Whether you are recently diagnosed or a diabetes veteran, if you dread going to see your diabetes doctor, that’s a warning sign that they are not right for you.
This doesn’t mean they are a bad physician, or even a bad person. Rather, when it comes to chronic illness, you need the leader of your medical team to be a good fit — a good fit with your personality, with your approach to diabetes, with your station in life, with your support network, and with your economic status. It takes time to find the right doctor, but the time spent is an investment with a huge reward.
But if you’re already seeing someone, isn’t looking for another doctor, you know… cheating?
Not at all. This isn’t a marriage. It’s more like a major purchase or a business relationship, in which your doc works for you. Hey, if your accountant wasn’t suiting your needs anymore, you’d look for a new one, wouldn’t you? And if you needed a new car, you’d shop around, wouldn’t you? See what’s new on the market? Read reviews? Compare features and prices?
It’s no different with doctors.
But how do you go about shopping for the right doc? Read on, we’ve got you covered.
You may benefit from working with health professionals such as a diabetes educator, nutritionist, or exercise expert to help you with day-to-day, in-the-trenches issues.
Also, depending on your type of diabetes, how long you’ve had it, and how good — or not-so-good — your glucose control has been, you might have quite a few different kinds of docs on your dance card. These may include, but are not limited to: eye docs, kidney docs, heart docs, and docs who specialize in feet, teeth, nerves, and even mental health.
But today, we’re just focused on your main go-to physician for your diabetes care. For all practical purposes, there are three choices:
- Primary care physicians (PCPs). These are generalist docs who are knowledgeable in everything from the common cold to bizarre skin rashes. Frequently, PCPs are the gateway professionals who refer patients, as needed, to other specialists. Finding a PCP with deep experience in diabetes and diabetes technology is tricky, but rewarding if you can do it, because you can see the same professional for both your diabetes and non-diabetes health concerns.
- Diabetes nurse practitioners. Nurse practitioners who hold the prestigious Board Certified Advanced Diabetes Management (BC-ADM) designation, while not doctors, have full prescribing authority and in many cases more experience with diabetes than primary care doctors. These healthcare professionals, who train in the nursing track, have a broader-based, more holistic way of looking at both disease and patients, which some PWDs (people with diabetes) prefer.
- Endocrinologists. On the other end of the spectrum, endocrinologists are specialist physicians who focus exclusively on disorders of the endocrine system, including diabetes. One advantage of having an endo on point for your diabetes care is the growing trend of health insurance companies refusing to accept prescriptions for diabetes technology from primary care docs or mid-level specialists. So if an insulin pump and/or CGM (continuous glucose monitor) are in your diabetes playbook (or you are considering moving in that direction), having an endo to write the prescriptions will be a huge time-saver for you.
No matter which kind of doc you choose, that person will do you no good whatsoever if they don’t have a financial relationship with your health insurance company. This is often called being “in network,” which simply means that the doc has a billing contract with your insurance. Using an “out-of-network” doc will cost you dearly, so when hunting for docs, an important step is checking with your health insurance to ensure the doc you’re considering is in network.
Once you’ve chosen a type of doctor that makes sense to you, and you’ve determined that your health insurance will actually pay them, the next thing to think about is how far you’re willing to travel for healthcare. Or whether you’re willing to travel at all.
When you need to buy essentials, are you more likely to drop by the corner store or boot up Amazon? In today’s modern, connected world you can get almost anything online, and that includes healthcare — or at least a large portion of it. If the online life is for you, consider these options:
- Remote diabetes education. No good diabetes educators in your area? Or your work hours are too crazy to be able to see one? Consider someone like Gary Scheiner, who, through his company Integrated Diabetes Services, offers a range of remote one-on-one services to patients throughout the country via phone, email, private chat, or video conferencing. His practice focuses on insulin users, with expertise in everything from pump basal testing to advanced carb counting.
- A meter and an educator in a box. There are now several companies that offer a package deal of blood glucose testing supplies and remote coaching/care. OneDrop, for example, was one of the first to buck the strangling three-strips-per day limits placed on insulin-using PWDs by health insurance, by providing unlimited test strips. That company offers great gear, a robust multi-faceted app, and virtual support from real, live, certified diabetes educators. Other device- and data-driven virtual care platforms include Livongo, which advertises that their tech empowers people to live better and healthier lives; and MySugr, whose tagline is that they “make diabetes suck less.”
- A virtual clinic. If you already use CGM, consider Steady Health. This is a new virtual clinic that’s growing nationwide, offering one-on-one care direct from diabetes educators and endocrinologists through a series of video calls and their app. Their recommendations are all based on your stream of CGM data, but the care team can remotely order lab tests and issue medication prescriptions too. Check out our interview with Steady Health’s founder to learn more.
Of course, online healthcare isn’t for everyone. But even if you crave local care, the internet can help you in your search.
A key place to begin searching is on your insurance company’s website (portal), where you can generate a list of in-network local providers of the type you’ve decided works best for you, your diabetes, and your life.
Then you can read “customer” reviews of these local docs at sites like:
Just remember that when reading reviews, the angry voices are often the loudest. So read reviews with an open mind. Still, where there’s smoke, there’s often fire, so multiple negative reviews may indeed spell trouble.
If you happen to belong to a local diabetes support group, you can ask other members for recommendations — and why exactly they’d recommend that particular doc. The key thing to keep in mind is that the choice of doctor is very personal. What works for one PWD won’t necessarily work for another.
Once you’ve created a list of potential providers who are in-network and have decent reviews, you should do some detective work on their office’s approach to the business of healthcare. Call and ask:
- What are their office hours? Are they compatible with your schedule?
- What is their appointment lead time? Be sure to ask what the typical wait time is for appointments for both new and established patients.
- How can you reach the doctor if you have questions? Can you call, message, or email? Is that important to you?
- What is their policy for emergency access? Will you be able to get in quickly if a problem develops?
- How do they handle prescription refills? Can you request refills online through a portal, or will you need to call in? Or will you have to visit in person?
Back to our analogy of buying a car: Would you buy a car without taking it for a test drive? Of course not! And neither should you buy into a doctor without a test drive.
Of course, this phase of choosing a doctor is time-consuming, and not without cost. You’ll need to make insurance copays, and your insurance company will place limits on how many doctors you can see in a row, when it comes to trying new doctors out.
Big insurance companies typically allow one new doctor visit per month. For example, giant UnitedHealthcare, in their online FAQ, states that they allow changes in PCPs once per month. Likewise, Blue Cross Blue Shield, in their tip sheet on choosing a PCP states, “If for any reason you are not happy with your choice, most Blue Cross Blue Shield plans allow for you to change your primary care physician anytime during the plan year.”
Since you can’t just visit a different doctor each day, use your research to narrow your list down to the top three or four. Next, rather than call the office for an appointment, visit in person. This will allow you to experience the “vibe” of the practice. How does the place look, smell, and feel? How does the staff treat you? Take time to fill out new patient paperwork in the waiting room to give yourself the opportunity to tune into the mood of the patients waiting to see the doctor.
Along with the vibe of the office, the most important thing is finding a doctor you feel good about. This has more to do with personality than knowledge or skill — not to say those things aren’t important. But if you don’t feel respected and heard in the presence of this doctor, all the medical knowledge in the world will do no good; you will not thrive under their care.
Personality is of course impossible to assess through reviews and other investigation. While you can get some clues through doing your homework, in the end you have to meet your potential new doctor on a “first date” to really get a clear picture of whether or not they are the right one for you.
An important part of “good fit” is this individual’s fundamental approach to the doctor-patient relationship. Broadly, there are three types of doctor-patient relationships:
- The doctor as the boss. The doc is IN CHARGE. Of everything. For many years, this was the dominate doctor-patient relationship, and it still works for many people, especially for the newly diagnosed.
- The doctor as a guide. Other PWDs prefer a talented guide who can advise them about options, and while the doctor remains the leader, the patient has input.
- The doctor as a partner. And finally, still other PWDs crave a partnership in which ideas can be freely tossed back and forth and consensus is forged on the best path forward.
None of these styles is right or wrong. They’re just different, and you need to be sure that you understand what you want. If you crave teamwork, an authoritative doctor will drive you nuts. On the other hand, if you need an expert to guide you, a collaborative doc will just frustrate you.
The test drive is crucial, because the only way to really understand a doc’s style is to experience it. Also, during your test drive, be sure to pay attention to:
- Body language. Sometimes what isn’t said is loudest. Does the doctor seem impatient, bored, or distracted? Or attentive to what you are saying?
- Vocabulary. Does the doctor use terms you don’t understand, or plain English? Or do they dumb things down too much for you?
- Questions. Are questions respectfully received and thoughtfully answered? Do you feel like the doctor is listening to you? When you ask a question, do you feel like you get a satisfying answer?
If you don’t have a good experience on your test drive, don’t be afraid to move on to the next doc on your list. Sure, it can be frustrating in the short-term, but once you find the right one, it will be worth the effort in your (long and healthy) life with diabetes.
Or maybe we should focus on the intermediate term…
Because there’s something important you should know about the long-term: The doc who’s right for you now may not be the one who’s right for you down the road. Many newly diagnosed PWDs are more comfortable with in-charge docs early in their experience, but want to take greater ownership later on as they gain knowledge and experience.
As your needs change, so too, in many cases, will your choice of doctor. And there’s nothing wrong with that.