Choosing a Diabetes Care Provider

As you start to choose your health professionals, it may help to listen to the experience of other people with diabetes. Consider the stories of James and Helen, decades apart in age, but sharing an initial sense of confusion and a little fear about finding quality care for diabetes.

James had just started college 500 miles away from home when he was diagnosed with type 1 diabetes. Mastering glucose management by blood glucose monitoring, insulin shots, and carbohydrate counting was confusing and a little scary, especially because he was also trying to get used to college life. Being so far from home, he knew he would have to find a new health care provider near campus. He would have to see the provider at least every 3 months, and perhaps more often while he was trying to get his diabetes care plan established. He wasn't sure he could get home that often and wanted someone nearby in case of an emergency. Besides, his familiar family doctor was not an expert in diabetes and suggested that he find a local provider with expertise in managing the disease.

Helen was just starting to plan for her early retirement. Over the past 10 years, she had put on a little extra weight. Between taking care of the kids and working long days at her high-level government job, she had little time for exercise and was always eating on the run. Her health care maintenance had fallen by the wayside also. Although she visited her gynecologist every year or so, she hadn't seen a primary care provider or had a complete

physical in nearly a decade. She was looking forward to doing some traveling, taking up some new hobbies, and starting an exercise program when she learned that she had type 2 diabetes.

Both James and Helen needed to find new providers who had experience in coordinating the care for people with diabetes. Although James and Helen had different types of diabetes, they both had similar concerns and needs in finding the ideal doctor. Helen wrote down a list of the important qualities she was seeking and was able to express what she was looking for in a provider:

"I wanted someone who would really listen to me and answer my questions in English, not medical-ese. So many times, doctors have treated me as though I were a child whose only duty was to obey. Well, I'm the one who has diabetes, and I'm the one who's got to take care of it. I guess I just want a provider who won't talk down to me, who would treat me as another professional."

James is also concerned about communication:

"It's hard to talk to doctors sometimes. I mean, a lot of times I nod my head as if I understand something when I really don't. But there's a lot of stuff I'm worried about. Like, someone told me that a lot of men with diabetes become impotent. I want to know if that's true and whether there is anything you can do to prevent it."

Like James and Helen, you may have personal concerns about diabetes. Before you choose a diabetes care provider, you may want to schedule an appointment to talk with several candidates. Some health care professionals may charge an "interview fee," so be sure to ask about this ahead of time.

Come to your interview with questions you would like answered. If necessary, write them down in advance and don't be afraid to look at them during your interview. Write down answers to your questions during the interview, if need be. Here are some common questions and concerns you might discuss:

Where did you go to school? Are you board certified in endocrinology or internal medicine? Do you hold professional memberships in associations such as the American Diabetes Association (ADA), the Endocrine Society, or the American College of Physicians?

What percentage of your patients have diabetes? Are they mostly patients with type 1 or type 2? How many patients like me do you see each month?

What insurance do you accept? Are you a provider in my PPO plan? If I require a referral to a specialist, do you have colleagues who also participate?

How often will regular visits be scheduled? What tests are conducted routinely?

Who covers for you on your days off?

What procedures should be followed in the event of an emergency? What conditions indicate an emergency?

How do I know whether I should call you?

How hard is it to get an appointment?

Are you associated with a nurse educator, dietitian, or other health care professionals so that I can benefit from a team approach?

Are you likely/willing to try new approaches/therapies to diabetes management, or do you prefer to wait until new methods have stood the test of time?

After the interview, take time to reflect on it. How did it feel? Were you comfortable with the practitioner? Did he or she seem concerned about you as an individual? Was the provider willing to work with you to achieve your health goals? Did you feel free to express your feelings? Did you feel that he or she was listening to you? Were you given sufficient time to get all your questions answered or did you feel rushed? Did the provider seem directive or nondirective—is he or she likely to tell you what to do or work with you to reach your goals?

In addition to your interview, you may want to get a sense of the practice from his or her staff and other patients.

Is the office convenient enough for you to get to regular appointments? Maybe the closest endocrinologist is 50 miles away and you would like someone closer. In that case, you might want to find an internist or primary care practitioner with expertise in treating patients with diabetes.

Are the provider's current patients satisfied? Is it easy enough to get an appointment? Does the provider meet his or her appointments? Ask other people who see this provider. You can also contact the ADA for a list of recognized providers (1800-342-2383; www.diabetes.org) or receive referrals from a physician you know and trust. Your local hospital or community health organization may also provide referrals. Professional medical societies may provide recommendations as well.

Is the office neat and clean? Is the staff polite? Are you accommodated at your scheduled appointment time or are you kept waiting? Are educational materials on display? Is there someone you can call with questions or concerns?

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