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22 Responses

  1. Michael Ratrie
    Michael Ratrie September 17, 2009 at 7:25 am | | Reply

    Very interesting. I am going to print up the “ideal patient” example. However, as I read this article a few(?) things really struck me.

    1 – Does Dr. Peters provide the “ideal patient” example to each of her new patients (or ones that aren’t “ideal”)? Alternatively, does she have her staff reinforce this on a regular basis (along with in-office signage)?

    2 – 10 minutes! How can we increase that time?

    3 – It may seem obvious that patients should arrive early for their appointment, but we have busy lives too! Maybe a practical fix to arriving “5 minutes early” would be to simply build it in to the appointment.

    4 – 10 minutes!

    5 – Downloading meter info immediately prior to the appointment…wow! Surely this could be done via the internet/e-mail the day before couldn’t it?

    6 – The less than ideal patient “doesn’t have a list of meds…” OK, but shouldn’t the doctor (or staff) have a list of what was subscribed and what should need refilling? (Granted my endo doesn’t either…)

    7 – Did I mention 10 minutes!?

    Amy, methinks you need to have a post titled:

    “How to Be a Good Endo, From a Patient’s POV

    Fair Winds,
    Mike

  2. Carol
    Carol September 17, 2009 at 8:43 am | | Reply

    I can understand and appreciate the time crunch, and would say that this dr would likely consider me a “good” patient. I arrive with a notecard containing my questions and current pump settings and averages and am respectful of the time allotted for our visit. I’ve brought printouts of BG readings, but there is never time to go over them. So I agree w/ Michael. 10 minutes is simply not enough if we are to review data and tweak insulin doses together. The last suggestion I got from my endoc was nonsensical. He thought my tendency to trend upwards starting around midnight was due to rebounding from lows. Ummmm, good theory, but I have a CGM, and it’s obvoius that’s not what’s happening. I asked him…”but wouldn’t I see that on my cgm data, it’s a steady line upwards?”, but he just went on and didn’t have time to look at that. So I just nodded and smiled, got my prescription renewals, and tweaked my basal rates up slightly starting at 11. He’s great at ordering the labwork, seems to keep current, and recently uncovered a vitamin D deficiency. But nope…I don’t trust the 10 minute visit advice for insulin adjustments.

  3. Lauren K
    Lauren K September 17, 2009 at 10:14 am | | Reply

    Wow, I cannot believe this post. It is horribly condescending. I take it that this endo is not a person with chronic illness herself. Granted I am only a medical student but I can’t imagine treating my patients this way –as if they are expected to fall in line and obey orders. They are human beings struggling to stay healthy. I’m not going to treat them as if they are in boot camp.

    First of all, doctors run late, and that’s unforgivable. Doctors should never, ever keep a patient waiting — if they are overbooking appointments or booking them at 5-10 minute intervals when they clearly require more time, the physician is running the office poorly. The physician is at fault for tardiness, and deserving of many complaints. As a patient, I should not have to “bring a book.” You, the doctor, should be running ON TIME.

    Secondly, I decide whether my glucose data will be shared. It’s my life, my health, my body. ‘Patient autonomy,’ remember? The doctor is only a consultant there to answer my questions. I make the choices and I decide what’s best for me, and what I’m comfortable with. Downloading meters and looking at logs is 100% useless for me. I know why my glucose goes up and down. It’s not a mystery.

    Third, how many times have I come in with journal articles that my endo hasn’t even heard of? I have been asking about hematopoeitic stem cell research (very promising trials) for months now, and no one seems to have a clue. How about doctors doing THEIR homework and staying current on research?

    And, as for ‘leaving the charting until later,’ is that a good idea? Are you really going to remember everything about every patient at the end of the day?

    Patients are people. We are vulnerable and often we feel powerless and betrayed by our own bodies. We should not be scolded, chided, lectured, told we are ‘making excuses,’ etc. This post is a wake-up call showing me how NOT to behave. I have seen medicine through both lenses — doctor and patient — and I hope to never become as detached and disconnected as the author of this post.

  4. strawberry
    strawberry September 17, 2009 at 10:35 am | | Reply

    I totally agree with this doctor. This is exactly how I approach my appointments with my endocrinologist (I’m putting myself in the “ideal patient” camp). I think my doctor really appreciates this, so we have a great relationship, and I usually leave feeling like we’ve got a plan and maybe we even solved a problem. When I was planning for pregnancy, I was frustrated by the short appointments and felt like I was getting nowhere… so I demanded more time and got several worthwhile appointments with an outstanding CDE at the endo’s office. Granted, I clearly have a stellar insurance policy that covers all of these things, so I know I’m one of the lucky ones. We really must be our own advocates in this health care mess. If you’re doing your very best as a patient and the doctor still isn’t giving you what you need, then you need to find a new endo. But I don’t think we should come down too hard on this one — she seems to be one of the great ones!

  5. Elizabeth Joy
    Elizabeth Joy September 17, 2009 at 12:11 pm | | Reply

    Amy–Let me know if you want me to write a “rebuttal” post. After 37 PWD years (and probably 10 endocrinologists, some good and some…um…not so good), I know what works and what doesn’t work in motivating me to take better care of myself.

    From the endo’s perspective, I certainly see where she’s coming from. I understand how frustrating it must be for doctors to have to leave most of diabetes care in the hands of their patients, and then learn on follow-up visits that their advice isn’t being followed. In some respects, it probably makes them feel like a failure as well. As for the “10-minutes” and patient-unpreparedness issues, all doctors are so very, very busy…There really aren’t many endos out there, and at least with my doctor, he’s booked 2-3 months in advance. Of course their time is in demand, valuable, and shouldn’t be wasted. And although 10 minutes isn’t nearly enough for good diabetes care, it’s often all they can afford without shorting other patients. I don’t blame her at all for her frustration…

  6. Melitta
    Melitta September 17, 2009 at 1:53 pm | | Reply

    My endo is always happy to see me, and I am one of her “ideal patients.” But this certainly gives me ideas on how to be more organized and better prepared, so thank you!

    I always bring a good book. I remember once my endo was dealing with a newly diagnosed/just-admitted-to-the hospital Type 1. I’ll sit and be patient and read a good book for that.

  7. dargirl
    dargirl September 17, 2009 at 6:09 pm | | Reply

    My endo appointment was yesterday. I believe that I would be considered an “ideal patient”. Log, notes, shoes off, prior diabetic plan with items check off, lab work pre-done. But, this is how I was trained 37 PWD years ago by my CDE.

    During my appointment most of the discussion and issues are talked about with the educator. She is really the one that I have built a relationship with. 10-15 minutes into the appointment the Dr. walks in we all come to a conclusion/plan of what needs to be done. Everything is reviewed and on my way I go. That’s an ideal appointment.

    I would like to bring another “Dr’s Office Foo-pa” discussion to the table. “Does your Dr. sometimes ask you questions about your health while typing in the computer?”. This is rude. I feel as though the Doctor is “twittering”, “texting” during my appointment. I realize that the medical records collection is crucial, but I do not consider this as a face to face interaction. As anyone else notice?

  8. Bob S.
    Bob S. September 17, 2009 at 9:08 pm | | Reply

    According to the article, if I were the ideal pwd, then I wouldn’t need an endo but to write scripts. Next time I’m in to see my endo I’ll make sure I stick to the “diabetes only” concerns because anything else that is happening surely is not concerning. What a waste of time I am to be such an inconvenience.

  9. riva
    riva September 18, 2009 at 4:17 am | | Reply

    I agree with everyone, but dargirl raises a point I can’t get out of my throat. My endo, my podiatrist spend more time typing into their computer than looking at me. It’s as if I’m the chair in the room and the computer screen is the animate object. Don’t know the resolution, however, as if they don’t do it then and we want computer records when will it get done? riva

  10. Gretchen
    Gretchen September 18, 2009 at 6:47 am | | Reply

    I’ve sometimes had the opposite problem. I get my labwork results before the appointment, decide what I think is the most important problem, and start off summarizing it, in order to save time. I might say, “Most of my labs haven’t changed, but I’m not happy with this A1c.” The endo will say, “Slow down. Let’s go over this.” The endo then slowly goes through the lab results, comparing them with the last time. By the time this is done, half of the appointment is gone.

    I realize no endo can remember previous lab results from thousands of patients, or even what they prescribed before without checking the records. But there ought to be some way they could set aside some time at the end of each day to review the records of the patients booked for the next day so that the time wouldn’t be wasted on review.

  11. Kelly Rawlings
    Kelly Rawlings September 18, 2009 at 8:00 am | | Reply

    First, I would like to send a heartfelt thank you to the dozens of high quality healthcare professional who I have selected and paid to help me with my diabetes self-care. I hope that I have done my share despite ridiculous limitations in the length of office visits and lack of use of technology to get needed glucose/food/meds records (my endo’s office stopped downloading from meters because there were too many kinds!) in making our working relationship a smooth, efficient, and results-oriented one.

    Dr. Peters raises some excellent points and I appreciate she has entered them into the wider dialogue. But I have to agree that her “what you can do for me” attitude and method of delivery has, unfortunately, added to the ongoing and justified dissatisfaction many of us living with a chronic condition experience in our relationships with health care providers.

    Go, Mike. We need your “patient” POV pronto!

  12. Linda
    Linda September 18, 2009 at 9:09 am | | Reply

    If I had a nickel for the 30 to 60 minutes I have sat in a doctor’s office even when I’ve shown up early! Don’t tell ME to be on time! I have to take time off from work and wasting another hour doesn’t help my mood either!

  13. Robert
    Robert September 18, 2009 at 2:12 pm | | Reply

    I think it’s precious that an endo is telling the world how to be a great patient. And clearly, this Dr. is one of the few that we’d all be lucky to have access to.

    HOWEVER:

    While I show up early to EVERY appointment, I’ve NEVER actually seen the Dr. on time. I routinely am left in the waiting room for 15-30 mins after the appointment is to start.

    Once I get in to the exam room, I get asked a series of questions that may as well consist of: “I’m too lazy to look at your chart, and we LOVE redundancy here so could you tell me all of the information that I already have in this little computer thingy?”

    I am routinely spoken to as if I have a third grade comprehension of physiology, even though I make it clear from the outset that I have a thorough understanding of my chronic illness and its treatment.

    Worst of all, I can’t get in to see my endo with less than 3 months notice and if I have to change my appointment I go to the bottom of the list. This makes me feel like I am absolutely last priority and absolutely not a “partner” in facilitating health treatment.

    All that being said, I’ll be sure to sit in the chair so as not to create “a disparity in height between provider/patient.” I wouldn’t want my Dr. to feel as screwed by the process as I do.

  14. Symposier
    Symposier September 19, 2009 at 6:12 pm | | Reply

    Well from now on I’ll take some of the “Ideal patient points” as my guide to follow when visiting my Endocrinologist. I think that as patient we must be aware that our Doctor is still a “normal human being” ((with lots of knowledge’s and abilities)) and we most treat him/her as we like to be treated. Thanks for this interesting article

  15. June S.
    June S. September 20, 2009 at 4:03 pm | | Reply

    Well, I’m glad to know that I fall in the category of “ideal patient!” In fact, I routinely arrive 15 minutes early for an appointment, though I often have to wait at least 1/2 hour after my appointment slot to actually be seen by the endo. I’ve been writing lists of questions for years – I think it’s a great idea for everyone to do that. Rather than blast this endo, who is trying her best, just realize that there are time constraints placed on her by insurance companies. It would be lovely if “Obamacare” would solve all of these problems, but I doubt that it will.

  16. Cathy
    Cathy September 20, 2009 at 6:28 pm | | Reply

    Wow! I agree with Lauren K…. the med student and Type 1 diabetic.

    Unless you live with this disease day by day… hour by hour…. minute by minute…you really just can’t look at the numbers and expect to have a grasp on what to recommend and do for someone. There are too many variables. Insulin dosing changes constantly depending on all of the variables that a doctor can’t or should not predict.

    I think doctors think that their formulas/ I:C ratio’s etc. are the only and absolute way to handle diabetes and they are the “LAW”.

  17. Santosh
    Santosh September 21, 2009 at 5:12 am | | Reply

    Thanks for the information.

  18. Sasha
    Sasha September 22, 2009 at 2:19 am | | Reply

    “a disparity in height between provider/patient.”

    Would someone explain this one to me? If I am reading it correctly the Dr. does not want the patient to appear taller than her? For what reason? At best this seems condescending but perhaps someone can offer a different view of this comment by the doctor.

  19. Edwin
    Edwin September 22, 2009 at 4:23 am | | Reply

    Great suggestion!
    I hearing that the millions of afflicted Americans are confused, frightened, and often receiving sub-par treatment from inexperienced primary care physicians.

  20. Emily
    Emily September 30, 2009 at 10:58 pm | | Reply

    I agree with somethings that the Dr. wrote and others piss me off.

    First off… The closest Endo to me is almost 2 hours away… So although I am normally 15-20 min early please understand that I drive almost 2 hours with no traffic and well over 2 hours with traffic… Also I have a job, go to school, as well as take care of a 5 year old since my borther is in Iraq. and I AM ONLY 21!!!!
    Two: I usually do write down my blood sugars, carb intake, and insulin (as well as where a pump and CGMS) although if I forget it or lose it on the way PLEASE FORGIVE ME! But I am only one person trying to do a job of a village.
    Three: You do NOT live with this illness everyday… It is a frustrating, non forgiving illness. So if I forget to check my blood sugar or plain just don’t want to do it, forget to bolus or just don’t… Keep in mind that I am suffering the consequenes of my actions (or inactions) you are not… you are not my parent, my uncle, my aunt, or my grandparent. DO NOT TREAT ME LIKE I AM A 5 YEAR OLD! In the case of my doctor I have had Diabetes longer then you have had a medical degree. So lay off it!
    Four: YES I do get depressed from Diabetes as well as fed up and sometimes wish I could grab it by the shoulders and throw it against a wall! But other times I don’t… So forgive me when I tell you this because MAYBE JUST MAYBE I need to get it off my chest or maybe I just need to cry! Don’t look at me like I’m crazy and keep typing… Why don’t you stop and talk about it with me…

    Why don’t Doctor’s try to understand what we are going through and treat me/us like adults that have to deal with everyday stressors as well as this damn illness.

  21. john3347
    john3347 July 9, 2012 at 6:25 am | | Reply

    Several of you here comment on the Dr. typing on the computer while you are present. Do you really want the Dr. to wait until you have completed your visit before they record vital information? My Dr. types in my presence and I am able to look over his shoulder and see what he is typing. It is all very important information that provides a complete physical picture for them months or years from now. Very important that these observations and comments are recorded immediately to insure completeness and accuracy.

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