Friday, July 18, 2008

What To Do, O Blogosphere?

I'm waiting for my A1C results today, after a whirlwind of six-month-follow-up appointments yesterday. (I also gave blood for a research study for the first time, which was exciting.) Though I'm pretty confident my level will be around the same as it was in January, I come to you conflicted, O Blogosphere, for I have lost confidence in someone very important: my primary care physician. What to do? Here's a little context:

The Good:
  • She's been my PCP since 1995
  • She was the one to urge me to switch to Lantus back in 2000
  • She's helped me get my A1Cs down from the high 7s to the mid- to high 5s
  • She's been very agressive about treating any cholesterol and cardiac-related issues, infections, cuts, low thyroid function, etc.
  • She's on staff at a major teaching hospital, which has long specialized in diabetes care

The Not-So-Good:

  • At my last three appointments (in the last 9 months or so) the office seemed more frantic and less organized than usual (forgetting my appointment, losing my chart, etc.)
  • At my last appointment (yesterday), she actually told me to "back off" my intensive management and cited the ACCORD study as evidence that "a lower A1C increases your risk of a heart attack." (and yes, D-world, I was shocked...I remember reading this thread among others, along with the ACCORD and ADVANCE studies, and coming to the conclusion that as a type 1, neither applied to me. I thought the American Association of Clinical Endocrinologists' guidelines were pretty clear on this too...)
  • She hasn't reviewed any of my medications in a year
  • I was the one to remind her of what tests needed to be done--yesterday I wouldn't have had a urinalysis or a foot inspection if I hadn't prompted her
  • There's something missing I can't put my finger on...lack of attention, maybe? Also at my last three appointments, she has seemed noticeably more distracted and less familiar with me & my history.

I'm befuddled, dear OC friends. As alarming as it is to hear a doctor tell me to let my A1Cs go up, contrary to all the evidence, she also wants me to see her in a month to follow up on some wonky blood pressure numbers. (Yes, I may need another pill...ugh.) So I can't fault her for lack of care there.

My husband recommends I think about it, then write her a letter or mention my concerns to her at that follow-up appoinment. In unrelated matters it is far more difficult for me to physically get to her office nowadays. I might be better off with a doctor in my own neck of the woods, or closer to my excellent eye and girl doctors. What do you think, dear OC? Should I bring it up, or just cut her a break and let it go?


Lili said...

I dunno, I would be inclined to find a new doctor, since it sounds like it's been going on for awhile.

~Suzanne~ said...

Hmmm...This is a tough one, I must admit. I would certainly not just "let it go", but I wouldn't necessarily run off to the nearest PCP around town, either. She KNOWS you, which says a lot, and has given you over 10 years of good care...but that should be expected at every appointment. Maybe at your next appointment you could sit down with her and just ask whether everything is ok in the office, that you have noticed some things over the past year. Once she realizes that long term patients are noticing a change, she may make an effort to do something about it. It is possible she has gotten caught up in the hooplah of life or new staff has come in that aren't quite on the ball (those darn gen X and Yers!!*) and just hasn't realized her patients are being affected by whatever is going on.

But then there is the distance, too... Tough tough question!!

*Oh yea...I AM a Gen X/Yer!!

Scott K. Johnson said...

I hate when I lose confidence in a caregiver. It's just a yucky situation.

Minnesota Nice said...

Oh, this is disturbing. Yes I have read bits and pieces of the ACCORD study and don't know what to think - I keep telling myself that I'm not a trained scientist so it's ok if I don't interpret the results. much that we still don't know.
I have to remind my PCP of everything too, but now the clinic system has a "purple sheet" for their db patients where you document what was done on what date. I just started a statin because my "bad" cholesterol was creeping up and I have a massive faily history of heart disease.
And, when I scheduled my next appt they asked if I wanted to come at 10, 10:10 or 10:20 - I said I thought the appts were 20 minutes long and she said they are, but that's just the way they're scheduled..........duh?

Minnesota Nice said...

Oops - sorry I was blabbing on and didn't answer your question.
Yes, definitely bring it up. Maybe plan out before hand the points you want to make - put it on paper - brief and concise but getting the message across.
10 years is a long time to have a doctor/patient relationship. Maybe she should have one more chance, but not much more than that.