Tuesday, June 26, 2012

My Worst Endo Visit Ever--DSMA June Blog Carnival

I held back the tears until I exited the office and got into my car. But, once I plopped in the driver's seat--I cried. Last month, I had the worst medical visit of my diabetic life.

My Endocrinologist (the one that I raved about during my DMSA interview) was out of town and I had to see his assistant. I felt pretty good about going for my 3-month A1C check-up to chart just how well I've been doing. But things quickly went sour.

When the PA walked into the room she shook my hand and said, "Hello I'm Dr. ____'s PA. My name is Ms. ____, I don't think we've met before."  I replied, "No we haven't. I'm--" Before I could get my name out she had moved on to the table, opened my chart, and started asking "Do you have a history of Diabetes?"

I couldn't believe that this woman had not even waited to hear my name. If my name doesn't matter, then do I? If she's more interested in seeing the chart than looking into my eyes then how can she care for me? This was the first problem and shortly afterwards came the second.

"Do you have a history of Diabetes?" she asked again, snapping me out my thinking process of examining how rude she just treated me.

"I have Diabetes," I said.

She looked up from the chart and turned to me and asked again, "Do you have a history of Diabetes?"

Thinking that she probably has a hearing problem, I said more clearly and more detailed, "I was diagnosed with Diabetes last year on February 15th."

"Yes, but I'm asking if you have a history of Diabetes?" She said firmly.

Okay, so now I'm wondering what her problem is but, then I figure, maybe we're being lost in translation since her accent tells me that she not native-born American. Could she be asking me if I have a family history of Diabetes? "I don't have a family history of Diabetes. I am the only Diabetic in my family."

Apparently agitated, she responds "I am not asking if you have family history of Diabetes, I am asking if you have history of Diabetes."

So, now I'm looking at her like she really is a complete idiot. Just before I could reply the nurse walked in to give the PA something. And I could tell that the nurse recognized that something was wrong me, but she closed the door almost as silently as she opened it.

I spoke, "I told you that I'm Diabetic. I am at the Endocrinologist's office. I was diagnosed with Diabetes last year on February 15th. No one in my family is Diabetic except for me. If you call being diagnosed with Diabetes for a year a history, then yes."

"Well, you have Diabetes, correct?" She asked.


"Then you have a history of Diabetes."

I was moved from being aggravated to borderline pissed off since that whole segment was about 10 minutes. Plus, who in the world asks a Diabetic if you have a "history of diabetes"--you either HAVE Diabetes or you don't. And, the first thing I said was "I have Diabetes."

We both attempted to move forward. But even in moving forward the clashes kept coming. She made me feel less than. And it wasn't until I told her that I was Dr. P. a professor at the local university that her attitude changed.  It was as if there was a new PA in the room when she found out that I have more education than she does (a PA in grad school trying to finish her dissertation). All of a sudden she seemed almost hopeful that this commonality would bond us. Sorry, chick.

It made me cross the borderline to being pissed off. Why? Because I thought about the countless people that come into this office that don't have college degrees. The ones, like in my own family, that can't demand that she call them Doctor. I thought how sad it was that for 15 minutes I was being perceived as less than now all of a sudden she wants to value me. I thought about the level of arrogance she must have to treat people like this and feel that it's okay. I wondered how far I would be in my Diabetes management had I met her rather than my fabulous Endocrinologist when I was in the hospital and scared to death that I was less than 24hrs away from a Diabetic coma. I knew that I would probably still be on medication--either for being an experiment for her dissertation or because of her terrible attitude and unfriendly approach making me have a lackluster approach to Diabetes management.

That wasn't where things ended, either. Next up was my prescription for strips. I requested strips for testing 3 times a day. She said, "I will only write for once a day."

"What? Once a day is nothing. I test when I wake up in the morning, test before I go to the gym, and then after I workout," I responded quickly.

 "The insurance companies will look at this chart and then ask why are you testing 3 times a day if you're numbers are in good range."

"What numbers will they look at?"

"These. The ones in the chart?"

"Are you talking about the ones that the nurse just got from my glucometer?"


That's when I informed her, "In order for the insurance company to know that I'm in normal range means that I've been testing 3 times a day and have data to show them. Even you asked how are my numbers in the morning, at lunch, and before bed? If I am only testing once a day, I won't know what my numbers are, can't tell you, and the insurance company won't know either.  Can you write in my chart that I am going to the gym and need to test before I work out?"

"I can't do that. They aren't going to care. They are just going to see you have good numbers and not want to pay for testing that often."
I felt like crying then because at this point I'm SO OVER all the clashes from this visit. But I say,

"Look. I run the risk of passing out if I am low before working out. That is the reason why I wear a medical alert bracelet. Testing at least 3 times a day is what has gotten me to be a med-free diabetic and in order to stay med-free, I need to know what my levels are."

She simply could care less. Whatever else came out of her mouth on the subject of strips was a blur because she was not budging. The idea of writing the prescription and letting me hash it out with the insurance company also did not waiver her stance.

I thought about all of that. And before the visit was even over, we had yet another clash. This time, about getting the results of my A1C. I asked, "If I call you next week, will you be able to give me the results of my A1C?"

"I don't usually give results over the phone," she said.

"Well, I'm going to China at the end of this week, so if you could make an exception, I would appreciate it," I asked.

"Your numbers are good. You look fit. You tell me you're working out regularly. I don't foresee a change in your numbers. And, even if there were we couldn't make changes until you returned anyway."

I knew that any more comments would return us to the beginning of the conversation. And I would rather leave on a better note. I simply said "Okay" but I had resolved that I would NEVER go back to that office if my Endocrinologist is out of town. I left the office so hurt, aggravated, and angry that I released all my frustrations out through my tears in the parking lot and on the drive home. 

I am not sure what's going to happen in the future but I will NEVER EVER go back to see that woman again.
Here are my 5 suggestions:
#1-Remember that a greeting goes two ways. If you want me to hear who you are, then listen to me when I tell you who I am.

#2-Asking a diabetic if they have a "history of diabetes" is an assassin question.  The proper question is "Are you a Diabetic?"

#3-Treat all your patients like they are someone's child or mother. If you're having a bad day-stay home. Your patients have a life on top of managing a chronic illness...the last thing they need added to their day is your nasty attitude.

#4-Patients don't want to see or hear about the way(s) you're compromising our health to bow down to insurance companies.

#5-If you don't have a chronic illness, then you can't imagine the fear, vulnerability, uncertainty, and layers of emotions your patients experience every single day. Never forget that we are fragile and when we come to you we are perhaps at our most vulnerable state because we're sharing information with you that we may not share with anyone else. So, be gentle.

Saturday, June 9, 2012

A Peace that China Gave Me

I went to China last month. It was my first trip to China, my first flight longer than 8 hours, and the first time I went two weeks without worrying about my pancreas hourly.

I went to China for work and work trips no matter where they are located are the kind of trips that take up 95% of your time. So my post is only about a snippet of that 5%.

Worries before Departing: I have to say that almost everyday before going to China, I worried about how I would manage diabetes, I had to make sure I had enough strips, my gluometer, snacks, and I even had one of my students write "I have Diabetes" in Chinese for me in case I needed that information to be known. I kept that piece of paper in my black carrying bag.
Also, I worried about the flight. 13 hours...THIRTEEN WHOLE HOURS, on a plane..what in the world would I do to occupy my claustrophobic mind? I brought just about everything a carry-on luggage could manage just in case I got bored with one activity, I could move to the next. However, in the end, Advil PM solved that issue really quickly.

I worried too about this issue I have of my glucose level dropping when I am on a long flight. So, I brought some carbs and protein with me on the flight (my grandma's fried chicken wings). Sure it's not the healthiest option, but I was CERTAINLY glad to have those wings when I arrived in China where I was fed pigeon (but told it was chicken).

Managing Diabetes LESS: For the first two days in China my numbers were abnormal (they ran higher than I'm use to seeing, but not over 200).  I didn't know if was the flight, if I over-corrected a low, the effect of being on the other size of the world exactly 12-hours ahead of the Eastern Standard time zone, the noodles upon noodles, a mystery element, the thick visible pollution, or a combination of all of these things. Whatever the reason, I do not know but it caused me to try something new--worry less about diabetes and check my glucose less.
The experiment wasn't easy.  I had to force myself not check my glucose before each meal (this is the advice my Endocrinologist has been suggesting for a while since I am now a med-free diabetic.  But my response has been "How do I stay med-free if I don't check the same way I did in order to get med-free?"). Plus, I didn't get diagnosed on a random appointment visit to the doctor or at an annual check-up, but rather when I was at the brink of death and needing insulin STAT, which means it's been hard for me to take the non-worrying route.  I've been feeling like one day without checking my glucose at least three times a day could mean another visit to the hospital.

But in China, I tried it. I reduced the amount of times I checked to once a day when I thought about checking at other times, I forced myself not to do it. And the results...

I actually felt good. I felt like I was given a part of my old life back. I still counted carbs, but not checking my glucose at every meal meant that I didn't need to explain to my Chinese co-workers what was going on nor did I have to go into a filthy restroom to prick myself. It also gave my finger tips space to heal from all the pricking (I had begun to HATE shaking people's hands because far too many people don't wash their hands regularly and with tiny open holes on my fingers I would get grossed out with the idea).  Counting carbs and trying to stay within a reasonable amount given the, sometimes limited, options of non-rice and non-pasta dishes wasn't always easy.  And there was a slight bit of liberation felt not knowing exactly how much the noodles affected me.  I felt like the parts of my brain that had been taken hostage with diabetic-worries were on recess. And, I was allowed to absorb more of my first Chinese experience.

It was the perfecting timing for this type of experiment...being on the other side of the world where road rage is uncommon, but chaotic driving is normal. A place where food is eaten as a community not alone. A location where one of the wonders of the world still amazes us.

China granted me a small peace about the way I manage diabetes and for that I am thankful.
I'm outside Beijing at the Great Wall

Audrey 2
Thanks China