Monday, 20 August 2012

Same song, different chorus

So I had my annual review at the diabetes clinic earlier this afternoon, and I'm sitting here feeling frustrated and angry.

I will start off by saying that in general, I really like this clinic: the DSNs are awesome, through this clinic I've been on a DAFNE course and moved from Mixtard (when I first arrived) all the way to an insulin pump, and my diabetes management has really improved.  However, I have one major grip with the clinic, and it's this: I never see the same doctor twice.

Usually, I find this mildly annoying, but no big deal. Then I had the appointment with Dr Pillock and it really threw me. I was so angry after that appointment, and I sat in that waiting room afterwards waiting to see the DSN feeling like a complete and utter failure.  I know that isn't true, and I generally don't feel like that, but now every time I go to that clinic, I sit in the waiting room not knowing which doctor I'm going to see, and I remember that appointment and how I felt, and I stress.  The last two appointments I saw a DSN (which was actually quite good) and a doctor who seemed very nice.  Today, one of the doctors I've seen before (and got on really well with) was in clinic, so I was hoping I'd get him, and instead I got a patronising *insert naughty word here*

He started off by asking me the same questions they always ask (while reading over my notes) we had the usual surprise that I'm not in regular touch with the DSNs *sigh*, and I asked about my HbA1c.  Turns out it's actually gone done a little bit, and is now 6.7%, which I was very pleasantly surprised by, as I was convinced it would have gone up.  The last three months covers our honeymoon and all the surrounding chaos and I felt that I was completely slacking in my diabetes management.  In the last month or so I've got back on track and really made an effort, and maybe that's what made the difference.  Regardless, I was pleased, but I think part of the reason that I'm so frustrated by today is that the rest of the appointment took away from that.

Anyway, I mentioned that I thought that some of the reduction in my HbA1c has probably been helped by the fact that my liver doctor is currently in the process of reducing my steroid dose, which he then looked up to see what had been written in my notes, and then proceeded to get confused as to whether I had stopped or not, and why I was on the dose I was on.  We then got into a slightly heated debate where he seemed to decide that I didn't understand any of it, stated that "we know what we're doing with prednisolone because we're endocrinologists," explained some of the tests I'd had in baby language, and started to suggest things they could do with my steroids.

At this point I was pretty much ready to bash him over the head with my Biochemistry PhD certificate and tell him that there was no way in hell I was letting him do anything to my steroid dose because I wasn't under his bloody care for that and he'd met me once.  *takes a deep breath and counts to ten* Instead, I explained, as calmly as I could (which, to be honest, probably wasn't all that calmly...) that I had discussed all the options with my liver doctor, and that we had decided on a course of action that we were both happy with. He scribbled something in his notes, and stopped pushing the matter.

I'm sorry, but I trust my liver doctor.  I've seen him every couple of months for the last two years, and I really like him.  He treats me like an individual, and he always discusses my options and asks my opinion.  He knows my case far better than some endocrinologist who has just looked at my notes for the first time and decided that he knows better.

Then he went through my last appointment notes, and asked if my basal rates were the same.  When I told him that they were considerably lower (about 40%, because of the reduction in steroids), he said that he didn't want to write all that down, and moved on...

I just...I feel that the appointments are worse than useless. At best, I get my HbA1c results, and check everything else is ok, and nothing else; at worst, I walk out feeling like this.  I don't get anything out of the appointments, and to be honest, I'm not even sure what I *want* to get out of them, but I know that when I have doctors like the one I have today, I don't want to ask questions, I just want to get out of there as soon as I can.  And that's not right.

I'm pondering emailing one of the DSNs at the clinic (since apparently I should be doing that anyway...*coughs*) and asking what the actual policy is in the clinic, and if there's any way I can make sure that I see the same doctor/group of doctors. I don't want to make an actual complaint, but I'm tired of walking out of the clinic feeling frustrated, and it's pushing me to do something about it. 

Any thoughts?


  1. Double rant here! I have exactly the same problem (maybe because we go to the same clinic?), and this is actually the only thing I don't like about it. Last time I had a review I explicitly asked to specifically see Dr X, knowing that I had to discuss important things (aka pump funding). I know that junior Drs have to start somewhere, but honestly I wouldn't listen to anything a random Dr would tell me (I was once told to stop drinking water because I said something about needing to go to the loo quite often!), so in the end these random reviews are a waste of time for me as well. I do get my blood work done via my GP, so I don't need someone commenting on a result that I know already.

    I think that next time you’re emailing your DSN you should let her know how frustrating this is for you, especially because of the other meds you're on, but to be honest I am not sure there is something that can be done.

    I'm starting to think that these annual reviews are not that useful anymore -- especially after DAFNE -- and I usually get in touch with DSN when I want to talk about something. Somehow this is not fair though, because we have to live with this condition for the rest of our lives, and it would be nice to meet the same Dr during the few times a year we have our annual reviews!

    1. Yeah, it's like you say - I feel like I'm just going for the test results, because I don't trust a random doctor I have just met, especially if they then hit out with something that doesn't make sense!

      I think the main issue I have is that I don't tend to email the DSNs that often (another thing the random doctors take issue with), so I don't really feel like I have *any* continuity of care in the clinic. I'm starting to think slightly longer term, such as having kids etc, and at the moment I'm know I wouldn't be happy discussing this at all in clinic.

      I'm in the middle of trying to compose some kind of email to one of the DSNs, so at least I feel I've done something. If it helps, it helps, and if it doesn't...well I guess I'll continue to nod and smile!

  2. So it's not just me! My last review was really frustrating too. I saw a different registrar who I could hardly understand. We had a bit of a moment when he wanted to see my foot ulcer and I refused. The reason for my refusal was that my podiatrist had spent 20 minutes only the day before packing and dressing said wound and I couldn't see how him looking at it would help. Not to mentionm that it would be impossible to redress. Awkward silence. We then had a quick discussion re: my HBA1c (my results were higher than I had expected so I immediately felt depressed - given that I have had the ulcer for 4 months and counting my HBA1c was probably not terribly surprising but I hate bad results and it upset me) but he was not very encouraging, he basically grunted and just went through my list of meds and told me to come back in four months.

    1. Sorry, I've only just seen this comment!

      I find it really frustrating that we have to be so militant about our care. What happens if you're not that kind of person? I know someone like my mum would go along with whatever the doctor said. We shouldn't have to be arguing our case with doctors on every single visit, and we need support and encouragement when we're not doing so well, because diabetes isn't going away!

      I've found out that apparently you can ask to see a specific doctor when you go to clinic (from a very lovely DSN), and I know that labradorknitter (commenter above) has tried that and it worked, so I'm going to try and do that next time. Might be worth trying at your clinic? Hope your foot ulcer has gotten better! :)