Being Asked to Speak to Another Group

The weekend after our meeting with the doctor, a group from another town about 20 miles distant, asked Tim and I to speak to them on insulin. Because of the doctor involved, we decided not to accept. We had a suspicion of what may have been behind this and as such, I was thankful I already had another commitment. Tim said he agreed with me and agreed we should not become involved in this since this doctor had the reputation of not wanting his patients on oral medications to test.

Tim sent the regrets explaining that I had a commitment and he would not do this by himself. Tim called me the next day saying something that was a total surprise. This doctor was asking for our help on insulin and testing for all patients with diabetes. He was realizing that he was in the wrong and felt that since our group was having so much success and had in fact converted several of his patients to testing, that he needed to learn about us and to get his patients started in testing. Tim added that he felt we should accept the challenge. I stated that I was committed to my meeting and that he should talk to the local doctor and maybe he could attend with him. I said that maybe Allen should go as well.

The following day, Tim called again to say the local doctor had called this doctor and said that he could come if allowed along with Allen and Tim. Tim said the doctor was happy with this and that yes, he wanted this very much. I said this was great. I then explained my commitment of a late afternoon medical appointment and a speaking engagement in the same town to a diabetes group that had been scheduled a month ago. Tim said this sounds good as three of us were involved in spreading the word. I suggested to Tim that Allen should raise the issue of vitamin and mineral testing on their way there so that if necessary, they could sound out the doctor before the meeting about raising this in the meeting as well. Tim said they would be traveling in the same car and he felt this was worth exploring. I said good, and that we should have a meeting the day following to cover both meetings and learn from each other. Tim agreed and asked about including the doctor and I thought why not and told Tim to explore this.

So the day following our meetings, we met after hours at the doctor's office and had a good discussion. This doctor had forgot there were three groups in our town and the size of the groups. The third group was now at six members and hoping to add more members. The group the local doctor led was now at 10 members and he felt that would be more in the coming months. The group that I had spoken to was 18 members attending and they were hoping to grow. The two doctors leading this group were confident the number would grow. Tim stated that the group they had met with was 9 members and that they were shocked that there were so many groups. The doctor commented that this doctor realized that his diabetes patients were being spread out in different groups and knew he was being called out about not testing. He just did not have the knowledge he should about diabetes. At first, he was angry at what was happening. Then he realized that it was him causing his own problem and he needed to learn.

The doctor from our town said this was good for several reasons. He continued that we were being asked to speak for the next several months and now that this doctor was aware of my blog, he wanted me to speak about that. Allen said he had been asked by several of the people there if I was for real and a few had read some of my blogs, but wanted to know if I meant what I was saying. Allen was happy to say that he was the one I had written about in the testing for B12 and Vitamin D and yes, I was interested in people and helping to educate people about diabetes.

The doctor had discussed vitamin and mineral testing with this doctor before hand and had given Allen permission to bring up the topic. He knew there were tests, but had not taken them seriously, so he would also need to learn more about them. The doctor with us said he will be working with this doctor over the next few months until he can get to some continuing education courses and felt that this was a step in the right direction. We all agreed and Tim said he was surprised that this doctor was actually transferring a few patients to our town that needed insulin. The local doctor confirmed this and said there was too much for him to learn for the patients he had and had asked if this would be possible.

This was why the doctor wanted us back for more talks to his group since we knew insulin and this might help make the transition for these patients easier. I commented that none of us were patients of his.  Our local doctor admitted to having only a couple type 2 patients on insulin, but he would look to us for assistance. I suggested that since the three of us all were at the same diabetes clinic, maybe he could talk to them as well. I pulled out the card I had and photocopied it for him. He looked at it and said thank you, as he was not aware of the clinic being so close. He knew of the one in another larger city south of us, but not this one. He then said that he recognized the doctor's name, but did not realize where he was practicing.

He said he had the permission to refer the patients to our group for education if we were willing. After a short discussion about location, he said he would rather use video and have them learn this mode so they could email us when they had questions and use video if needed at any time. We agreed that would work for us and I explained I was already doing this for several doctors in other states. The doctor wanted to learn more and asked if I would email the contact information so that he could check how this was working. When I said yes, he handed me a card of his with an email address on it. He explained that was the office email address and for this purpose only. Then he added his home email address and said this was the one Tim had. I said I also do some peer-to-peer work for the doctor on the card and he said good. That would give him a good reason to call him and asked other questions.

Then he surprised all three of us and thanked us for our being up front in our recent conversation. He had approached us with other motives and when we had been up front with him, he realized that we were more interested in education than taking patients from doctors. He as very appreciative in being asked to go to the other doctor and felt this was a real help in getting this doctor on the right path. He said this proved to him that we wanted to help more that hurt those doctors that were not as knowledgeable about diabetes. He said that talking about the diversity of topics that Allen and Tim had covered during the meeting even showed that doctor you were more interested in education than pushing patients away from him.

Allen then asked if he knew the doctor he named. He said yes and was there a problem. Allen said this was the doctor he had left because he would not test him for vitamin and mineral shortages. That if it had not been for Tim and I taking him to see their doctor and the tests proving he needed shots and vitamin and mineral supplements, he might not be alive today. The doctor said he would get this corrected if possible, but it may not be easy. He asked us if this is what we do when a doctor does not step up when asked. Allen said yes, and he had not planned to leave this doctor, but when the test were done and he was asked to surrender his license because he was severely deficient in Vitamin B12 and D, he knew that it was severe. He had not liked having his license taken, but after considering the alternative of having to surrender it to the state, and then having so much on record, he said that that made him feel better. He stated that when his levels were normal they had given his license back and that made him feel even better about it. Allen said that our aggressive nature after the doctor refused to do the tests probably saved his life and for that, he was grateful.

The doctor looked at us and said that you normally give the doctor the opportunity to make the mistake first. I said that the doctor they were now working with had a reputation and it was the pharmacist that sent them to another doctor. He said either way, we are not trying to divert patients away without cause, and we all said yes. He then said we could consult any time with him and if we had a doctor that refused to step up, to bring the patient to him and he would see that they were taken care of and what needed to be done. If we were correct in our thinking like we seemed to be, then he would attempt to get the situation corrected. He said even if this meant loosing a friend and colleague which he then told Allen that the doctor was that he had left. He said that yes, he was aware of his position on vitamins and minerals, but for him to let someone on metformin become that deficient was inexcusable and he agreed with our actions.

We concluded and went our way home. Yes, several emails followed, but we wanted to think more about what had transpired.

Finding the Best Doctor-Patient Fit

This is a topic I have been avoiding and I thought I would not do this. However, with the activities of the last few weeks, I decided I should restudy this blog and see what I could determine for myself. Nancy Finn does make some good points. In talking this over with some of our group members, I have made my own discovery. When talking about doctor-patient fit, this is so individual that some ideas can only be generalized.

Because I live in a fairly rural area, many doctors are over 30 miles one-way to see them. And presently, most of mine are at that distance. This is also a determining factor not covered by most writers. I am patiently waiting to discover one that will use telemedicine, but I doubt I will see this in my lifetime. Too many obstacles standing in the way. This will be limited by the state medical board, other local doctors, and the medical insurance providers. I am not the only one that could benefit, as several in our group would consider this. Many people could benefit if the doctors could provide a list of reliable internet sources, especially in the more rural areas of this country.

If you live in a more doctor dense area or a larger city, then what Nancy Finn has to say may be of great assistance. I will list her points (in bold) and give my comments.

#1. What is the doctor’s specialty and does that match your health issues? We are fortunate that the two cities, about 30 miles distant, do have a large variety of specialists. Some are excellent and others are just specialists. We also have an advantage of being about two and one half hours drive from the Mayo Clinic in Rochester, MN. I have not needed to use their services
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#2. What is the doctor’s background i.e., what medical school did he/she attend and where did he/she train after medical school? This is interesting as this is something we look at, but for the most part, we have little choice.

#3. Has this physician passed the required medical boards (that information, as well as information on whether the doctor has ever faced any sort of disciplinary action can be found by contacting your state medical board. Again, this is interesting, but not easy to accomplish, as our state medical board is very secretive and hesitant to disclose information like this. We normally know something is wrong when a doctor just disappears and very little has been said about it. It is easier to discover information in local court proceedings.

#4. Does this doctor accept your medical insurance? (Check with your insurer and they should be able to provide you with a list.) In our state, currently the medical insurance company provides us with a list of doctors that have accepted the terms of the company. Also, most doctors post a list of insurance companies they will not accept. For us this is a good thing. On one occasion, I did ask the insurance company who would be a provider and I was told none, but if I went out of state, there were three available.

#5. Is the doctor conveniently located near your home or work? Does he/she have evening or weekend hours? This is not applicable here and a very few have evening or weekend hours. Most work Monday through Friday with a half day off during the week.

#6. How long has this doctor been practicing this medical specialty? Has he/she published any papers? Is he/she involved with any medical organizations? Again, this is interesting, but seldom practical in this area.

#7. Is the doctor in a solo or group practice? Again, you take what is available.

I dislike saying that in many circumstances that you need to take what is available, but this is often the case and if you do not establish a good doctor-patient relationship, you may be required to travel even farther. Therefore, the patient is generally the one that needs to work the hardest to make the doctor-patient relationship work. I will give the majority of doctors credit because they work at the relationship. A few are known for operating on autopilot and some do use the cookbook style of medicine.

Nancy Finn does list many sources that can help find a good doctor if you are in a doctor dense area and not in a largely rural area. So check out her blog for these sources.

In selecting someone with whom you want to have a long-term relationship, it is permissible to request an introductory phone call. A doctor that refuses to do this might not be the right person for you. Some of the personal questions you need answered before making your choice may include:

#1. Are you choosing a primary care physician or a specialist? The criteria are different, but in our area, you take what is available.

#2. Do gender, language, racial differences matter to you? Seldom do you have a choice. I have some of each gender and really feel better with a woman doctor when available for most things.

#3. Will the doctor communicate with you between office visits and about treatment options and choices? Some will, but with most, it will depend on whether they can send you to an emergency room.

#4. What hospital is the doctor affiliated with and is it a place where you would be comfortable if you had to go there? Many are employed by the hospital in the two larger cities. With many local county hospitals eking out an existence and depending on Medicare handouts, it normally is wise to head for the larger hospitals about 30 miles distant. In many cases where using an ambulance is necessary, they are required to take you to the nearest local hospital if Medicare is involved to make sure you are stable enough to be transported to a larger hospital. In some instances, I have known people that have a spouse or relative drive them to the larger hospital to bypass many of the local hospitals.

Many of the decisions can be yours in a doctor dense area, but in many rural areas, you will not have a large choice unless you are able to travel many miles round trip.

Doctors and Patients Both Need to Listen

Human interactions can create funny happenings and tragic results. It is small wonder with all the different types of personalities we encounter on a daily basis that most interactions are constructive and positive. Doctors and patients also fit in this category, especially when they are in a room with each other. Add to the equation that the patient is ill and the doctor has no idea the cause. This may lead to several possibilities.

If you think every story has two sides, you would be correct. Only sometimes there can be many factors leading to several sides and this is when both sides can become very confused, frustrated, anxious, and angry. This blog should really make you think and appreciate a little from both sides. Back on May 18, 2010 I wrote this blog and I am still surprised how much is applicable today. Then on July 16, 2010, I wrote this blog about my appreciation of what Dr. Rob Lamberts wrote in his blog.

Again I need to show my appreciation for a blog written by Dr. Lamberts on January 29, 2012. Yes, it has taken me awhile to write about this; however, I have had this on the list of to do blogs since he posted it. Plus sometimes things do not fall into place as neatly as we want. I get started and then something interrupts and says write about me first.

Dr. Lamberts lists ten things he uses in the process when he approaches a patient with a problem they want solved. I will let you follow the link in the paragraph above and read the list and his explanation to keep this from becoming a lengthy blog. He follows the first list with seven tips of advice for patients. I sincerely wish more doctors would have the same doctor-patient philosophy.

His list is more constructive and easy for a patient to understand. If more doctors could even come close to following this list, we would not need to be so proactive in our care and at times a pain in our doctor's backside. When a doctor tunes me out or goes on auto-pilot with me, I do have a way of bringing the doctor back to my world. I will not say how I do this as I have to vary the method with other doctors. As it happened with one doctor, he actually stopped and said thank you for bringing him out of auto-pilot. We did discuss this and how easy it was to recognize when he started on auto-pilot. It seems he has some words that when a patient uses them, he tends to go there, but did not realize how recognizable they were to patients.

It is great to see other doctors blogging about listening to patients and that they see the need to let others know how important this is to patients. Please read this blog by Dr, Peter Pronovost. His blog is about patient safety and how doctors and hospital staff can sometimes do the simplest of things right when needed. Then at other times, can cause harm because they ignored a piece of key information because they do not listen.

The third blog is by Dr. Peter Elias about his experience of not listening to a patient and the lesson he learned. I admit I admire him for his forthright admission and how he handled it with grace after being shown the error of his ways.

For doctors to be blogging about listening to patients is encouraging for patients to read. Hopefully, more doctors will heed their advice. I admit I like doctors that talk with me and explain what they would like to see happen. This gives me the opportunity to ask more informed questions and make sure I understand what is expected and what my responsibilities are to make it happen.

I admit I am old enough to be crotchety and bold when a doctor talks at me. I normally go into a bad mood and start badgering the doctor to be more specific and throw questions to wake the doctor up to the fact that I am a person that does not appreciate being talked at or about. Only one time have I had to stop a doctor and tell him that I was leaving to find another doctor because I did not appreciate the fact that he would not discuss things that I was asking questions about and was talking at me instead of with me. He stopped long enough to say the pharmacist could explain the medication. To this I said it would be too late as I had an allergy to an ingredient in the medicine and was trying to tell him that the medication was wrong for me. I flipped the prescription slip on his desk and said he would be directed where to send my medical records.

About three days later, I did receive an apology letter admitting he had not looked at my allergy list when he prescribed the medication. I did respond saying I had saved him a lawsuit by rejecting the prescription because I felt he might remember the lesson more by being told how wrong he had been. Handing things over to his liability insurer would not have taught him anything. In the years since, we greet each other and talk occasionally. He does remember and asks me if I have had any more problems like him since. So far, I have been able to say no problems like him.