July 2, 2011

Doctor Patient Relationships

Most of the good articles on diabetes put the burden of diabetes management and management improvements on the patient. Doctors do not seem to be in agreement and want to be in control. I hate to say this doctors, but until you live with me 24/7/365, stay in your office so that I can find you. Since you are incapable, doctor, of living with me, the management of diabetes and possibly some related complications falls to me.

I will still seek your advice and consult with you about how I manage my care, but that is where the relationship ends. If you do your best to educate me, I will probably do a much better job of managing diabetes. If you try to direct my management or micro-manage me, kiss me goodbye. It is education I need, not educated guesses from someone miles away from me. Try to use fear with me and you will not get the time of day from me.

To the rest of you that are patients, learn that if you let the doctor manage your diabetes by long distance, you have no one to blame but yourself for poor management. When you forget one important piece of information and the doctor changes your medication for a stronger one when you do not need it, it is your fault. Come on patients, the doctor is there to aid and assist you, but he does not live with you. He can ask questions, but he does not always ask the right questions – unfortunately it is called internal bias, and some will call it punctum cecum (a blind spot).

Patients, others have said this and it is worth repeating. As a patient with diabetes, you need to become your own science experiment and learn what works for you. Learn to document what happens so that you can discuss this with the doctor. Even if you decide to try some of the holistic remedies, keep a record so that when you stop having success with them, you will know it and can discuss this with the doctor. This may not make the doctor happy, but generally, if you are honest with the doctor, you will be better off for it.

Learn to be concise with your record keeping and be prepared to leave a copy with the doctor. Yes, this goes against the grain of patient privacy, but the doctor may see something in your notes that could be a clue for giving you better tips in managing diabetes. Remember, you are the science experiment and the more eyes analyzing the data, the easier it can become to manage diabetes. Granted, your doctor must work with you in this and not against you. If you have a doctor that works against you, hopefully you have the ability to be able to find a doctor that will work with you and are not locked into one doctor because of distance.

Learn to manage your diabetes and you will have a successful science experiment and probably slow the progression of diabetes to a crawl and possibly avoid some complications for many years and maybe some complications altogether. There are no guarantees, but if you chose to ignore managing diabetes, you will develop complications. You will have them and probably more of them and sooner. Once you have them, your management of diabetes will become more difficult, creating problems that you may not be able to manage.

A concept that needs more attention is the concept put out by Dr. William H. Polonsky of the Behavioral Diabetes Institute of San Diego, CA. Read the blog of David Mendosa on his presentation here. Also read this blog by Gretchen Becker on the same presentation. This concept is “diabetes causes nothing”, that is right – NOTHING! It is the lack of diabetes management that leads to complications.

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