Scott Johnson is one of my favorite fellow diabetes bloggers. Always has been. This post will show you why.
A Guest Post by Scott K. Johnson, of Scott's Diabetes Journal
Amy's guest post from Dr. Anne Peters last Thursday on "How to be a Good Diabetes Patient" sure ruffled some feathers. I wanted to take a stab at the other side of the story: How to be a good endo, from a patient's point of view.
Before I dive into my thoughts, I want to introduce the elephant in the room. As a person living with diabetes, I feel very dependent on the endocrinologist I see. Is it because he has the (almost) final say on my prescriptions? Is it because he is the one who interprets the lab results (which I often don't know how to make any sense of)? What creates this tilted perception of power? Am I the only patient who often feels this way? I know, I know. My endo works for me. Blah, blah, blah. While that is true, it is also bullshit. I need a good endo on my side, and because of that there is an unnatural sway in the balance of power and control.
I think there are a few different things that might help explain this. I turn to him when I need help, when I can't figure things out on my own, or when I end up in the hospital for whatever reason (diabetes related or not). Naturally, if he's able to come up with some solution I didn't, I am apt to look up to him for his knowledge and experience. I also think changing endocrinologists is a LOT of work. Because of all the work involved in finding, and then moving to, a new endo, things have to be going really badly for me to be motivated to make that decision.
Finally, for the record, I am FAR from the role model for pushing my care team to their limits in regards to them providing top-notch care.
Unfortunately, I settle for less way too often. I don't think I'm alone in this though, which makes me feel better and worse, all at the same time.
Now, what makes a good endo? I bet that each and every one of us would have a different answer to that question. BUT — we would all have a few things in common.
1) Respect — we need to be respected as a person, first and foremost. We are not to be viewed as another insurance claim to help keep the lights on. I could be your brother, son, father, or friend. Treat me with respect.
2) Acknowledgement — diabetes is an all-encompassing condition that eats up every single second of our lives. Do you have to wonder why we are sometimes frazzled when we come into your office? Acknowledge that in addition to the unimaginable task of managing diabetes around the clock, forever, we also live overflowing, and often stressful, lives. Acknowledge the fact that I had to schedule time off work to come to the appointment. Acknowledge the fact that I might be broke as hell, but still have to pay for parking and transit to come see you. Acknowledge the fact that I am trying very hard to get this diabetes thing right, but might need more help. Acknowledge that 20 minutes is not enough time to help. Acknowledge that we might BOTH be frustrated about things out of our control. Acknowledge that I might be completely overwhelmed and am not sure what the hell to do next.
3) Listen to me — I acknowledge (see above?) that you, Endo, have a challenging task here. You have to keep the discussion focused on diabetes. I know that this is not always easy to do, but if my favorite trainer in the world (hi DeeAnn!) can keep a whole group of rowdy folks focused and on task, you can surely keep one patient at a time on track.
4) Cover the basics — check my feet, ask if I've had my annual diabetic eye exam, check my blood pressure, etc.
Beyond those points is where different patients might want different things. It is your job, Dr. Endo, to recognize and react to those different needs. Some patients will want you to push them a bit (in a respectful and encouraging way) for that next level of management. Some will want you (or a resource, like a good CDE) to go over detailed records with them.
Some will be in need of some resources for the mental aspects of living with diabetes. Some will need help with their carb counting or dietary questions. We are all different people, and while a few of us might fit into some crazy diabetes recipe box you have constructed in your head, most will not. We all need different things, which is what makes you so valuable.
YOU are the one trained to help us recognize what we need when we can't see it for ourselves.
We all want to do well. Sometimes we just need a little different help than what you used on your last patient.
You rock, Scott. 'Nuff said.