Doctor Spock and the
Case of ‘Mild Diabetes’
About a month ago, I started visiting a new medical
facility; a sliding scale facility different than the usual ‘free clinic’ I
used to attend. The ‘free clinic’ had a lot of bad aspects to it, such as a
long wait for medical care. But it also had one wonderful thing going for it:
its volunteers – people who really believed in helping patients and making
health care accessible to all. These volunteers were excellent at people
skills, reached out to others, and helped many of us be our own care providers
– especially those of us struggling with diabetes. I had built a trusted
relationship with them where I didn’t have to constantly argue my points, or
push my arguments.
Sadly, the free clinic is no longer operating. The sliding
scale clinic is the new gig in town, and I no longer have many options in
clinicians. I am now at the mercy of a doctor who I will call Doctor Spock.
Doctor Spock is not an M.D.; she’s a P.A. Almost as a kind of uncertainty about
her role as a professional, she doesn’t seem to care for the patient as an
‘expert’ in their own self care. She wants to have full and unquestionable
authority. Of course, I am well aware of people who educate themselves loosely
with the internet, and don’t allow medical professionals to be medical
professionals – but let’s face it: we, type 2 diabetics, don’t exactly get the
most information from our medical providers and often that information is flat
out wrong or outdated. On top of that, we’re only presented with the point of
view of the American Diabetes Association – and not of other, also well
respected, diabetes advisory organizations. We have no choice but to look
elsewhere for our learning, so there has to be an open dialogue with our
providers.
Doctor Spock is relentless. She doesn’t seem to care much
for my decisions: “Why do you test so many times a day – when you could just
test once?” “Why do you want to be on such a high dose of Metformin XR, when
you could be lower?” “There’s no need to be on Metformin XR… you don’t need
that, I won’t give it to you.” Of course, I had the better answers, so I won
those arguments, but I absolutely hated
that she thought I could control my diabetes with just one strip a day. I
simply told her I disagreed with her assessment. “I have to know what my
numbers are in order to better control them.” In disbelief over my numbers, she
seemed to almost roll her eyes. “Wow, people don’t really have 140 as a top
glucose number. That’s a hard thing to do for most people.” Everything was an
argument with Doctor Spock.
I sat in her office, annoyed at her stupid questions. She
sizes me up, and with a sterile disposition, asks me about my weight: “You are
37 years old, and have a BMI of 48. What do you have to say for yourself?” What
do I have to say for myself? How about that I’m a survivor of maternal neglect,
of being given soda constantly as an infant, of dealing with endless trauma
related to conditions like Polycystic Ovarian Syndrome? How about “I have
deeply ingrained food/behavioral issues?” How does one easily explain oneself
to a stranger? A judgmental stranger? How does one explain 30 some years of
struggle – of hurt and psychological disordered eating? How does one say “I
don’t need to explain myself to you. I can tell you my story, but I don’t OWE
you an explanation.” How does one say “I deserve patient dignity?”
On my chart, she marked me as having ‘mild’ diabetes because
140 mg/dL is my glucose goal, and not 180. It might seem like a silly thing,
but later when I got home and read it I could feel the outrage flowing through
me. ‘Mild diabetes.’ Sure, it’s better than ‘non-compliant…’ but obviously she
doesn’t know the A1C I had at diagnosis – or can’t fathom it. Obviously she
doesn’t understand that these numbers aren’t ‘a given.’ I work for these numbers. They don’t magically happen – the diabetes
gods don’t bestow them upon me. I work
very aggressively at these numbers because I don’t have ‘mild diabetes.’
*Sigh* I must remember to breathe in, and breath out. I must
remember that at the end of the day, this woman supposedly wants to help me.
It’s going to take some time and work to get adjusted to Doctor Spock. Like
many a doctor I’ve encountered, she doesn’t seem to be much in the know about
modern type 2 diabetes management. It bothers me how hard some medical
professionals make management for us. One strip a day? Seriously? Why not give
me a bicycle with just one wheel. Same thing really.
We should have education as to what testing is for, and
access to ALL the strips we need. No questions asked. Alas, this is the rub of
having type 2 diabetes. A patient with type 2 diabetes is a patient that often
gets little respect, little trust in their own self knowledge, little dialogue,
little to no tools… and a LOT of blame. I gathered my thoughts as best I could,
all emotions aside, and I let her know my view. I ‘explained myself’ to
her. To my surprise, she became a bit
more flexible and open minded. I might be able to train her after all.
