The Importance of a Good Physician

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.

 

May 18,2017

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.

Best Regards,
Jenna

My Diagnosis Story…

Me on the 4th of July 2016. The morning before I would find out information about my health that would change my life.

I want to take the opportunity to introduce myself and tell the story of how my journey with type 1 diabetes began. My name is Jenna and I live in beautiful Southern California with my two kitties. I am the very proud auntie of a spunky 5-year-old niece and wild almost 3-year-old nephew. I don’t have any children of my own yet, so, I am obsessed with spoiling and loving these two little humans that mean so much to me. I have two sisters; one older, who is the mother of those sweet kids I told you about, and a twin sister, who has Cerebral Palsy and lives with my parents. I’m in love with all things makeup and fashion and I have a slight addiction to iced coffee; only iced though, I hate hot liquids! I also feel it’s necessary to lay some ground work here and note an important component to my story: my mother is a type 1 diabetic and was diagnosed as a teenager. I would say that prior to my diagnosis, I had a good working knowledge of what type 1 diabetes was; at least what it was in my mother’s life. I knew how hypoglycemic symptoms presented in her and understood what needed to be done in order to correct them. However, because she has always managed her disease on her own, I was not completely aware of the intricacies of this disease and the risks and side effects associated with it. To be honest, I never truly understood the seriousness of it because I didn’t have the scientific knowledge behind it. It was something that was always a part of her life and it was our normal. My mother had been diagnosed with the disease long before I came along and she always knew how to take good care of herself.

My journey began in June 2016; I was 29 years old at the time and other than being somewhat overweight, my health was that of a normal twenty something. One morning, I got ready for work as usual, but when I got in my car and began to drive, I noticed that all of the street signs were abnormally blurry. I instantly thought that all of my years of fighting the use of contacts and purposefully forgetting my glasses, had finally caught up to me and my eyesight was beginning to worsen. As the days progressed, my eyesight seemed to continue to decline. Even though I hated wearing my glasses, I finally caved and began wearing them because my eyes had become so blurry that I could hardly see a person clearly, just standing a few feet away. When I finally made it in to see my optometrist, the doctor evaluated my eyes and much to my surprise, he indicated that my vision had not really changed much since the previous year; definitely not enough to warrant such drastic alterations in my vision. This was puzzling, but the doctor began to ask me questions that puzzled me even further. He questioned me regarding my thirst and frequency of urination, to which I replied that I had noticed an increase in both, but chalked it up to the summer heat that was imminently  upon us. My eye doctor immediately told me that I needed to go see my primary care physician. He mentioned type 2 diabetes, as he had some familiarity with it, being diagnosed with it himself a few months prior. This caught me off guard, but I knew I wasn’t a healthy eater and loathed working out, so I figured the idea of this disease couldn’t be too far fetched. I left his office that day nervously obsessing over what could possibly be wrong with me. I knew I needed to lose some weight, but it just didn’t seem like my health and age warranted such a serious condition. Not to mention, to be so suddenly hit with these symptoms did not make sense either. Nonetheless, I made an appointment with my PCP for a few weeks out, as that was the earliest time slot available. I returned to my optometrist a few days later to pick up some trial contact lenses and the doctor seemed overly concerned that I had still not been in to see my primary care physician. He told me I needed to go see a doctor sooner, even if it meant that I had to go see a different one that was available now. He actually told me not to come back to his office until I had seen a medical doctor! I left with contacts in hand and even more concerned about what could be going on with my body. As the days progressed, I began to get this unquenchable thirst. It was so strong like nothing I had experienced before. I remember going into my boss’s office and raiding his case of water bottles and I would just drink them one after another. I was constantly running to the restroom, even waking up in the middle of the night to make multiple trips. I started to become very frustrated with the symptoms I was experiencing.

I finally made it to the long 4th of July weekend and headed to my parents’ house for a few days. My scheduled doctor’s appointment was still a couple of weeks out, but luckily, my mom whipped out her blood glucose meter so we could finally check to see if my blood sugar was out of normal range. Both mornings that we checked that weekend, my fasting blood sugar was over 350 mg/dl. This obviously concerned us even more, but still, the thought of type 2 diabetes was in our minds and we figured it would all be sorted out at my upcoming doctor’s appointment. After all, I wasn’t sick like my mom was so many years ago when she was admitted to the hospital at the time of her diagnosis. I was also older than the typical type 1 diabetic at diagnosis; but in the same right, I was much younger than a typical type 2 diabetic patient. It was all very confusing! On the 4th of July, I had left my parents home and went back to my home to celebrate the holiday with my friends out on a boat. I felt ok in the morning, but by the time the afternoon was upon us, I started feeling progressively worse. I was guzzling any liquid I could find and spent more time running to the tiny restroom on the boat, than I did enjoying time with my friends. I also began to feel extremely fatigued, to the point that I could hardly stand up. I felt like I was going to pass out. I ultimately made the decision to leave the boat and go to urgent care by myself. I arrived to my local urgent care office about 30 minutes before closing and upon giving the nurse at reception my symptoms, she immediately too me back ahead of the others in the waiting room. The doctor evaluated me and requested the usual blood, urine, and glucose labs. He asked me a series of questions and ultimately diagnosed me with type 2 diabetes. He even joked that I was a “very sweet young lady,” after assessing some of my results. I explained that I understood what diabetes was because my mother is a type 1, but he told me that due to my age and weight, I was a clear type 2, which was different. My official blood sugar reading from the labs that evening was 518 mg/dl. In case you are unfamiliar, standard is around 70-100 mg/dl. The doctor mentioned that he wanted to give me an injection of insulin in the office, but didn’t want to risk sending me home without a way of monitoring my blood sugar. Instead, he sent me off with a prescription for Metformin, told me not to eat any carbohydrates and asked that I come back the following day to see him again. I felt miserable for the next 24 hours as I tried not to eat or drink a single carb, scared that something worse would happen! I was so uncertain as to what this diagnosis meant for my future and obsessively Googled everything I could on type 2 diabtetes. I returned the next day without having so much as a single carb, practically starving myself all day. My blood sugar was 168 mg/dl this time and the doctor appeared to be pleased with how the Metformin was working and told me to follow up with my primary care physician.

After a couple of weeks on Metformin and watching my carb intake, I began to rapidly lose weight. I remember waking up one morning and all of my clothes were too big! It was the strangest thing because I had always struggled to lose weight and it was now practically melting off of me with ease. My co-workers noticed and would ask me what I was doing to shed the weight. I honestly didn’t know what to tell them; the truth was that I wasn’t doing anything!

The appointment with my PCP finally came and my doctor spent roughly 45 minutes going over type 2 diabetes and the various things I could do to manage the disease. She even explained that I could essentially get rid of the disease if I lost some weight and began exercising. I was optimistic about my diagnosis and was determined to rid myself of this disease. After all, I had the option to make it “go away,” type 1’s like my mother, did not. I left that appointment and continued to lose weight with minimal effort; in my mind attributing it to the fact that I was now conscious of my carb intake. I had a follow up appointment with my PCP a week later and my mother’s diabetes doctor suggested that I request a GAD antibody test, just to see if I had the antibodies present for type 1 (autoimmune) diabetes. Having never evaluated me herself, my mom’s doctor did not doubt my diagnosis; she just thought it was something I should look into as a precaution. When I met with my PCP again, I asked her about having this test run, but she was not familiar with it. She said it was not necessary because I was a classic type 2 diabetic. However, she finally agreed to run the test, to “make my mom feel better.” (On a side note, I don’t mean to paint a bad image of my primary care physician; I really did like her. This just proves that you must always be persistent and advocate for your own healthcare). The lab was sent off and I received a bit of a shocking email from my PCP a few days later, explaining that I DID indeed have the antibodies and needed to monitor my blood sugar closely, as this was indicative of type 1 diabetes and I could become insulin dependent very soon.
I was glad to have an answer as to what was going on, but I was so scared as to what this actually meant for me, for my healthcare, and for my future. In order to reconcile my fear, I acted like it was not a big deal and I could handle it because my mom was a type 1 diabetic and I grew up around watching her take good care of herself. I was sent off to be seen by an endocrinologist and was formally diagnosed with type 1 diabetes mellitus. I didn’t understand it at the time, but my body had entered what my endocrinologist referred to as the “honeymoon stage,” where my pancreas was giving the appearance of normal insulin production. However, the antibody levels in my body were so high that the lab wouldn’t actually record the number; I was later told I “overachieved” in the antibody category. In a very rapid time frame, I had lost approximately 25-30 lbs, and this was mostly due to the side effects of untreated type 1 diabetes, not the fact that I started monitoring my carbohydrates.

A lot has transpired over the last 11 and a half months since diagnosis, but I am happy to say that I have the BEST endocrinologist and healthcare team (I will have a separate post dedicated to that topic). I am learning to live with a disease I watched my mother deal with my entire life, which I now realize I actually knew very little about. I am aspiring to continue to learn more and more every day. The purpose of this blog is to create an additional avenue of communication amongst the type 1 community and to share and spread awareness about this incurable disease that has been so impactful upon my life.