Diabetes Self-Management Blog

Web Editor Diane Fennell reported last week that frequent doctor visits help people get their diabetes under control. But what if doctor visits are stressful and unpleasant (not to mention expensive)? How do you find a doctor who actually helps you?

We keep hearing about doctors who don’t listen, don’t explain things, don’t answer questions, who aren’t up-to-date with diabetes science, who seem too rushed to pay attention. Some readers have criticized providers’ lack of interest in them as people, their giving impractical advice, or their treating them with a “one size fits all” approach.

Another common thread is doctors who aren’t available for follow-up or who can’t be reached when people need advice or help. A few older readers have commented that doctors would rather talk to their children than talk with them directly.

How a doctor communicates makes a big difference. They don’t call it a “doctor-patient relationship” for nothing. Like in any important relationship, you need to understand each other. Like any other close relationship — say with a spouse, a child, or a coworker — both people have to be willing to work at it.

According to dLife author Ilene Raymond Rush, you want a doctor who will share medical information with you, take an interest in your health concerns, talk to you, and respond to your questions.

All docs should do those things, but many do not for various reasons. Because of the economics of modern American medicine, many doctors are seeing four to six patients per hour. They’re rushed. They haven’t had time to digest what the last person told them, and they may be worried about how long the next person will be waiting. It’s difficult to stay in the moment and be there for the person in front of you when you’re under so much pressure.

Being rushed isn’t the whole problem. Physicians are highly educated people who usually come from higher socioeconomic backgrounds than their patients. They may not speak the same language we do, literally in some cases. Few physicians know about self-management or about living with diabetes with family and financial problems competing for attention.

Some doctors have not realized that we may know things about our conditions, things they haven’t heard yet. That’s because we only worry about one particular case — our own — while they have to know about scores of diseases and conditions and hundreds of patients. They may not realize that much important research is being done outside the United States, and so assume that if they haven’t heard of it, it doesn’t exist. Some even dislike the existence of blogs like this one, where people can inform themselves outside of medical control.

Many patients don’t make things any easier by coming to appointments unprepared or by not communicating clearly. A rambling, conversational style might be wonderful over coffee, but if a doctor has four more patients waiting, that style might drive him crazy. Get to the point! We’ve written about appointment preparation here and here.

But all the preparation in the world won’t help if you have a doctor who isn’t willing to listen, share information, or keep himself informed. How do you find a doctor who treats you well and has good knowledge and good skills? Especially if your insurance or lack of insurance limits who you can see or how often?

According to a New York Times article by Roni Caryn Rabin, the most common way is to ask around. Friends or relatives may have ideas. A more knowledgeable resource might be other people with diabetes. They’ll know what you’re looking for.

Rabin says the government compiles information on doctors, but doesn’t always share it with the public. The National Committee for Quality Assurance accreditation program is one possible source. But government databases won’t tell you anything about how a doctor communicates.

You may be able to find doctor evaluations from consumers online. Many physicians are rated on the HealthGrades Web site. Vitals is a free site that rates doctors and seems pretty good to me. Other rating sites are RateMDs and Yelp.com. On any of these sites, all doctors in an area are listed, but only some have been reviewed.

Money is another issue. “If you’re uninsured,” Rabin writes, “lab tests, blood work, X-rays, procedures and medications… are more likely to be covered or charged on a sliding scale at a community health center or hospital clinic.” To find such a provider, the Health Resources and Services Administration can probably help.

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Comments
  1. I found my doctor in a list of participating doctors in our health plan over 20 years ago; my main criteria were that she be a woman and that her office be in my town. I kept her because she is an incredibly good doctor. She is a good listener, discusses options rather than calling all the shots, is knowledgeable about treatments both allopathic and “alternative,” and knows who I am. She helps me manage my diabetes, my fibromyalgia, my osteoarthritis, and other assorted chronic conditions. She hasn’t been accepting new patients for years because her patients know a good thing when they have it - they only leave when they move away from town.
    I have not hesitated to drop a doctor when they do not have these qualities. I have assembled a team of great specialists I can go to when needs be. Most of them are female, which seems to be mainly because of the listening part.
    Whenever I visit a doctor, I prepare a health profile which includes current medications, allergies, medical history (a list, not a saga), and my current concerns and questions. Most respond very well to that and given my fibro-fog, it helps me recall what I need to ask. It keeps the discussion focused and lets the appointment move quickly. Though my primary care physician is very busy, she always makes me feel she has all the time in the world.
    I even get to accompany my husband to his endocrinologist, who is a fantastic doctor (did I mention she’s a woman?).

    Posted by Deb |
  2. I want to say something about doctors of older people who “talk to their children rather than to them directly.”

    Right now, I am on the other side of this problem. I am the daughter of an 89-year-old with moderate dementia. He does not realize how extensive are the losses he has had, which is, of course, the hallmark of true dementia. I take him to all of his medical appointments. I keep a book of written records of each appointment, and also keep a current list of his medications & lab results.

    When doctors ask him questions directly, he often gets the information wrong. He also gets very upset when I correct the wrong information, no matter how gently and tactfully I give it, even when I have a written record that indicates something very different. I greatly appreciate the one doctor who helps the situation by speaking to my father first, and then asking me if I have anything to add. That gives respect to my father, and acknowledges that I may also have valuable information. My father accepts my input much more gracefully when the doctor has asked me to give it.

    Posted by Beth |
  3. My best technique to find a good Doctor is random chance. South Africa’s loss was my gain.

    Posted by calgarydiabetic |
  4. Nurse practioners are taking over and I have two good ones who are better than my doctor. They are very good at listening and better at explaining. I was assigned to them when my doctor didn’t have time to see me and it was a very good. Also have had physicians assistants who have also been good. There are good alternatives with the doctor shortage.

    Posted by Ferne |
  5. WOW do I need a new dr. But with the economy I believe I am stuck….oh well.

    Posted by PAT |
  6. we are looking for a good doctor who can help my friend get his diabities when he needs them

    Posted by sandy |

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