Preferred by me is to be a team with a doctor, both caring for my health.
I am not there to live up to his personal expectations.
To get rid of my ill feelings I wrote a letter.
Not that Iamgoing to send it, unless he wants to know why I don't want to continue with him.
I'll just mail him that I don't want to continue and he can refer me to another doctor or one in training.
If he wants to know more, I will send him the letter.
Dear Dr. ...
I have reflected about the consultation of last Friday and cameto the conclusion that it is not wise to continue this doctor-patient contact.
I am looking for a doctor with whom I feel comfortable and who is also able to appreciate my reaction. I had already indicated in my email that I did not want to step on any toes, but I apparently did so in a very painful way.
I am looking for an equal relationship. I could understand your irritation, but I did not have the impression that there was any interest in my view on the stuation, let alone my feelings.
I am fine with semantic games - as a former editor-in-chief of a magazine I can even enjoy them -, but if it is a disguised power struggle then it defines the relationship.
As a patient I should have the space to take care of myself, even if that means that I exchange the strictly medical view for the somewhat different approach of the diabetes nurse.
As I said, everyone has their own working method and their own expertise. In addition, it was completely unclear to me in advance what the purpose of our contact was and what the medical focus would be on. After all, I had been referred to the hospital by the nephrologist and that referral had still not been honored.
Because I am not someone who simply drops out, I will also share my further thoughts about the consultation.
Content-wise.
It is easy to make assumptions.
Who says that I do not have additional autoimmune diseases?
And where is the hereditary component, which has been discussed several times in the hospital and should be mentioned in my file?
In addition, I wonder why my blood pressure had to be measured if nothing is done about it anyway? (Takes time, extra effort to get there, another waiting time). I still find it surprising that at this hospital you immediately get a blood pressure band that is too big, too small, or suitable, slung around your arm upon entering, still panting from rushing, without anyone checking whether you are in the right position for a good blood pressure measurement (no way!), while at the other hospital you are first calmed down and then, after determining your position, you'll get three measurements in a quiet room.
What additional checks take place during the annual check-up? I can still look at and under my feet very well myself, and, as I said, there are enough expert eyes focused on my feet these months.
The nurse has already checked my injection sites and discussed everything during our conversation.
Blood values are measured every trimester.
I assume also before the next consultation by a doctor or co who is unknown to me now?
Regarding your enthusiasm about the slightly increased eGFR. A logical consequence of a decreased creatinine, which can be expected when someone is forced from very active to immobile. Decrease in muscle mass.
The albumin/creatinine ratio and the increase in urea can then indeed have meaning. That is why I was not exactly impressed.
I wonder what the added value is of continuous remote glucose monitoring. It gives me the feeling that dementia has already crept into my life, that I cannot take sufficient care of my diabetes myself, and that big brother is watching me, all the time and everywhere. Registering and accumulating information that is in fact no longer relevant after an hour may be useful if people cannot manage their own diabetes, but don't we have the sensor to be able to react at the moment and to be able to evaluate our reaction immediately? And wouldn't the trust between doctor and patient be that the doctor trusts that I will come to him (or her), or the nurse if there are problems? Personally, I see the Hba1c more as a confirmation of what I have observed, than a check whether I am doing it right.
When I am a demented old lady, the situation will be different.
I also had a conversation with my first diabetes doctorin this hospital about Empagliflozin, at the time.
Back then, there was also a kind of commercial talk, in which the possible disadvantages of the drug were not mentioned.
Given the fact that this drug has been on the market since 2004, it could also be that I have tried it in the past.
The last argument was that it extends life (for me).
Not only should this raise the question of whether I want to extend my life (and there could be a very interesting answer to that), but it should also provide a clear view on the origin of this comment.
The research that led to comments about extending life was actually about a higher number of survivors while using the drug than after using a placebo. This research was also conducted on 7,000 patients with a very high cardiovascular risk, many of whom had already had a heart attack or stroke. An additional advantage of this type of research is that the monitoring of patients is such that fatal ketoacidosis is prevented. This of course influences the results. And unfortunately often also the subsequent research interpretations.
But why would I choose a drug with my history that is known for the risk of ketoacidosis, if I have good control with insulin without any significant side effects?
It was an interesting consultation. Especially the start of it made clear how you see a doctor-patient relationship.
For me as a teacher of doctor-patient relationships always worth experiencing again.
I would therefore like to thank you very much for all your effort and this educational experience.
I would like to be referred to another doctor. As far as I am concerned, someone in training is no problem at all.
After writing the letter I found a former student on Bluesky.
He conducted research on the diabtes medication mentioned.
With my history and family history, he adviced against taking it.
Wow! I know I have missed a post or two, so am not up to date on what has preceded this. I will have to go back read previous recent posts. You are amazing in your knowledge and ability to communicate with the doctor at this level. I hope you get the results you need that will be most beneficial for you!
ReplyDeleteYou should have been there!!
DeleteI am lucky that what I did in my life comes together. I studied medicine, but didn't do the exams. Couldn't afford two studies,so decided for psychology and thought I's do the medicalexams later. But I got children with special needs, that blocked it. But they delivered me a lot of doctors and I found out who worked for me and didn't. I learned to set my own limits. Lecturing research methods and techniques, gave me insight in medical knowledge. Journalism a way to write about it. I was lucky I got the "genes of explanation."...I can explain even the most complex issues to a small child. So at times like these all this comes together.And I also use it a lot when I help the veterans. Both for themselves, and for their communication to organisations that are able to assist them.
I am not sure though if this doctor is able to cope with what I say.