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Re: [IPk] Dissapointing meeting with Sasha,s consultant

In message <email @ redacted>,
Jackie Jacombs <email @ redacted> writes
>If anyone know of any centres that have a few children pumping will they let
>me know.  I has to be children and not adults.

Why do you particularly want to be at a centre with children pumping?
Yes, it may be harder for children to go through the first few weeks, as
they may not understand the need for 10+ bg measurements a day, the need
to be very careful, and perhaps even stop, all irregular exercise, etc.
etc.  And setting up their basals and ratios may not be as easy, but ...
it's not that different to adults pumping (compared to the difference
between mdi and pumping, say).

Did anyone else hear Casenotes on R4 on Tuesday night?  It was oncology,
not diabetology, but one doctor was asked about 'knowledgeable'
patients.  She said there were two kinds: those who did not appreciate
that their cancer would not respond to the treatment they were
advocating, and these were the easy kind.  You just explained that to
them.  The hard kind were those who were right: but you couldn't give
them what they asked for because you didn't have the budget.  The
interviewer pressed her, and she said, 'I do believe it is unethical to
tell an informed patient the reason I am not prescribing a treatment is
for his own good - or any other reason - if the reason is purely that I
don't have the money'.

I can see why doctors shut their ears to all evidence that pumps are
good things: if the only reason they are not prescribing them is money,
then it's unethical to tell the patient that it's because they're
dangerous, not needed, etc.  And what doctor in his or her right mind is
going to say 'I'm with you 100% Mrs Jacobs, a pump is what Sasha needs,
but the NHS is too poor to give her one'?  That is _not_ the way to win
friends and influence people among ones colleagues, who are far more
important than one's patients.  No, it's far easier to dodge the
ethically difficult by keeping one's head down.

It is, in any case, I believe, your GP, and not your diabetologist, who
makes the referral for a second opinion (and, indeed, your diabetologist
has no say whatsoever in whether or not you can ask for one).  I suggest
you make a long trip to see an expert on children-with-pumps (Charlies',
in London, perhaps?), and then if they're positive, go to your nearest
centre of pumping excellence - after all, _someone's_ child has to be
the first.

Best wishes,

(dm 30+, 508 1+)

Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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