Wisdom, Teeth and Patient Care

I had a wonderful experience with my (new) dentist this morning. I didn’t even mind the early 8am appointment time. Why? Becausemy dentistis compassionate and friendly. He does an excellent job and is a consummate professional He cleans my teeth instead of his assistant if I request it. . He takes the time to ask about my life, even when he’s running way behind schedule. His empathy and caring are not faked. He does all he can for me. I can hear it in his voice and see it in his eyes. He cares.

Prior toDr. Ed, I had been going to the same dentist for 27 years. Dr. H had bright blue eyes and an endearing smile. I saw his father when I was a little girl, and transitioned to his care as an adolescent. I would’ve kept seeing him despite his brusk manner because he was my dentist (and cute), and I knew him. I trusted him. Until my insurance failed to pay a bill and I owed the office about $300. It went unpaid for a couple months and I finally received notice that my beloved dentist of 27 years didn’t want to see me anymore. I had been dismissed. Let go. Broken up with. After 27 years. My whole family saw him and we spent thousands of dollars in his chair. All was gone over a balance of $300. I was very upset. And I did not go gently into that good night…

Oh no. I fought back. I wrote a heartfelt but stern letter to Dr. H and sent it directly to his home address (found in that antiquated thing called a phone book) so he would read it. He did. And he made his billing lady call and invite me back as a patient. I agreed to come back. He was very nice to me upon my return, for sure. But things were tense between the front desk staff and me, and I just didn’t feel comfortable with the office anymore. While I understand doctors need to get paid, I think there are better ways of going about receiving payment than dismissing a patient of 27 years over a couple hundred bucks. Bottom line: My faith in the office was gone because their actions showed me that they didn’t care about me. They just cared about my money. Well, my dentist got his money, but he lost me as a patient. After the initial “welcome back” appointment, my point had been made and I took my business elsewhere (and, like it or not, health care is a business). I am much happier with Dr. Ed. Had my prior dentist not dismissed me as a patient, I never would’ve known how nice a dentist appointment could be. I am now grateful for Dr. H’s jack-assery because it resulted in better care for me and my teeth!

But there’s more to the story of why I love my dental appointments than just the kind, compassionate Dr. Ed. The truth is I never have a bad check-up. I have “gorgeous teeth” and have never had a cavity (well, I had ½ a cavity filled once, but that’s it). Despite having t1 diabetes for 20 years, I have no periodontal disease nor do I have bleeding gums or any other trouble with my mouth (except it flaps a bit too much sometimes). I always have a great check-up and am showered with wonderful praise. This is praise that I didn’t earn, actually. Today, my dentist said “Wow, your teeth are so gorgeous! You are doing an excellent job of brushing. Your teeth are remarkable. You must keep diabetes under tight control; there’s no sign of any disease here at all. Great job!”

Even when I told him I don’t floss much, he bawked. “Oh, your teeth look great! Keep doing whatever it is you’re doing!”Truth be told, I’m notdoinganything. I brush my teeth twice a day, upon waking and upon going to bed. On particularly tiring days, I sometimes even fall asleep before brushing (gross, I know--but true). I rarely floss. Sometimes I’ll use a toothpick (again, gross, I know—but true) or chew gum. I rinse (when I feel like it). I know I have good teeth and I don’t need to worry too much about their care. Even though I don’tdoanything to deserve praise, it feels good to receive it nonetheless. Who wouldn’t want to go to a doctor where they use words likegorgeous, remarkable, no sign of disease?

My little brother, on the other hand, is extremely diligent with his dental care. He flosses multiple times a day, brushes religiously and does everything “right.” But his teeth have deep grooves and he was given my dad’s teeth but my mom’ mouth, which means braces, cavities and other issues. If anyone “deserves” a good check-up, its my brother, not me. He works hard for his teeth and he is, in many ways, the ideal patient. Except his teeth don’t cooperate, so his dental appointments have oft ended in frustrated and mandated follow-up appointments. His mouth is full of cavities and there’s little he can do about it.

How does all this relate to diabetes? The dental experiences of my brother (cavities, cavities) and me (“gorgeous teeth”) parallel the medical experiences of my grandmother (type 2) and me (type 1). My grandmother does everything “wrong” in relation to her diabetes. She ingests mad amounts of sweets and carbs and only tests her bloodsugar upon waking (if she feels like it). She is completely sedentary and does little to improve her care. Still, her A1C is always lower than mine and she’s quite proud of herself, too. Granted, her pride is completely unwarranted because it has nothing to do with her effort or control. Her lower A1C’s (which are still much higher than the average non-diabetic, but she doesn’t care because her doctor tells her she’s in range) and chorus of “Good job! Come back and see me in 3 months” proves she’s doing well.

I, on the other hand, have no such experience. My appointment with my endocrinologist was last week and, to put it eloquently, it blew. I came in quite early to have my bloodwork done and still ended up having to wait for 45 minutes before being seen by the doctor. She was rushed and completely behind schedule and poked her head in to tell me she was running behind (this was after the 45 minute wait) and once I told her I had an appointment at 3pm I had to get to (our appointment was for 1:10), she looked at me like that was an impossibility but she’ do her best to accommodate me.

Despite having lost 8 pounds and lowered my blood pressure and my A1C by over one point, she acknowledged none of it. She first told me my A1C had gone up to 8.8 or something and the realized she was reading the wrong thing and was way off. No acknowledgment of  dropping from my highest A1C reading in recent history pre-pump (8.8) down into a more reasonable range. Yes, I know 7.1 is still higher than itshouldbe, and frankly, I was surprised it wasn’t lower because that number didn’t synch up with the numbers I’ve seen over the last 4 months, but I digress…

My point is that the doctor (one of the most respected in her field) spent all of five minutes with me, didn’t listen to what I was telling her, made changes in my regime based on the bloodsugars she printed out for the last month which werenotcharacteristic of my normal sugars since I was living on campus, exercising a lot more than usual and eating high fat/higher carb cafeteria meals three times a day, and acknowledged none of my improvements. She’s trained to see what’s wrong and what I’m doingwrong, and made no attempt to mention the good things I’ve done, of which there are plenty. I inquired about having my C-peptide checked since this is a test I’ve never had done and am curious, and she replied, “I don’t do that test with people in your situation. You’ve had diabetes for 20 years and even with patients who are in good control, we rarely find any useful information from that test.” Smirk. End of topic.

Do you see the implication there? Totally dismissed. Labeled as having poor control. I literally wanted to ring her neck. I always feel like I need to be on the defense and I was very frustrated because I had a lot of questions for her that went unanswered. She told me to see her in 4 months. I’m more comfortable with 2-3 months, but that doesn’t matter. She’s harder to get an appointment with than Oprah. Seriously. I got in to see Oprah after trying for a couple weeks. With Dr. O, it’s four months plus. The receptionist told me she’s booked out until January. When I mentioned how Dr. O seemed overbooked she replied, “No. We don’t overbook here.” I replied, “Well, then she’s over-stressed,” to which she replied, “No. She’s just busy. She shouldn’t be stressed. We’re all busy here,” to which I replied “Listen, I just spent five minutes with her and my stress level went sky-high just in the few minutes I had with her. I had a lot of things to ask her, but couldn’t.” She replied, “Well, I’m surprised to hear that. Doctors are supposed to answer all your questions.” Yeah, I thought to myself, but what if I don’t even have a chance to ask them in the first place?

My point is this: Endocrinologist and all doctors need tolisten to their patients, and acknowledge the progress, the good stuff and what could be improved.Beside manner matters. They need to drop their cockiness and realize thatwe are the ones who know best about our own bodies. We live with this disease and ourselves 24/7.I didn’t make the changes she told me to in regards to my basal rates because I don’t feel they are necessary. I know my numbers. She could know them, too. I had a graph and log of my bloodsugars for the last two weeks printed out and ready to discuss with her, but she didn’t so much as wink at them. I tried to advocate for myself but felt so dismissed and upset that I was almost relieved when our meager five minutes together was over.

 

I no longer care about having the “best” doctor in their field. I don’t even care about being at a hospital such asFroedert, which has top notch technology and all the latest gadgetry if it means giving up the essential piece of patientcare: caring. I'm less interested how excellent my doctor is behind the scenes or  how many conferences my doc has presented at or been to, or how much research she's doing in the field. I want a doctor who understands the basics and is aware of progress being made in the field, but puts the majority of her energy and effort into providing excellent patient care while with the patient. What a concept!

I’m looking intoWheaton-FranciscanHealth Care because they seem to truly offer the care piece. I almost cried at one of their commercials which was simply a patient telling her doctors she’s more than what they see her as. Granted, it's a commercial designed  to garner business, but it offered me hope, which I need right now. Time will tell if new doctors will provide the care I'm after, but the amount of time I spent dealing with doctors and insurance affects me  greatly, and I need something better than the current model of health care.

I need hospitals or clinics that allot more than five minutes per patient. I need doctors who care about me and show that care by spending time with me, listen to me, trust me and gladly and thoroughly answer my questions. I need doctors who respect my wisdom and my life experience. It should be a team-effort. Just like in my teaching, I see myself as a facilitator and coach as much as a teacher. I don’t profess to know it all. I want my students to ask questions. I see us as equals, though I retain more power than they in the classroom. This deficit model of knowledge and education is wrong. I’m more Freirean in my philosophy and want my doctors to be, too. I could go on and on with stories of poor experiences with my doctors, most considered “top” in their fields, but what’s the point? I want stories of doctors who care, doctors who listen, doctors who are professional and compassionate. I want to start creating those stories. Don’t you?

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Please, share some good stories of good doctors with me. We all deserve to receive excellent patient care and I need proof and a solid reminder that it's out there!