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:
- 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
- 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?