Our wonderful reader, Helen Howes, has won the first Ask The Doc free question! Let’s turn the mic over to you, Helen –
“Why are diabetics all diagnosed with stupidity as a side-condition of the disease? My medics (all pretty good) seem to think that in spite of a usefully large IQ, a very good record in managing other chronic conditions, and extremely good motivation, that I will nonetheless be in the fridge at every opportunity scoffing ice-cream…”
Oh dear, Helen, you’re suffering from a nasty, pustular lesion that’s affecting your healthcare – one that’s epidemic, and highly contagious. It occurs during your monthly appointment and can make you crazy enough to lose your cool. That’s right, we’r e talking about that serious problem known as PMS (Patronizing Medic Syndrome).
Diabetics, as Helen well knows, are the ones who actually treat their own condition. Doctors, or medics, are merely coaches on the sidelines – people who can cheer, give tips, rub your shoulders, let you spit in a bucket and then push you back into the ring. They are absolutely NOT the ones fighting the fight. What we have here is a situation where Helen is at the Natalie Coughlin level of performance. She’s made the Olympic team, she’s hoping for some tips so she can move to a higher level and, instead, she’s got a coach tossing an arm across her shoulders and saying, “See, this is a pool. Do not run around the pool. Do you understand that, Natalie? Do you?” It gets old, being Olympic caliber and having to deal with waterwings at every visit. Especially when you know there’s more you could be learning, if only your coach wasn’t such a (unintentionally, perhaps) patronizing bozo.
So how does this lesion fester and develop? Most of healthcare training is aimed at the bottom – the bottom of doctor performance, the bottom of patient motivation, the bottom of the curve of complications. Dragging the bottom up, instead of helping the top half move higher, is the unstated goal of healthcare. In general (as all Internet advice must be) an adequate doctor isn’t taught how to be even better, and an adequate diabetic is left to her own devices (ahem). The constant mantra in the medical world is made up of all the things that can go wrong – and none of the ways to make the good better. So what’s a diabetic Olympian to do?
First, here are some possible reasons for the spread of this nasty contagion – 1) do you already know more than your doctor – and all he/she can do is stutter warnings? 2) do you see a different doctor most visits, so that no one knows how great you are already? 3) is your medical record inappropriately full of faux warnings about your inability to manage your problem? and 4) frankly, are you being too kind to inflated doctor egos?
Second, no matter what the cause (including unchangeable doctor-bozo-ness), here are some possible steps you can take to improve the situation:
1) Start each appointment by reminding your doctor where you left off at the last visit. As in, “I’ve asked the last two visits about how to improve my middle-of-the-night control by adjusting my dose, and you said you would get back to me after consulting Endocrine – did they have an answer?”
2) Politely rebuff. “Hey, that’s the fourth time you’ve said I shouldn’t eat ice cream. Is this a serious problem for your other patients? Because I’m kind of baffled by it.” Probe a bit – “is there something in my labs that’s making you worry?” Once patients do this a couple of times, most doctors will re-adjust their world view. Doctors have been shown, in some studies, under carefully controlled circumstances, and with numerous props and reminders, to be sometimes teachable.
3) Bring data. A four-days-before-the-visit detailed food diary with sugars is priceless for you and your doctor to use when discussing specifics. Sure, it can be a pain to do, but it may save you wasted time talking about theoretical situations – and force your doctor to be more nitty-gritty. Keep in mind, this may reveal the tattered holes of your doctor’s knowledge, in which case, it’s time to…
4) Ask for specialty referrals. Endocrinologists do tend to know more. Sadly, they do not suffer less from PMS (Patronizing Medic Syndrome), but if you can maneuver a twice-a-year check-in with someone with advanced knowledge, you could bring your data and advanced questions, and get some Olympic level tips – even if you have to swallow some bilge-water to do so.
5) Check out other specialist resources. There are two goals in addressing this problem – one, to tone down (and reduce!) the number of PMS comments, and, second, to get great, appropriate advice. If doctors are only coaches, keep in mind that some of the very best coaches are (to use the Natalie metaphor) actual swimmers. Other diabetics, nutritionists, and other non-medic staff can be great sources of insider tips on how to rocket off the starting block and maintain your powerful, steady pace.
Because this is a race you want to win.
Good luck, Helen!