooked.

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[Guest guest]

>

>

> In our litigious society today, what can they do? What can we do? They

> have to make money, but then when I see signs that say if you need an rx

> or

> an ins form filled out in between appointments it will cost $10 or

> whatever,

> I begin to wonder just what the 'h' is going on.

I'll play the devil's advocate here... I'm sure people won't really like it.

But doctors have to do something to try to minimize the number of non-paid

encounters patients expect to have between visits. There as to be a point

where the doctor has met his commitment for the charge of a single office

call.

If your boss came to you and said, " I have a few more things I want you to

do, and let's just consider them included in what I paid you for last weeks

work " you would laugh at him or sue him. Where does that doctors

requirements end after you walk out of the office?

I'm not saying you are one of them .... but there are people who, for one

reason or another, seem to always have one more reason to contact the

office/doctor... they need a form filled in for work, they forgot to do a, b

and c at the visit, they have a new 'issue' that they want addressed on the

phone.

All of these things take time. I think it's unfair, regardless of how much

your office call was or how little time the doctor spent with you, to think

that since you had one office visit, every issue you have between that visit

and the next should be addressed for free and at the expense of the time

allocated for scheduled appointments. I've sat in the waiting room and seen

people come in with paperwork they need " right now " and expect everyone to

drop everything and deal with them when they just decide to show up.

Sure some offices do a better job than others in handling all of these

requests and calls, but where is the line?

Personally, I think if you are judging your physician, it should be based

upon the quality of the experience during your scheduled appointment time.

Doctors are not mind readers, and patients can sometimes be overwhelmed

during what can sometimes be a 'rushed' visit. We are really responsible

for getting all of our questions addressed. That's why I've always

advocated making a list of questions before a doctors visit. Now, if your

doctor won't take the time to address your issues during your visit, it's

obvious you need to find another one. But if you don't make the best use of

that office visit, how will your doctor know what else you need?

Mike

[Guest guest]

>

>

>

> I'll play the devil's advocate here... I'm sure people won't really like

> it.

>

> But doctors have to do something to try to minimize the number of non-paid

> encounters patients expect to have between visits. There as to be a point

> where the doctor has met his commitment for the charge of a single office

> call.

>

Well, okay, but I think there is a happy medium between " will only talk to

patients during office hours and will never return a single phone call

outside that time " and " drops everything at a moment's notice for every

person who comes in off the street needing a signature on a prescription " ,

you know? A lot of problems can be resolved over the phone, and I would say

that a lot of us probably have doctors or endos who encourage us to fax

in/call in our numbers so that they can give us a phone consultation - saves

time over having to have everybody come in for an office visit. My feeling

is that if a doctor is going to say, " Fax your numbers in, " or whatever,

then that doctor should reserve a spot of time during the day for calling up

patients to review faxed-in charts.

My doctor's office has a sign on the wall saying, " Please limit yourself to

one concern per appointment, " which I don't have a problem with. I also

don't have a problem with having to wait to have a prescription re-written

(although charging for it seems a bit over the top) or with having to wait a

day or two for a callback. Those things seem reasonable. What does not

seem reasonable is waiting over a week for a callback, or never getting a

callback at all, or faxing your blood sugar numbers in and *never getting

any feedback whatsoever*. Diabetes is a cumulative disease, and if an

endocrinologist is looking at a chart where all the numbers are higher than

target, I think she/he has a responsibility to the patient to attempt to fix

the problem. Even if the attempt is only a call from the receptionist

saying " Dr. wants you to come in for an appointment. "

A lot of endocrinologists are overbooked to the point that you have to make

an appointment four months in advance (mine is this way). I don't think

it's reasonable to expect people to have to wait four months every time they

need to increase/decrease dosage or whatever. Taking calls outside regular

office hours should be an expected part of a doctor's care, especially for

endocrinologists, who tend to have the double whammy of being overbooked and

also of having a lot of patients who need regular fine-tuning adjustments to

their meds and other care.

Molly

[Guest guest]

Mike,

you're right. I don't like your answer even though it has some good

points.

I am not advocating that drs/nurses/office staff accommodate insconsiderate

patients.

I am saying that if a patient does what you suggest - make lists, come on

time, get to the point during an office visit - that this patient should be

given the same respect if on the phone in between visits.

Although my specialists tell me the next time they think I need to be seen

and we make an appointment per their recommendations, I also have the option

to make appts as often as my insurance and/or pocket book will allow. I

shouldn't have to be seen in person to have a specific question - not an

office visit on the phone - answered.

So that is just my opinion. But then again, I have multiple disabilities

and illnesses and different doctors for most of them. I have a lot 'dr

experience' you might say. I've been fired by doctors and I've fired drs.

Finding drs that are like the ones from my younger days are few and far

between. But that is also how society is moving in general I guess. I just

wasn't meant to be living in this century.

Before I became disabled and sick, I was a horse professional. Most of my

work was free lance. How do you deal with people who don't pay? You don't

make another appointment with them. In this case of pt/dr the drs can

easily choose to make appointments with patients who respect them and who

want to get better if they are sick. The others are wasting the dr's time

and the other patients who want to work with and pay the dr for his

expertise and time.

JUDITH

--

> I'll play the devil's advocate here... I'm sure people won't really like

it.

>

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