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1 How to pick a good diabetes doctor and get the most out of the relationship

FINDING YOUR DOCTOR

Diabetes is a lifelong disease, so choosing a good doctor to take care of your diabetes will be a long-term decision. Think about other relationships you have established for your business or in your personal life. More than likely, good communication and trust are largely responsible for the successful relationships you have had. You will be working together with a doctor for years, so choose carefully, and expect to build the relationship over time, not just at the first visit. The following tips should help you in this important search.

GET PROFESSIONAL ADVICE

Ask your favorite current health care provider (family doctor, dentist, ophthalmologist) to recommend someone. If you like this provider’s professional style, chances are, they will recommend someone who uses a similar style.

DO SOME SCOUTING BEFOREHAND

Some physician offices and clinics have marketing packets or office information packets that could be mailed to you. The web is also an excellent resource. Many insurance companies, hospitals, and even municipal websites offer online physician finders. Many doctors and clinics also have their own website with information on credentials, services, and insurance policies.

Making Peace with Diabetes Technology

Many of us could happily live our lives without owning an MP3 player or sending a text message. But when it comes to your diabetes care, it’s time to accept some degree of technology, because it will to play an ever more important role in your health. For instance, some physicians use health data banks and software that allow you to input your blood glucose information and management information online. You can send in your numbers and get an update on your management without setting foot into a doctor’s office! Many health care professionals also communicate through e-mail, which can sometimes be more reliable than a phone call. And let’s not forget the number of diabetes management software programs available on cell phones, personal organizers, and computers. Most of these are very easy to learn and can make organizing data, analyzing your numbers, and spotting trends much, much easier.

So even if you wouldn’t own a digital camera if someone paid you, it might be time to accept that some technology can simplify your diabetes management and improve your health.

CONSIDER COMMUNICATION STYLES

Start your selection process by considering your communication needs and preferences. If you are the type who likes to have frequent contact or ask a lot of questions, you might want to consider a physician who has an on-call resource for after hours or enough trained staff to answer questions when the physician isn’t available. Ask if the health care professional or physician takes direct calls, or if you are routed to others or through a frustrating electronic messaging center (“press 1 for more options, press 2 if you are tired of options, press 3 if you want us to disconnect you for no apparent reason, press 4 if you would like to throw your phone across the room”). If you are very comfortable with technology, seek out a doctor who is using the latest technology in their office (see sidebar).

HOW MUCH TIME DO YOU NEED?

If you prefer one-on-one time with a human being, you may want to ask about the time slots for appointments, or even take a casual visit to see the waiting room. If appointments are scheduled every 10 minutes, the waiting room is overflowing, and the staff looks harried, it may be sign that you may not get a lot of face-to-face time with this particular doctor. Conversely, some offices employ support persons to help with your visit, including a dietitian, laboratory staff, and diabetes educators. With this extra staff, you will probably get more personal contact. You will also get the scheduling flexibility of a multidisciplinary team, rather than being dependent on just one person. Remember that diabetes is a multifaceted problem, and a team can help in your overall health care treatment plan.

GROUP PRACTICES VERSUS SOLO PRACTITIONERS

Larger offices may have several partners, so ask if you will (or can) be assigned to one particular physician, allowing you to develop a relationship if that is important to you. If not, you may be scheduled with the “available” physician when you call, meaning you may be seeing a number of physicians or professionals. Finding someone you “click” with and can talk openly with is very important; you are developing relationships that will undoubtedly grow over the years.

CHECK THEM OUT AT A CHECKUP

The best time to make the first visit is for a simple checkup. This way you can see how the office works and meet the physician without the stress of an illness. At each visit you should generally expect:

Weight check

Blood pressure check

Physical exam

Feet and leg check (skin, circulation, and feeling)

Current medication review (take vials and bottles so they can verify them)

Home management plan review (diet, activity, and medications)

Blood glucose log book or records review (looking for highs, lows, and trends)

Lab work

Time for questions and answers

Discussion on preventative measures

A plan for your care

An appointment time for your next visit

After the visit, consider how it went. If the checkup wasn’t thorough or the conversations didn’t go well, this may not be a good sign for when you have an urgent need or problem in the future.

NEIGHBORLY ADVICE

When choosing a doctor, common sense has you looking to neighbors and friends for a recommendation. This is indeed a good idea, as long as you also keep in mind that a friendly personality does not always mean quality care. When you get a recommendation, follow up by asking your neighbors and friends to describe their diabetes control. They might have a nice, friendly doctor, but if that physician is allowing your neighbor to have a long-term A1C higher than 8% or continuous unsolved glucose swings, well, it should raise some red flags.

PICK THE BEST

Fortunately, there are established standards of care that exist for diabetes management published by the American Diabetes Association (ADA). You may want to get to know these standards by visiting the ADA website (www.diabetes.org), calling the toll-free number (1-800-DIABETES), or asking a certified diabetes educator (CDE). Physicians who have met these established national standards can apply for a unique voluntary status known as “American Diabetes Association Recognized Provider.” This rigorous application signifies that the physician has achieved and maintained national standards of care in diabetes. Something else to note—this is a volunteer process that takes time and effort. The mere fact that the physician felt it important enough to pursue can say a lot. To find a physician who has achieved this recognition, go to http://recognition.ncqa.org.

FINDING PHYSICIANS ONLINE

To find an endocrinologist in your area, try the following websites, which have physician search options.

Web Address	Site Sponsor
www.ncqa.org	National Committee for Quality Assurance
www.diabetes.org	American Diabetes Association
www.dlife.com	dlife Incorporated
www.aace.com	American Association of Clinical Endocrinologists
www.ama-assn.org	American Medical Association
www.healthfinder.gov	U.S. Department of Health and Human Services
www.abms.org	American Board of Medical Specialists

Many insurance providers have online physician finders that also list affiliations and accreditations. These finders offer the benefit of looking specifically for doctors that accept your insurance. Finally, your state medical association should also have information online.

INVESTIGATE THE RECORDS

Find out what your potential provider’s qualifications are and how long they have had them. The local state medical board may be able to provide you with information about physician status and previous outcomes. In the near future, doctors may also have “report cards” available on the Internet that will provide you with information about quality of care. In addition to the physician, do your homework on the other staff members. Some offices use physician assistants or nurse practitioners to help with the growing numbers of patients. These health care professionals also have state licensing boards that can be contacted for researching information.

WHERE WILL THEY SEND YOU?

Consider the hospital or diagnostic centers your potential physician is affiliated with. If you are not impressed with the facilities to which they will refer you, it could add undue stress when a need or emergency arises. Check to see if the center or facility has a CDE on staff (search for individual CDEs at www.aade.net), or has achieved American Diabetes Association Recognition (search for recognized sites at www.diabetes.org). Also ask where you will receive diabetes education classes—a pamphlet on “diet” and a free meter won’t do.

LOCATION, LOCATION, LOCATION

This may seem like an unimportant detail, but the location of your doctor’s office can affect how willing you are to make appointments. You will more than likely require several checkups or “well visits” during the year, so carefully evaluate the location of the physician (including their parking areas!). Make sure you have reliable and accessible transportation to the office. If you have a good relationship with your doctor, it may be worth a longer trip. However, don’t set yourself up for a long drive if you feel it will keep you from making regular appointments. Missing check-up appointments will disrupt your physician’s ability to perform preventative assessments and interventions for your future health.

ONCE YOU’VE DECIDED ON A DOCTOR

BE CONSIDERATE

Remember the doctor-patient relationship is a two-way street. No-show appointments are a pain for physician offices, as they are lost time that could have been made available to another person in need. Be considerate. If you make an appointment, stick with it, or call well in advance to reschedule. When calling, talk with the staff with the understanding that you are not the only patient in the practice, and that some demands may take longer than what you anticipated. Staff remember bad-tempered patients as well as patients remember bad-tempered staff.

MAKE THE MOST OF YOUR VISIT

Bring the following items to your appointment. Doing so can mean a more efficient and thorough visit for you and your health care providers.

Specific list of questions and concerns (don’t leave it up to the doctor to ask all the right questions, or expect him or her to be a mind reader)

Blood glucose meter for downloading

Accurate (and honest) blood glucose diary (hand written or computer-generated)

Easy to remove footwear—to allow a foot inspection (if your doctor doesn’t do this at each visit, make them)

List of current medications, including over-the-counter products and nutritional supplements

An update on recent illnesses or ongoing health problems (be sure to fill out that sometimes-lengthy health questionnaire at your visits and update it when changes occur, even though it is tedious)

Current insurance card(s)

Name and phone number of current pharmacy to refill or renew prescriptions (will save you both a phone call later)

Paper and pen for writing down new information or instructions

A friend or family member who can help provide both support and a second set of ears to hear and remember the information provided during the visit

If you leave the appointment feeling you need more time and assistance understanding diabetes care, ask to be referred to a diabetes education class. Use available resources such as diabetes-related magazines, books, cookbooks, websites, and local support groups. Call your local ADA office to find out about these and other hometown and national resources.

MORE RESOURCES TO EXPLORE

MAGAZINES, JOURNALS, AND OTHER PERIODICALS

Position statement: Standards of medical care in diabetes. American Diabetes Association. Diabetes Care 30:S4-41, 2007

BOOKS

Diabetes Type 2 and What to Do, 2nd edition, by Virginia Valentine, June Biermann, and Barbara Toohey. Lowell House; Los Angeles, CA. 1998.

YOU—The Smart Patient: An Insider’s Handbook for Getting the Best Treatment, by Michael F. Rozen and Mehmet C. Oz, with The Joint Commission. Free Press; New York, NY. 2006.

WEBSITES

American Diabetes Association……WWW.DIABETES.ORG

National Committee for Quality Assurance……WWW.NCQA.ORG

dlife Incorporated……WWW.DLIFE.COM

American Association of Clinical Endocrinologists……WWW.AACE.COM

American Medical Association……WWW.AMA-ASSN.ORG

U.S. Department of Health and Human Services……WWW.HEALTHFINDER.GOV

American Board of Medical Specialists……WWW.ABMS.ORG