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[IP] The other side of the perfect endo (it's from Bob, so it's long ;-))

Ted wrote in response to Don:

>OK, here's 1 for you. I moved to Syracuse, NY at age 7, 2 years after my 
>diabetes was diagnosed. My Mom went looking for an endocrinologist (or ANY
>doctor) that had a clue as to how to get me into ANYTHING approaching
>Mind you, this WAS before home glucose meters.
>Anyway, she found the best endocrinologist in town was Dr. Arthur Dube. He
>didn't want to take me on as a patient, he preffered Type 2's. Mom kept
>pushing till he finally decided to help. 
>He then spent 3 or 4 years trying EVERY combination of insulins and diet
>to get me in at least general control, with only occasional periods when 
>I was stable for a while. He always treted me with great consideration
>and kept trying. In '62 he decided to give his less controlled Type 1s
>a new pill in addition to insulin, known as DBI (Phenformin). I straightened
>out incredibly, and became his model patient. This is an endo that REALLY
>does more than anybody could expect for his patients, including caring for
>SO, yes, there ARE good endos who do everything possible for us, including
>feelings. They may be rare, but very much prized.

Ted, this really caught my eye. I was a patient of the same endo you found
to be such a good partner. I saw him for several years at the Diabetes
clinic which he headed up.

I found him to be extremely knowledgeable, very competent (as far as I
could tell), and very well thought of in the medical community. Yet, I
could *not* work with him. Our relationship just didn't "gel" properly.
Because something was missing in this relationship, I couldn't seriously
consider anything he told me. The endo was "good", but that was not helping

This bothered the hell out of me, because everyone kept telling me how good
an endo he was. It was easy for me to start down the "self doubt" path. You
might have been down that path, so many of us have ... Goes something like:
"There is obviously something wrong with me, because I'm the only one
feeling this way". That doesn't do good things for your diabetes
management, and you end up in a frustrating cycle.

I'll admit that I was not the "easiest" person to work with (I still feel
this way at times ;-)). I was stubborn enough though, to realize that a
good partnership was an effective way to deal with this disease. What I
really needed was a good partner, someone who could put up with my
limitations and frailties, someone who I could "gel" with.

The next scheduled visit at the clinic, the endo (Ted's) wasn't  available
(breathe long sigh of relief here). The "junior" doc on the team, (his
assistant at the clinic) agreed to see me. Instead of telling, he asked.
Instead of being quick and impatient with my lack of understanding of the
basics (as I perceived the endo had been with me), he listened to my
questions. He made suggestions that I *could* try if I wanted to see some
results, but didn't mandate that I follow them. He was genuinely interested
that I had been diabetic for about 25 years at that time, with no apparent
difficulties, despite very erratic "control". He asked me to tell him what
I thought about his suggestions, he asked what I thought would work (after
all, I am the one living with the disease). It was like a light went on ...

I've seen this doc ever since, at least 18 years now. Ted's endo retired,
and my internist took over as head of the diabetes clinic.

What did I learn? A bunch - the "world's best endo" as rated by others, may
not be the "best endo" for me or someone else. His skill and knowledge,
though very important, didn't matter a bit, if we couldn't work out the
communication stuff. What matters a lot is that a true relationship is
allowed to develop between the patient and the doctor. That relationship
should foster communication, which I think is one of the core requirements
for a successful partnership with your health care team.

I also learned that medicine is changing - it's changing the costs
associated with care, it's changing priorities for the health care system
in general. It's changing my doc and it's changing me.

I don't know how this will ultimately affect me or my doc. I hope the day
doesn't come when we need to go our separate ways, due to these factors,
but I'm not naive enough to think it won't happen. I just pray that I have
the wisdom and strength to recognize that moment. I hope that I have the
presence of mind to visit my doc, chat as we always do, then shake his
hand, thank him for everything he's taught me, and go shopping for someone
else to keep working with.

I won't give up, though, because I feel that would have wasted both our time.

Bob Burnett

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