He walked into the room and asked “have you been keeping any logs?”, probably expecting my usual “no not really, sorry…” but instead I produced a folder containing 2 months worth of fingerstick logs and probably about 20 pages of CGM data. He was more than a bit surprised
If you read my other thread in which I was concerned about telling him about the MiaoMiao, I did not end up telling him about it. I was planning to, but we actually spent the majority of the appointment going through my graphs and trying to troubleshoot a problem I’ve been having with overnight highs. I’m not sure if he’s seen Nightscout reports before, he didn’t seem surprised by them and didn’t ask me about where they came from but it also seemed to take him a little bit to figure out what all the carb and insulin entries on the graphs were. The phrase “these are a nice set of traces” was uttered more than a few times. He also shook my hand probably 3 times, and overall he was clearly very pleased with the difference in me.
He did suggest I try eating lower carb… which is valid advice to reduce my variability but I’m probably not going to follow it. I’d rather keep testing different bolus strategies and eat whatever I’d like.
After all the time going through the graphs he started getting up to leave and I had to quickly bring up the pump issues again, he made sure to add the fact that I need a new pump to his notes. I also requested prescriptions for pens in case my pump actually dies before I can get the new one. He apparently was not aware that pens with 1/2 unit dosing are even a thing, because I said I wanted one and he said “it’s not really in my control, you get whatever form its in”. I said something along the lines of “I looked into it, there are a couple of different pens with 1/2 units for Humalog…” and he said “Hm, I’ll add 1/2 unit to my notes”. So I guess we’ll see what I end up with, he sends my prescriptions directly to my pharmacy. I should have just explicitly said I wanted the HumaPen Luxura HD but I was feeling a little flustered since he was clearly already late for his next appointment.
I didn’t really have time to bring up the Dexcom G6 but I think at this point he would sign off on it, based on how he was so into going through all my graphs and discussing them with me. I have another appointment in 2 months (because he still wants to keep an eye on me, see if I slip back into my old ways) so hopefully by then I’ll have the new pump and I can bring forward that whole set of requests.
@glitzabetes Congrats on the great endo appointment.
There is just one thing that bothers me. If my endo got up and started to leave for his next appointment while I still had questions, I would firmly tell him to first finish with his current appointment.
I must say that in 41 years of practice I never left a patient who had more questions.
Yeah that bothered me too. I was surprised when he started getting up, all I knew is I needed to get the discussion about the pump out before he was gone, but a higher level of assertiveness probably would have been good
Really great to hear that you had a good appointment experience. Getting on top of this beast of a disease is great to see and something worthy of celebrating!
After you get your pump situation sorted out, you may want to email your endo’s practice about the G6. Also, we try to bring a list to our endo appointments and hand a copy of the list to them early in the appointment so we don’t forget items. (I always forget items if I don’t put them on the list)
Finally, your glitzy background has inspired me to add a background to my profile. Thanks for the nudge.
I have a hard time with this too. I’m not the best at being assertive in these situations at all (actually I’m pretty terrible at it). Good job at least sticking up for yourself and getting the pump question out there… I know that pump was a big priority for you. I hope he comes through for you and you get what you need!
I agree with @Chris that you may be able to contact them about the Dexcom before your next appointment if you don’t want to wait. I had a similar situation with my endo when I wanted to start the Omnipod. In that case I ended up going straight to the Omnipod folks who got the approval from his office without me ever discussing it further with him
Yes, once the pump thing is sorted out I will probably go through Dexcom to try and get the G6. I just don’t want to get into that quite yet, I get enough calls from the Tandem rep, don’t need to add another player to the mix right now
Making a list of things to discuss and giving it to him would probably be good… I kinda had notes going into this but I didn’t get around to all of them.
Ok, so I’m a doc (not an endo) as well as parent of a kid with T1D, and I totally agree that your doc is ethically obligated to answer all your questions before moving on BUT I will make one plea…if you want and appreciate this approach, don’t get mad at your provider when they run late. Like, sometimes really late. I have 20-30 minute appointment slots (I see cancer patients who often have a lot going on) which supposedly include time for documentation, and many private practices force their docs to have shorter slots than that. If I give each patient the time they deserve and slow down when someone has a particular need, I’m apologizing all day for being late, then at 6pm I haven’t eaten lunch, I haven’t eaten dinner, and I have 2-3 hours of note writing if I want the notes to be good enough that I actually remember your concerns next time I see you. It is, no question, a sucky way to provide health care, but your doctor didn’t invent it. It may help to realize you and the doctor are probably both un-thrilled with the scheduling setup. However when someone like you comes in and has been working so hard to get healthy, it definitely makes your provider’s day and makes it worth it!!
There is, but it isn’t cheap. My mother used concierge physicians prior to being old enough for Medicare. The concierge physicians were much cheaper than insurance (she was self employed) but obviously much more expensive if you have employer subsidized insurance.
These doctors would spend an hour with my mom at each appointment, she had their cellphone number, they would do housecalls if needed, they personally arranged her tests at other facilities and even helped her negotiate rates with outside providers.
My primary care physician had to close up shop because he couldn’t afford spending 1+ hour with each patient. It was awful; I felt like he was an awesome provider and actually cared about me. Now I feel like my providers can’t remember who I am from visit to visit because we are only together for 10 minutes. I also work in healthcare (pediatric audiologist) but fortunately it is a job that allows for longer appointments!
The discussion going on about the difficulties in spending enough time with each patient while also not overextending the doctor is a good one and I’ve been glad to hear from healthcare providers here to understand the situation a bit better.
I am honestly irritated at my endo today though. A week has gone by and I never heard from any pharmacy that my new prescriptions had been filled, so I decided to call my endo’s office to see if they were ever sent. And the desk person confirmed that none of them (test strips & pens) appeared in my chart, no prescriptions created from my appointment at all. I’m annoyed, I have to go to these appointments specifically to get these prescriptions and yet I have to call back and remind him to give them to me?
Is any of that electronic? All of my providers are now on electronic medical records (EMRs) so they click click and then I get a text from CVS on the way home that my prescriptions are ready.
