I like my doctor. He’s a little quirky, but a very good doctor. Although I visit him only once every three months, he seems to remember a lot about my health and seems to actually care.
The one thing that drives me crazy about my doctor, however, (and most doctors I’ve seen since being diagnosed with type 1 diabetes) is the fact that he doesn’t seem to strive for excellence as far as my diabetes management is concerned.
My approach is that my numbers should be the same as those of someone who doesn’t have diabetes. I’m far from getting there, but I believe that should be the goal. Diet, exercise, medication, pump or injection should all be determined with that goal in mind.
Achieving the goal – having a normal HbA1c level (below 6%)– with very few lows or highs, will probably mean, at least as far as diabetes is concerned, a long and healthy life with very few complications.
However, this “goal” does not seem to be the common approach of family doctors or diabetes specialists. Extreme sports and very strict diets are usually considered crazy, if not unhealthy, by most of the doctors I’ve met, my doctor included.
So, I went to my doctor today to get new prescriptions and paper work for blood tests. While there I decided to ask him what he thought of the idea of me getting an insulin pump. His reaction was “Why? Your HbA1c is under 7”.
I can understand why he didn’t ask about my highs and lows, or about how the pump would affect my running or diet. What I cannot understand is why “less than 7” is considered healthy when you have diabetes, but not if you don’t. I understand why doctors need a minimal measure for people with diabetes to strive for but, if that measure isn’t really normal, should they stop there? Shouldn’t doctors say “maybe you can do better?” Especially if they know their patient is the kind of patient that can drive himself to do better?
Atul Gawande, who writes a lot about excellence in medicine, has a fantastic piece from a few years ago on measuring quality of medical care, and whether the pursuit of the medical optimum (in our case, non-diabetic-like glucose curves, or in the case of cystic fibrosis, non-CF-like breathing) really matters: http://www.newyorker.com/archive/2004/12/06/041206fa_fact The short answer is, it does– so, yes, ruthlessly pursue excellence, and require your doctor to do the same! A good read, though, diabetic or not.
I don’t get it either. If you want near normal control–because you want to feel good, you want to perform well athletically, you want to live life with health and spontaneity and you want to avoid complications, the default reaction seems to be “you’re obsessive”. The only thing I can think of is the medical model doesn’t apply to diabetes. The doctors don’t get to control what we do so they assume we can’t control what we do. So, they just aim for good enough (and perhaps that is what a lot of patients want–good enough and more freedom). But… Read more »
This is the topic of my post for later this week. Our last visit the PA came in and before she gave us the results of my daughter’s A1C, she said: I told him (the endo) you wouldn’t be happy with it (it was 8.0, and I wasn’t, but not for the same reasons they thought). I wish they understood that what we are managing is not towards an agreeable number but towards a normal day like everyone else.
Hear you Michael. Diagnosed just 6 months ago, I saw my primary physician this week. Because of my A1C of 6.5 a month earlier, she seems to think I’m golden. She didn’t ask to see my daily numbers; told me I no longer need to test daily; seemed unconcerned that my waking numbers are a little high. I received much more probing from my other doctor who is training to be a CDE . . . but my 6.5 knocked me off her roster. What do we learn from this?: diabetes is a condition where the patient really needs to… Read more »
Thanks Catherine,
I’ve been thinking about the pump but am not there yet.
If my next A1c is bad I’ll probably get closer to getting one.
Get a pump. Insist on it — especially with your exercise schedule, I think you’ll find it really useful (in fact, I can’t imagine doing the type of exercise you engage in without one). I agree with you on how frustrating it is when doctors don’t seem to want to let you have high standards. I had a similar frustration with my previous endocrinologist, who responded to my concerns by just saying, “Catherine, you’re doing fine.” I was like, yes, I AM doing fine. But I have things I’m worried about and would like to improve. Isn’t it your job… Read more »