Sunday, February 27, 2011

Secrets I Wish My Patients Knew

  • Our coding/billing is dependent on complexity and risk. So, we get paid more by your insurance for higher risk situations. But having said that, I would rather have your diabetes be well-controlled and make less, than have patients with uncontrolled hyperglycemia.
  • Yes, it's probably your fault (not for all patients obviously, but 90% of the ones referred to me) that your diabetes is badly controlled. You don't check your sugars, and miss your insulins. But would it surprise you to know that as your physician, it makes me feel like a failure? I really do want to help, but I can only do so much without your support.
  • I really do wish my patients and my staff would call me by my name, not Dr. So-and-so. That's an academic title and says nothing about one's capabilities as a person. I may have had more education than some of you, but many of you know more about life than I do and so the respect you give me is often overstated and undeserved.
  • I take no pleasure putting you on medications. I do so only because the research has shown that it improves your health down the road, whether it means you'll live longer, or decrease your chances of kidney failure. And no, I don't get any perks from the drug companies (see my earlier post about my sentiments for Big Pharma).
  • I might be a doctor, but I am a person. I am a son, brother, husband and father.
  • I really do want to help my patients. But when you come to me for your 3-monthly visits and bring no glucose logs nor even check yourself, and yet your A1c remains above 10%, I'm at a loss. In fact, I'd rather you not come, but reschedule to a week when you CAN bring in some numbers for us to review together. Without numbers, we're adjusting blindly and that can be dangerous.
  • I might be an endocrinologist, but I don't have all the answers. I can't tell you why you're tired, or are losing hair (tell me when you figure this one out!), or have mood swings, or can't sleep.
  • I'm old school. I like the cheaper generics whenever possible. Don't ask for the newest drugs just because they're new. They're also more expensive, and lacks the longer track record than the older guys.
  • I know I'm sometimes late; I'm sorry. It's often because of the guy before you. Having said that I do wish you were on time. We have patients come 15 mins early so that my nurse can reconciliate your medication list, and get the vitals and bloodwork started. But when you come in 15 mins late for your appointment, you're really 30 mins late, and the rest of today's patients end up waiting for your delays.
  • I don't always go by the rules. Yes, the guidelines recommend that your LDL be below 100, or that your A1c below 7%. But for some of you it probably doesn't matter anymore. So, I'm probably not going to be aggressive and start my 92-year old patient whose A1c is 7.3% on insulin, because, damn, if you're 92 years old, you've done well on your own thus far, and don't need a doctor trying to fix what don't need fixin'. Likewise, I'm probably not going to start you on some expensive 2nd-line cholesterol medication just to lower your LDL another 10 mg/dL.
  • We're human too. We make mistakes, hopefully not big ones. But when I do, I feel horrible about it. But yes, I believe in honesty and I WILL tell you if I messed up.
  • If I treated you for gestational diabetes, I REALLY do like it if you bring your baby for your postpartum follow ups!


Blogger Saiful said...

Just brilliant self assessment. This would just cheer me up for my Endo & Diabetic clinics, especially the latter. I call it their MOT day.

2:59 PM  
Anonymous Anonymous said...

Few weeks ago my patient who had Idio Pul HT on bonsentan, PAP of 100 and on 8L home O2 came in with worsening SOB. Ruled out PE and infection. Sidenafil started after the family shouted at me for not doing anything, despite the respi boses doubted the effect from the beginning. Patient died. I received a complaint letter (which relatives sent to the Med Board) stating'Dr X deliberatly witheld treatment and has serious GOD syndrome.'
God please forgive me for playing GOD

1:32 PM  
Blogger vagus said...

I sympathize- often when emotions are high family gets all heated up as it much have been a trying time for them. Having said that, you did your best. DOn't let these get to you.

8:26 PM  
Anonymous pavlova said...

just gotta let it go you can't please everybody and have perfect situations all the time.
we just have to be content that we did our best with every patient, everyday.

4:24 AM  
Anonymous Anonymous said...

thanks for being supportive. Sometimes I wonder I could carry on med career- putting my whole heart into people yet have to go through such things. But those little cute elderly ladies keeps me going, including the nasty ones~ when you see the old demented lady went slapping on the other demented lady's face who's opposite to her bed. Sorry, but I just couldn't stop laughing......

9:13 AM  
Anonymous Kit said...

Hi there - I stumbled upon your blog reading up on endocrinology and diabetes etc.

Thanks for sharing this. I am afraid that I'm one of those patients who would tell the doctor that I have problems sleeping etc. Thought that would help him in his diagnosis...

Anyway, you're a great doctor and I hope that you're teaching future healers too on how to "first do no harm".

Cheers from sunny Malaysia!

12:34 AM  
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8:24 PM  

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