Sunday, November 4, 2012

The Games End

I've learned some things about myself in the last few months since my license was suspended. Well, I've learned a lot of things, but the one thing I've figured out, I want it to be all about me. I want my doctor's full attention. All of it. Not just a piece of it.

Credit: Mike Hoskins, The Corner Booth: Diabetes Art Day 2011
Before the Driving Event, I would arrive for appointments, and my endo and I would have a brief conversation, "Do you have any concerns?", "Let's tweak your settings some more", that kind of thing, followed by extensive number crunching and subsequent pump setting changes. And that was enough when I was an average person with diabetes. But it seems to me that since the event, I am no longer just average, and the landscape has changed. I am now on a mission to change it to a landscape that will work for me.  

My endocrinologist, Dr. K, works in a large teaching hospital, and I have discovered that doctors and patients engage in games, and I don't like games when it's my health at stake.

Remember the broken telephone game that we played when we were kids? You know, the one where everyone sits in a big circle, then someone reads a phrase, then whispers it into the ear of their neighbour, and that neighbour into their neighbour's ear, and so on? Until the end of the circle, and the last person has to say the phrase out loud. Inevitably it is always wrong, and sometimes has hilarious results. However, it's not so hilarious when we're talking about our health.

Game #1 - The CDE/Doctor

In between appointments with Dr. K, I have ongoing email exchanges with my CDE, Sophie (not her real name). It's her role to review my weekly BG numbers and suggest appropriate changes. At times, I had some concerns or questions for Dr. K, so I would tell Sophie, and she would tell Dr. K of my concerns on my behalf, and afterwards, she would paraphrase Dr. K's answer back to me.

This kind of worked, so I thought, however, each time the air was just a little chilly. So I was left to wonder what may have really been said. Did Sophie not relay my message as I wished it to? Did Dr. K misinterpret Sophie's words? Who knows. I wasn't there.

Game #1 Score:  Endo 1, Jamie 0

Game #2 - The Appointment

The rules of engagement for appointments plays out like this: First I meet with the nurse, who records all my vitals. So far so good. Then I meet with a resident (never the same person) who leads discussion, asking questions relating to my health and BG numbers on various charts, and then goes away to give her summation to Dr. K. Again, I am not present, so I cannot assess if she is understanding my intentions and concerns. I cannot hear what the resident says, I do not have the opportunity to clarify anything at all, until she says something that shows the disconnect. After their meeting, both return, and Dr. K leads the appointment from then on.

By this time, over the past couple of months, Dr. K has only heard my concerns through Sophie and the  resident. Everything except my BG numbers has been tied up neatly in a bow, and this is really all Dr. K seemed to want to focus on. At no time did she follow up about the concerns, or even seem to have time for them, and was ready to focus on my numbers only.

However, as I tried to discuss some of my concerns, I realized that she somehow got the impression, and wouldn't let go of the impression, that I wanted my license back no matter what, with no regard to my safety or health. Which was NOT true. But something had happened that gave her that impression. At one point I told her that I felt frustrated by how long this process was taking. Dr. K told me that I must "accept the reality".

... umm, doctor, first of all, it was you who told me the timelines that I could expect months ago... and did you just tell me to suck it up??!

Game #2 Score: Endo 1, Jamie 0

Game #3 - The Teaching Opportunity

Something else has also occurred to me. Throughout the whole process of reporting my Driving Event to the doctor, I had expected that she might be reporting the event to the Ministry of Transportation. I know of other doctors who used discretion on a case-by-case. However, one might wonder if this option may have been coloured as a teaching opportunity for the resident who is present throughout the appointment. This is the Teaching Opportunity session of How To Tell A Patient That You Have An Obligation To Report As Legislated By The Province Of Ontario.

Hmmm, perhaps true? Perhaps not. I don't know, but it kind of seems that way to me.

Game #3 Score: Resident 1, Endo 1, Jamie ?

Ending the Games - Next Steps

So there's a little more game playing in my future. I will continue to work with my team group of professionals to provide a successful report to submit to the Ministry. My next appointment is in a couple of weeks. And then, hopefully I can implement steps to put that behind me.

I can't guarantee anything, but my future medical team is going to look different.  It's going to be one where my voice is heard, directly from me, to those I am working with. For this is how relationships are built.


  1. Read this and want to yell 'exactly!' I can never understand why so much of the medical process happens in secret, away from me, who actually does the 24/7! I can only assume its because they have negative things to say that they can't say to my face.... I'm pretty sure there's some playground rule that covers that... Lets all just sing 'the medical model sucks!, the medical model sucks!' To the tune of the back of the bus sucks

  2. What a frustrating bunch of situations. I don't blame you for wanting to shake things up a bit.

  3. I'll bet 4 out of 5 patients arrive at their appointments with the attude "I'm here but I don't want to be. Now do your magic so I can go home." It kind of sours doctors to the reason they entered the field of medicine to begin with. Show that you're concerned, that you care and truly want to understand what's going on with your body, and the doctor might be pleasantly surprised, and the dynamic of the whole relationship might change.