I love the endocrinologist who oversees my diabetes care. He is upbeat and funny.
I fear the endocrinologist who oversees my diabetes care. He is smart and analytical.
He is kind to me. He evaluates me. To be more precise, the way he cares for me and my illness is to assess how well I manage diabetes on my own.
His assessment, which I face at my quarterly visits with him and which includes the essential A1C test, is in part validating. The assessment tells me, with numbers, the state of my overall health, which is very good. The assessment also illuminates the shortfall in my self-care and where my control has, well, failed. (Those early morning hypos on the day after intense exercise? A failure in prediction.)
Perfection in diabetes care is unattainable. I have intellectually accepted that. Emotionally, though, I can be a ball of nerves and fear in the week leading up to my regular appointment with Dr. A. I feel as though I am going to see him more to be judged than to be helped.
Interestingly, I’ll bet if I asked him why he went into medicine and why he stayed, he might say, “To help my patients enjoy good health.” He really seems to like me and also his other patients, which I occasionally overhear him talking to in the clinic hallway as I wait in an examining room. He is friendly.
And, yet, his job is to motivate people with diabetes to pull themselves up from the muck and to keep their toes away from it. Don’t get sucked down by food temptations, excessive couch-sitting, glucose meter neglect, and injection avoidance. He can’t be there all the minutes of every day that it takes for all his patients — and he may have hundreds of them — to care persistently for themselves.
So he assesses us, identifies problems, and prescribes changes and goals as well as medications.
Imagine if your closest friendships were based on this dynamic of assessment and prescription. How intimate could you be with such a friend?
Certainly, I know that my doctor is not my friend, although he is on my side. What is really challenging, and what I really fear, is the revelation of myself — my diabetic self — to him in a way that would make it possible for him to help me do my best and really know me as a person and all I struggle with. My job as a Type 1 diabetic, I have learned, is to achieve excellent control, and so the pressure is on to prove my excellence. When my control is not excellent, whether too many highs or too many lows, I start fearing my upcoming performance review. I have one scheduled (and feared) for next week, in fact.
I am preparing for it by getting my papers (that is, glucose record) in order and reflecting on what has been going well and what hasn’t. I am also girding myself to get my grade (the A1C) and suggestions for how to do better.
I have tried to imagine what would make me look forward to these visits. A recent visit to my dentist, whom I love and do not fear even though my teeth are not perfect, gave me some insight. He too is very friendly, and as I sat and waited for him to probe my mouth, he said to me, “It’s always great when you come in. You are a wonderful patient.”
For the rest of my life, I will be caring daily for both my teeth and my diabetes. I think what I would like from my diabetes doctor is what I get from my dentist: just one moment, now and then, of unconditional positive regard.
Fear is a strong motivator, yet so is (clinically appropriate) love.
Image “love & fear” by David Pham on Flickr, via a Creative Commons license.
It’s odd how deeply felt those clinical compliments are, isn’t it? I had a doctor (my OB/GYN at the time) storm into the examining room once, look at me, and say, “I love smart patients.” Presumably she’d just come from a frustrating encounter with a less-than-acute one…but still, I have to admit, I took a guilty, childish pleasure in having “aced” the doctor test (which I didn’t even know I was taking). And yes, it was very motivating, too.