Finding an Endo 101

From the “Advice Column” file today:

Sometimes finding a good endo can seem harder than finding your soul mate! Whether it’s disagreements over treatment or they seem to be stuck in the stone-age on A1c levels, it’s discouraging how difficult it is to find Dr. Right.  We have all witnessed stories of people who have had to fight tooth and nail to get the right treatment or had to put up with a technophobic doctor.  Insurance companies supply you with a laundry list of doctors covered in your network, but where do you go from there?  Close your eyes and take a stab at the computer screen?  Doesn’t seem very efficient.

Here are some ideas for picking the best endo for you:

1. Get a second (and third) opinion

There are several places you can get referrals for doctors. The Internet is a hotbed of opinions and there’s no shortage of people wanting to say what they think about their doctors online. Visiting places like TuDiabetes, Diabetes Daily, Diabetic Connect or blogs are a great way to find people who live in your area who may be able to refer you to a great local doctor (or tell you who to stay away from!).

Kathleen Weaver, a pioneering blogger with type 2 diabetes, says she found her endo by going to the Insulin Pumpers website and looking for reviews. You can also get second opinions from people who attend local diabetes support groups or meet-ups. You can also call up your local ADA and/or JDRF chapter to find out if there is an endocrinologist who is an active participant in the local diabetes community. Doctors who come out to support groups, participant in local diabetes educational events or work with children’s diabetes camps are more educated and engaged with the diabetes community and are likely to understand the diversity in diabetes treatments.

2. Find an endo who’s tech-savvy and pro-educated patient

Gary Scheiner, CDE and owner of Integrated Diabetes Services in Wynnewood, PA, offers this piece of advice: “Ask the pump and CGM company reps which local endos use their products a lot. That will at least give an idea as to which doctors are technology savvy and progressive in treatment.” Another option: ask the receptionist what percentage of patients are on insulin pumps, or if the doctor has particular preferences to prescribing insulin pumps to young children or people with type 2 diabetes. It may also be helpful to ask if the doctor has any particular allegiances to a pump or meter company – if the endo only knows Animas and Minimed and you’re gunning for an Omnipod, you may want to take that under advisement!

Lauren Golden, M.D., an adult endocrinologist at the Naomi Berrie Diabetes Center in New York City, says, “Endocrinologists are all trained to manage diabetes, but different practices/MDs will have different levels of patient volume, comfort and experience with type 1 diabetes. Practices that see a large volume of patients with type 1 diabetes tend to be more comfortable with recent advances, technology (pumps, sensors etc) and have more resources available to patients in this area.”

In addition, you want to find an endocrinologist who is open to trying new products or theories that the patient may bring to the table. Zoe appreciates doctors who are open to new ideas and concepts, such as LADA and low-carb eating. She says, “I want a doctor who not only is okay with [me] doing my own research and determining my own path, but actually prefers to have well educated patients who can conduct the self-management that is so much of diabetes treatment.” Well said!

3. Look for a full-service clinic

Gary, not surprisingly, also recommends finding an endo with a full-time CDE. But hear him out! “The CDE is the person you’ll probably wind up working with most of the time anyway, so considering interviewing that person rather than the physician. The quality of the CDE can make or break the quality of care.” CDEs, like endos, should be well-educated in a wide variety of treatments, be regularly active with the AADE and the local diabetes community.

Dr. Golden adds, “A multidisciplinary approach (either within the practice itself, or in collaboration with other providers) is important. We find that having input from educators, dietitians, nurses, CDE’s as well as MDs provides a more comprehensive approach to support our patients. This is particularly true when trying to fine-tune the lifestyle components of living with diabetes: i.e. exercising, eating out, changing schedules (work, school), travel etc.”

4. Find an endo who’s active- and not just physically active

A good endo will be one who is a member of the American Diabetes Association’s professional section, the American Association of Clinical Endocrinologists or the Endocrine Society. The AACE is predominantly clinical, Dr. Golden says, while the other two are a combination of clinical and research. Dr. Goldens adds, “However, again it is important to find out if the individual practitioner has experience with type 1 diabetes, as you can be a member of these societies and be a researcher only, or you can be an endocrinologist who does not see a lot of diabetes but specializes in thyroid, bone or some other area of endocrinology.”

Participation with the ADA or JDRF or other local diabetes organizations is also a plus. As Gary says, “It shows that their commitment to helping people with diabetes goes beyond just the office visits.” Websites like Healthgrades.com or Vitals.com or the clinic or university’s website will often list the memberships and awards the doctor has received. You’ll also want to make sure your doctor is not active in the bad stuff. Using the Federation of State Medical Boards, you can look into the malpractice and disciplinary history of a physician you’re thinking about seeing.

5. Find a doctor who’s flexible

Diabetes isn’t something that just happens during the hours of 9 a.m and 4 p.m. with an hour for lunch. It happens all the time, everyday, including weekends. Find out what kind of phone call return policy your doctor or their clinic has for weekend emergencies. Who are you going to be talking to? Can you get an email address for questions or do you have to go through their automated phone system? Will you get an answer from the doctor or from a nurse you’ve never talked to?

Nora Coon, a college student with type 1 diabetes and author of The Diabetes Game: A Teenager’s Guide to Living Well with Diabetes, says she appreciates that her doctor makes time for her outside normal business hours. These kinds of questions can help determine whether or not you’ll get the level of personal attention you desire. Some of you are perhaps more independent and don’t need to chat with your doctor all the time, but for others, it can be comforting to know there’s someone there to help bounce ideas off when things get crazy.

Bonus tip: Find an endo that has diabetes, too. OK, it’s probably a stretch but it has happened! Although most endocrinologists don’t have diabetes, it certainly doesn’t hurt to find one who is a PWD, has a PWD in the family or has a PWD on staff (such as a CDE or nutritionist).

Asking questions before you make your first appointment will save you a lot of time and trouble when looking for a new endocrinologist, whether you’re a newbie or a seasoned diabetes veteran. And always remember: Just because somebody is your doctor now does not mean he/she has to be your doctor forever!