Prior to my diagnosis with type 1 diabetes, I never really thought twice about who my doctor was or what qualities he or she possessed. To be honest, I was a healthy twenty-something that only went to see a doctor when I had a pesky seasonal illness that wouldn’t give up, and I needed antibiotics to get rid of it. When faced with choosing a primary care physician, I based this crucial decision on important things like gender and the quality of their picture listed in the hospital directory! It didn’t matter what medical school the candidate attended as long as they were female and had a seemingly warm smile. Age was also a sub factor; I felt if they were younger, they might be easier to communicate with and relate to. However, on the other hand, I didn’t want someone too young and lacking experience. So, needless to say, my primary care physician ended up being a thirty-something female with a great hospital picture that dressed cute (which was a total plus because I love fashion!).
Now that I am living with a chronic condition that requires at least quarterly visits to my endocrinologist’s office and frequent communication with my healthcare team, I have realized how important the doctor-patient relationship truly is. When initially diagnosed, I was sent to the diabetes clinic at my hospital, only to be told that there was a 3-month wait to see an endocrinologist! Since I did not have 3 months to wait to get started on a diabetes management plan, I was given the option of being seen by an endocrinology fellow. In case you are not familiar with hospital titles and hierarchy, a fellow is an MD that has already completed their medical degree, internship, residency, and has chosen a specialty and is working towards completing the training for that role. They are supervised by attending physicians in that specialty. My appointments would consist of about 10 minutes of interaction with the fellow and then he would consult with the attending endocrinologist and the two of them would come back and close out my appointment together, reviewing any changes or follow up steps. From initial T1D diagnosis, I had a couple of appointments with the fellow, but I found it extremely difficult to communicate with him. My visits were very cold and I usually left more confused than when I walked in! I’m sure this fellow I was seeing was very intelligent and great at his job, but in my opinion and through my experience with him, he was really lacking in communication and bedside manner. In fact, I remember when he was discussing my weight; he told me I was only “a little obese.” While I understood he was trying to communicate to me that I wasn’t extremely overweight, I think his delivery could have used some work!
After seeing what a great relationship my mother has with her diabetes healthcare provider and how it positively contributes to her overall diabetes management, I knew I wanted the same for myself. I finally became confused and frustrated enough, just trying to deal the acceptance and life altering affects of the diagnosis, that I picked up the phone and called the clinic and told the receptionist that I did not want to speak to anyone except for the attending endocrinologist that had overseen all of my appointments. I made it clear to her that I did not want to speak with a nurse, the fellow, my diabetes educator, or anyone else except THAT doctor. The receptionist seemed surprised by my forthright tone, but assured me that she would relay my message to the doctor. Within a short couple of hours, the endocrinologist called me back and worked through my questions and the confusion I was having about my disease. While I was on the phone with him, I asked if I could switch over to being directly under his care rather than the fellow’s. He was hesitant and told me his schedule books up very quickly and I would likely not be able to get an appointment for months. However, he agreed to take me on as a patient and much to my surprise and luck, I was able to get an appointment quickly, due to a cancellation from another patient.
I cannot say enough great things about my endocrinologist. I have such great rapport and communication with him and it truly helps to have someone that you can trust on your side. He will spend any amount of time necessary in order to make sure I am comfortable with my care plan, whether it is in the clinic or on the phone. I have spent countless hours over the phone with him when I need to make adjustments to my insulin regime. He always treats me like I am his only patient and as though I really do matter. My interactions with my endo have been so great and contributed so much to the overall management of my diabetes, that I felt compelled to write a letter recognizing him for his good works. He wasn’t just doing his job, he was going the extra mile every time and investing his time and talents into helping me live a better life with diabetes. I felt like he needed to be credited for doing things the right way, especially since he is a younger physician, still on the newer side of his career. Often times you only hear about the negative and more should be said about the positive. I sent the letter to the CEO of the prestigious hospital I go to, as well as a few high level physicians/executives within the department. I received responses from them thanking me for my letter, but I also got a personal call from my doctor, profusely thanking me for writing the letter. I could not believe the humility behind his reaction, which made recognizing him even more gratifying. I cannot stress enough how much having a great endocrinologist has helped me in managing this disease. I am better at caring for myself because I have a doctor that truly cares about me as a patient (and all of his patients!). If you don’t have a physician you are comfortable with, then speak up! No one will advocate for you like you can for yourself. My endo told me at my very first appointment that it takes a whole team to manage diabetes. You want to ensure that you have put the right team in place for your diabetes healthcare. I have made multiple threats to my endocrinologist if he ever tries to leave his current hospital and doesn’t notify me so I can transition with him! I’m pretty sure he knows very well at this point that I would hunt him down and show up to his new office! He is that good!
In case you are interested in reading the letter I wrote in recognition of my endocrinologist, I have added it below. I have changed his real name for privacy reasons.
Cedars-Sinai Medical Center
8700 Beverly Blvd
Los Angeles, CA 90048
To Whom It May Concern:
I want to take the time to recognize one of the outstanding physicians in the Department of Endocrinology at Cedars-Sinai. In to day’s world of rocky healthcare politics, physicians are often the forgotten piece of the puzzle; the last to be considered. Yet, they are the ones that continue to confidently grace the halls of our hospitals and clinics, day in and day out, committed to the very people that often times dismiss their recommendations, undermine their authority, and challenge their decisions.
In 2016, I came down with a sudden onset of symptoms that landed me in urgent care on the 4th of July and a diagnosis of type 2 diabetes. Weeks later, after further investigation and recommendation from my type 1 diabetic mother, I requested a GAD antibody test from my PCP. After receiving a positive test result, I was sent off to the DOTEC at Cedars-Sinai to be seen by an endocrinologist. Our suspicions were confirmed and I was formally diagnosed with type 1 diabetes mellitus, at the age of 29. This made for a whirlwind few months as I tried to wrap my brain around the idea that I was indefinitely going to live with the very disease I had watched my mother battle and manage my entire life. I soon became overwhelmed and did the only thing I could to reconcile the fear and uncertainty that filled my brain; I denied the diagnosis. I questioned everything from lab errors to the judgment of the very physician that had spent years learning about the human body, in order to understand diseases like the one I was facing. On the outside, I was telling people I had type 1 diabetes, but on the inside, I denied it with every inch of my being and thought in my psyche. It all came to a head when I decided to stop taking my insulin for a week because I had convinced myself I didn’t need it and was burnt out on the overwhelming components that make up a newly diagnosed diabetic’s lifestyle. After coming to my senses and reading too many articles on Google, I realized the error of my way. However, I didn’t know how to get back on track or how to start over, so, the next morning, I nervously called my CDE and explained what had been going on. She said she would let my doctor know and follow up. Not even an hour after calling my CDE, Dr. Smith called me. I remember being so nervous that he was going to be upset with me, or worse, that he was going to decide that he didn’t want to care for someone that didn’t heed his advice. Dr. Smith so empathetically and non-judgmentally talked me off the proverbial ledge I had pushed myself to and started me on a new diabetes management plan. I have had great interactions with him and have begun developing the essential doctor patient relationship that is so important to proper treatment and care.
When looking for qualities in a physician, especially for treatment of a chronic condition, education and academic awards are not what are most important. As an average person, I have to assume that all doctors are intelligent; all have graduated from medical school, passed grueling medical board exams, and survived exhausting years of residency and fellowship programs. The qualities that set them apart are their abilities to interact with and positively impress upon their patients. Dr. Smith has gone above and beyond any expectation I had when considering my diabetes care. He always responds to my queries promptly and will spend any amount of time necessary to ensure that I am comfortable and confident in my care plan. Most importantly, he treats me like I am a human and as though I actually matter. As a patient, it can often times feel like we are just a number or a lab subject in a science project. When I am in the clinic or on the phone with Dr. Smith, it is as though I am the only patient that exists under his care. He has set my fears and anxieties over this disease to rest many times. Type 1 diabetes is a disease that requires so much on the part of the patient. Outside of consulting with my physician and CDE, I am expected to manage this unpredictable disease on my own, day in and day out, without years of medical school or formal training. Patient empowerment is so important to the proper care of type 1 diabetes. Having a physician that is too busy to follow up or cannot provide the time and concern that it takes to assist patients that want and need proper treatment could be detrimental to a patient’s outlook on their disease and their willingness to comply with treatment. While I am sure you have many great endocrinologists at Cedars -Sinai, I have to say that I have been so blessed to be under the care of your best one.
I wanted to take the time to recognize Dr. Smith for his selfless contribution to the medical field and specifically to the care of my disease. He has positively impacted my life, and although I have many years ahead in dealing with this disease, I am encouraged by people like him that make dealing with this disease a little less isolating. A quote from William Osler says: “the good physician treats the disease; the great physician treats the patient that has the disease.” Dr. Smith defines that concept and has mastered early on in his career what some physicians spend their entire lives missing.