How Providers Fail at Providing Care

I understand that medical provider transition is rough. I totally get it. In the past 18 months I've had two endocrinologists and three therapists. 

I don't expect anyone to totally grasp me and get all of the nuances up front. I don't. Really.

But I expect a baseline understanding of me as an individual patient. And a baseline understanding of what my baggage is, and why boilerplate and treating me like I've never handled diabetes is really not going to work.

I have been with this clinic for almost 10 years now. They have had an electronic health record system for all of this time. 

There is no excuse why a new provider, upon meeting me for the first time, can't take a few minutes to scroll the highlights. Because thanks to the last endo and her level of meticulousness, the highlights are pretty clear without having to scroll back all 10 years. Eating disorder. History of hypoglycemia. Type 1 for 35 years. Previous CGMS user. Refuses to go back on CGMS that requires an abdominal site. And a record of reinforcing that no, we need to find a non-caloric way to handle this hypoglycemia. 

Yet, there I was that morning, listening to the nurse practitioner -- since the clinic was taking a "any warm body" approach to my request of "Um, we have a problem and I have a race coming up" -- treat me like I was a stupid patient who knew nothing about diabetes or my body. For almost an hour. (My favorite line during this time may have been when she looked at my logs, noticed periods with no boluses, and then said "So, do you not eat during this time?")

I appreciate that she took time, but she would have been better used actually reading the history and coming up with a solution that, you know, we hadn't already tried. 

But what did she do instead? 

• Pushed snacks.
• Pushed the CGMS. (And suggested that if I still had any supplies left from my time on it, to go back on it for now.)
• Pushed the clinic's two-week blinded CGMS (WHY? We did this first. I got scolded because I didn't know how to calibrate it. And it provided nothing useful, besides, "Oh, hai, your latte makes you spike. Try this.")
• Pushed checking my blood sugar more often. (Keep in mind that they only *just* got the health insurance to approve eight strips a day. How else is this supposed to work?)
• Reminded me that I need to eat. 
• Told me to fuel while I run. 

And most lasting? 

Told me there was no pattern. I knew there was no pattern. I reached out for help trying to figure out how to mitigate the fact that there was no pattern. And how to mitigate the fact that I'm spiking after workouts, and then getting smacked in the head with a hypo six to 12 hours later ... even on the days when I don't workout. But not all the time.

I get that these are all solutions that would carry merit ... if you were talking to a patient who isn't me. 

But when you're talking to a patient who has a history of saying that no, we need to find basal patterns that work with my life, and I'm not feeding the damn insulin... and a patient who says "I won't go on CGMS because it was horrible for my body image, and I can't wear two sites in my torso because it makes me feel fatter than I am."... Then why do you use these tactics again?

Because what was my takeaway from that appointment? 

That in medicine, here, I am a number. I am not an individual patient. I am simply another type 1 diabetic who needs to be talked down to. That my perspective doesn't matter. 

And it makes me want to not go back.