Visiting The Doctor

My daughter has visited a few doctors in the past month, including the pediatrician, the endocrinologist and a new specialist.  I find that my expectations of a physician visit have changed, based on our experiences with endocrinologists.

We’ve been blessed with three different excellent endocrinologists over the course of my daughter’s almost 9 years with diabetes.  When we visit, we are greeted warmly.  We are taken into a comfortable room and spoken with.  We are asked open ended questions and listened to.  A gentle physical examination is given.  We are given excellent feedback and encouraged to play a part in clinical decision-making.  We are educated about the disease and any new research or technology coming along.  We are not allowed to leave until the physician is sure we are comfortable with any changes in treatment.  We leave empowered and reassured.

When the endocrinologist downloads the numbers from my daughter’s pump, he doesn’t immediately start reprogramming basal rates or carb ratios.  First he says, “Look here….she seems to be coming in low at dinner time most nights.”  Then I say either, “You’re right, I can’t think of why that would be,” or “Yes…she had softball practice every day this week.  Next week it’s only Tuesday so I’m not sure that will be a pattern.”  Then he suggests treatment changes. We discussed over 2 visits the pros and cons of switching our fast acting insulin brand.  When lab results come in, they’re facing me on the desk with the doctor leaning over and explaining the numbers.

Therefore, I find myself expecting a conversation at my own and my daughter’s other medical appointments.  Too often, even with excellent physicians, a brief interview and exam will lead a doctor to a diagnosis and to begin to start talking about treatment.  “Wait,” I’ll say, “She didn’t mention that she’s also having occasional muscle aches too.”  Or, “Your diagnosis sounds very likely, but I’m wondering if you’d consider x as well because,” and I’ll state my reasons. 

I don’t always do this, of course.  When the strep test comes back positive, we take the prescription, do not pass “go” and head for CVS.  If there’s a cavity, we have it filled. But when I do start to discuss, doctors are often surprised.  I know they’re pressed for time.  I’ve just sat in the jammed waiting room, and can see the harried looks in their eyes.  I also know they’re not used to conversations about the diagnosis they’ve come up with.  It’s easier if I nod my head politely and assume they’ve solved my problem.  

I’ve learned however, that in the long run, a working relationship with a physician is much more useful than the more traditional model.  Not only is the doctor more likely to get all of the information about symptoms and concerns to make a more informed diagnosis, but I leave more comfortable with the prescribed treatment and therefore more inclined to follow through with it. 

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