Moving to a new state has brought a whole bunch of craziness into my world, and among the necessary evils have been figuring out where I'm going to get my diabetes prescriptions filled and finding new doctors to be part of my D-management team.
In late August, I visited my new endocrinologist for the first time. Are you ready for this?
I am now seeing Dr. George Grunberger, who's been practicing for three decades and runs the Grunberger Diabetes Institute in Bloomfield Hills, MI (about 22 miles north of Detroit). At the moment, Dr. Grunberger is serving as president of the American Association of Clincal Endos (AACE) and he's been a key source in some of the news stories we've featured here on the 'Mine in recent months.
I'd never seen him before as a patient, but this doctor isn't a stranger... as it turns out, he's one of the most well-known and respected endos in our D-Community, and of course I've now known him in a professional "reporter-source" role for several years.
This brings a whole new level of weird for me, blurring even more that line between personal and professional when it comes to diabetes.
When I've written about my endos and other docs in the past, I've used pseudonyms. But this time it's different, in that I've quoted Dr. Grunberger directly and he knows what I do in the DOC (Diabetes Online Community) and diabetes advocacy here at the 'Mine. I asked about using his name, and he said it's OK -- as long as I'm fair and don't criticize too much, he laughed.
Since I grew up in Southeast Michigan before moving to Indianapolis 11 years ago, I know the area well. While there are many endos locally, Dr. G and another endo were the top two on my list. The other is actually a fellow type 1 D-peep who is much closer to my house, and for a while, finding someone who "gets it" in that way was a big priority for me. But this time around, Dr. G's reputation was a big draw; he's highly recommended by others in the local D-Community. Plus, I was also hesitant about the other endo's "team approach" in which you are required to rotate through all the providers in the office, and you're unable to even request seeing the main doctor at each visit. That's not appealing to me.
So while Dr. G is about 45 minutes from where I live, he is the endo I have chosen.
After just one visit, I'm already a fan for several reasons: he listens, knows his stuff, is definitely open to letting me go fast or slow in D-management changes, and isn't afraid of helping me tackle the psychosocial sides of life with diabetes. And I love knowing that he's a proponent of the DOC and cares about many of the same advocacy issues that I support.
It's also important to know he's a guy who appreciates good craft beer, as I do, and that means we'll probably see eye-to-eye on being able to enjoy this hobby in light of my ongoing diabetes management.
So he has a lot going for him, right from the start.
A New Diabetes Office Setup
Honestly, Dr. G's office is one of the most well-setup clinics I have ever seen in my many long years of visiting adult endos. By that I mean, you walk into his office and can instantly get a flavor of all the options you'll have with him as far as tools and treatments. His walls are plastered with the latest info on D-tech like continuous glucose monitors (CGM) and pamphlets explaining the newest diabetes medical advancements.
Of course, because he's a key AACE leader and so you can see the org's quarterly newsletter and other endo-specific info around the office. I also found it fascinating that he has some cool offerings for patients, like basic medical ID bracelets you can buy for $1 and an ADA-fundraising sock monkey with local Detroit sports team logos.
It was a nice bonus to receive a "new patient" tote bag after my first visit wrapped up, packed with a bunch of D-101 materials as well as a nice logo pen (writers love this!) and even a medical alert ID card inside. Very cool!
Fees for Service
With this new office, I'm also being exposed to a new side of the "business of diabetes" in a way that I've never experienced before. I received the common "new patient packet" in the mail a few weeks before my visit, and tucked into all the papers on medical history and Rx forms, I found a one-page sheet outlining a fee structure for some basic office services:
- $5 processing fee for calling in prescription refills to a local pharmacy
- $10 to get copies of your blood sugar logs or copies of lab documents
- $25 for a pre-authorization letter to insurance
- $25 for a form letter for traveling with diabetes ($50 if customized)
- Need anything in a hurry? There's a $10 rush fee
This was a new experience for me, and it really raised my eyebrows. On one hand, I feel entitled to these things from my doctor. But then again, I get the realities of the endo business and know these are time-consuming tasks for the staff.
Luckily, they don't charge to download my diabetes device data -- a practice I've heard some endos do.
I know from past conversations with Dr. G and others that endos are chronically underpaid and under-reimbursed for much of the work their practices do.
Fighting for proper reimbursement for reviewing diabetes data from devices like pumps and CGMs is one huge issue that the AACE is addressing (under Dr. Grunberger's leadership, of course), and with that in mind it's not surprising to see his clinic charging for some of these tasks. Specifically for CGM data review, Dr. G charges $85!
It was good to learn that the BG logs and prescription refill fees are not really enforced as long as you're a consistent patient, and not just showing up in the office to get Rx refills. I've never had a fee attached to regular doctor duties like ordering a refill or getting a travel letter. So this will be interesting to navigate, and may make me rethink how I interact my doctor's office.
My Diabetes (Um...) Management
Like most of us in the D-World, I *still* get anxious in advance of seeing my endo, thinking about what the response will be to my latest blood sugar data. This great post by D-Mom Meri Schuhmacher hit home for me recently. She describes that awful feeling when you're doing poorly -- especially when your doctor has no history with you so doesn't remember your previous awesomeness. (If I’m going to be judged solely on those numbers? KILL ME NOW.)
That was definitely the feeling I had, because here I was going in to see the famous and highly skilled Dr. G for the first time with blood sugars that were, shall we say... out of whack. I was getting a sweat mustache worrying about what kind of first impression I was giving off. Geez.
My stomach sank especially when we got word that my A1C was about a whole point higher than it had been earlier in the year. Again, no surprise for me -- but still a disappointment.
Fortunately, there was no judgment. Just honest recognition (on both our parts) that I need to do better and some changes need to be made. I was very impressed with Dr. G's attitude of "let's tackle one issue at a time," and he asked ME what I'd like to focus on first.
The obvious answer: My late night and overnight blood sugar trends that are regularly rising over 200 mg/dL after dinner and through the early morning hours.
Ouch, ouch, ouch. As I explained this, Dr. G just nodded his head and acknowledged that's where his eyes went first, too. It always feels good when you and your endo are on the same page, especially when it comes to focusing on specific changes.
We talked about my need to keep better track of carb counts and insulin dosing, and he bumped up my overnight basal rates while also reminding me to do some needed basal rate testing to make sure my carb and correction rates were also 100%. (The basal testing isolates those other factors.)
Overall, even though I'm doing kind of crappy, it was a good visit -- a start that I'm pleased with and happy to be able to use as a jumping off point for better D-management in the coming months.
Of course, a day after my first visit, I realized we hadn't talked about something I had wanted to bring up: trying out the new inhaled Afrezza insulin. I've been curious about this for quite a while now, but when my then-endo prior to my late summer move to Michigan wouldn't even discuss prescribing it, I decided to hold off on even trying to get Afrezza.
Now, I phoned Dr. G's office back and connected with the nurse practitioner, who said she'd let him know about my interest and that he'd get back to me. A week passed and I hadn't heard anything, and when I finally called mid-afternoon on the Friday just before the long Labor Day weekend, the office was closed early. It would be another 4 days before I could even call to check on this. Ugh. Typical, right?
Since I have been in touch with Dr. G through my work before, I do have his email address. But we hadn't made any agreement about using that for patient-doctor topics, so I decided against reaching out to him. I feel that without getting his OK first, that would be crossing a line -- unless of course he lets all his patients email him and it was something others had access to.
We've since connected through his nurse practicioner, and agreed to talk more about this during my next visit in a few weeks. For now, that back-and-forth is the only not-so-positive aspect of our doctor-patient relationship so far.
I am happy to have Dr. G as my personal endo, with all the knowledge and expertise he brings to that role. I'm glad he's willing to talk about options and listen to what I want, as that's a big "must have" when it comes to those I want on my diabetes care team.
This blog post, Top 10 Tips For Finding an Endo, from Medtronic's Loop blog came across my radar the other day, and I'm happy to admit that several of the hints there factored into my finding Dr. G.
I'm just getting started with him, but I'm already pretty sure that Dr. G will be better than any of the endos I've seen over the past 15 years. Now, I just need to find a new dentist and eye doctor to go along with him...