Diabetic Review with Doctor

[ringi]

Bless you thank you! As I understand it the DIRECT trial classes people in remission with an Hba1c under 48mmol/mol with no meds. I personally would rather see under 42mmol/mol which some of my patients have achieved through LCHF and some with LCHF and intermittent fasting.

Given that medform is now used to prevent type2 in people who are at high risk, would you include people who are on a low dose of metformin. (Personally I rather have 38 with metformin then 42 without.)

 

[ringi]

I think that Virta health also uses the 48mmol/m as a sign of remission which is unfortunate but still they got 60% I think in their trial.

That is the definition the American Diabetes Assocation uses. (Also remember that thier results include people who have been on high inslin doses for many years.)

 

[jlarsson]

It comes down to training. One boffin (can't remember which one) puts it like this, five years after graduating med uni 50% of that which you were taught will be out of date or wrong. The problem is that you won't know which 50%.

This is pretty much true of most if not all scientific fields, you will constantly have to update your knowledge. I think a lot of criticism here is unwarranted, it's impossible for any individual to have a deep knowledge of so many fields which is what people unreasonably expect of doctors in this case. It's easy to feel unfairly treated and expect supposed experts to know everything you need them to know, but at the end of the day you are not the centre of the universe and are unlikely to be what they are particularly interested in unless you're dealing with a specialist of some sort.

 

[CassellCath]

Given that medform is now used to prevent type2 in people who are at high risk, would you include people who are on a low dose of metformin. (Personally I rather have 38 with metformin then 42 without.)

I

Given that medform is now used to prevent type2 in people who are at high risk, would you include people who are on a low dose of metformin. (Personally I rather have 38 with metformin then 42 without.)

I have got people on metformin with an Hba1c under 48 but I wouldn’t class them as in remission as still on meds but I totally get what you mean as that’s how they feel too. It’s totally patient centred and what patients want to do.

 

[CassellCath]

Would you consider coming to live near me?

Hehe!

 

[Guzzler]

This is pretty much true of most if not all scientific fields, you will constantly have to update your knowledge. I think a lot of criticism here is unwarranted, it's impossible for any individual to have a deep knowledge of so many fields which is what people unreasonably expect of doctors in this case. It's easy to feel unfairly treated and expect supposed experts to know everything you need them to know, but at the end of the day you are not the centre of the universe and are unlikely to be what they are particularly interested in unless you're dealing with a specialist of some sort.

I agree. However, we are speaking here about patient health. In the real world we also have to deal with ego (on all sides). Gone are the days of 'Doctor knows best'. We are constantly told to take responsibility for our own health so we seek guidance from those 'in the know' and our GPs and DNs (in our case) are those people.
So what if 50% of what my DN tells me is outdated or wrong? It is not the same as other sciences in that this outmoded info directly affects my well being and my future quality of life and eventually my lifespan.

 

[bulkbiker]

unreasonably expect of doctors

If you were the head of "Diabetes Care" in your practise of about 10 GP's don't you think you would know about major advances in patient care? Surely CPD would mean that you should be aware of this stuff especially when it has been plastered all over the newspapers as well as in the medical press. The not head of "Diabetes Care" (one of the other GP's) was following a low carb way of eating herself so she had obviously heard of something.. I find it disgraceful that the guy had no idea.

 

[jlarsson]

If you were the head of "Diabetes Care" in your practise of about 10 GP's don't you think you would know about major advances in patient care? Surely CPD would mean that you should be aware of this stuff especially when it has been plastered all over the newspapers as well as in the medical press. The not head of "Diabetes Care" (one of the other GP's) was following a low carb way of eating herself so she had obviously heard of something.. I find it disgraceful that the guy had no idea.

Just because you're the head of a department(plenty of good examples in governmental positions) doesn't mean you're a specialist in the field, a GP is literally a generalist and not a specialist, that's why they refer you to a specialist. Furthermore, doctors just like regular people have different opinions and beliefs, medicine has conflicting ideas about the same problem and what works in one patient may not work in another. I understand that you may feel unhappy with the care you get but understand that there is a plethora of information, some conflicting, that they need to read and understand in order to do their job, and even then they will make mistakes.

 

[Guzzler]

Just because you're the head of a department(plenty of good examples in governmental positions) doesn't mean you're a specialist in the field, a GP is literally a generalist and not a specialist, that's why they refer you to a specialist. Furthermore, doctors just like regular people have different opinions and beliefs, medicine has conflicting ideas about the same problem and what works in one patient may not work in another. I understand that you may feel unhappy with the care you get but understand that there is a plethora of information, some conflicting, that they need to read and understand in order to do their job, and even then they will make mistakes.

Many years ago someone described GPs as telephonists, meaning that apart from the minor stuff a GP is there to point you in the direction of a specialist. I thought, at the time, how awful a statement this was and told her that doctors are boffins and she should have more faith.

I have changed my opinion on this. For example, statin prescriptions. I am of the opinion that my GP either just wants to tick the box on his screen or he knows nothing about cholesterol or he doesn't care that it affects my quality of life. Anyway you look at it, he is not a lipidologist. Personally, I got the impression (and here comes the ego bit) that I was being unreasonable about making a decision contrary to his advice.

 

[jlarsson]

I have changed my opinion on this. For example, statin prescriptions. I am of the opinion that my GP either just wants to tick the box on his screen or he knows nothing about cholesterol or he doesn't care that it affects my quality of life. Anyway you look at it, he is not a lipidologist. Personally, I got the impression (and here comes the ego bit) that I was being unreasonable about making a decision contrary to his advice.

Much like how teaching is for many of them and their institutions mostly about having an excuse to give people good marks and raise your profile etc for the government money, yeah.

Again, it's unreasonable to expect a GP to know everything about everything you want them to know about, if we're talking specialists that's a whole other problem if they don't know what they're on about.

 

[JohnEGreen]

"To become an independent General Practitioner in the UK, you must undertake at least three years of GP Specialty Training (GPST), normally including 18 months in an approved training practice with a further 18 months in approved hospital posts.

To ensure that you become a competent, effective and confident GP of tomorrow as well as directly addressing the GP curriculum, Deaneries will tailor your training to your individual needs and your particular rate of progress.

There is an increasing number of four year options available giving extra valuable experience. On joining a GP Specialty Training Programme you should register with the Royal College of General Practitioners. Gaining Valuable Experience.


General Practice Posts
All GP posts are undertaken in a wide variety of locations, and always in an approved training practice under the supervision of a GP trainer. Here you will receive personalised tuition from an experienced GP who has had further training as an educationalist, as well as other members of the Primary Health Care Team.

The training will be targeted to your identified needs.


Hospital Posts
The exact posts offered by Deaneries in their programmes vary, but you will be offered a complete programme that complies with the regulations set down by the GMC.

All posts are accredited and approved for GP training. The specialties available include: General Medicine Elderly Care Medicine Paediatrics, Community Paediatrics Obstetrics and Gynaecology Psychiatry and old age Psychiatry ENT Accident and Emergency Dermatology Ophthalmology Palliative Care Some Deaneries have innovative programmes that combine hospital and General Practice posts."

From here https://gprecruitment.hee.nhs.uk/Recruitment/Training

Note Diabetics absence from list of specialties how remiss of them.

 

[Guzzler]

Much like how teaching is for many of them and their institutions mostly about having an excuse to give people good marks and raise your profile etc for the government money, yeah.

Again, it's unreasonable to expect a GP to know everything about everything you want them to know about, if we're talking specialists that's a whole other problem if they don't know what they're on about.

I do not expect a GP to know everything about everything. I expect a GP to listen and to care. And I expect a GP and every other HCP to at least try to keep up with modern practice. For example, the Yellow Card system, less than 5% of GPs bother to yellow card a drug or treatment. How does this reflect on the listening skills of the other 95% ? (Source, Kendrick).

 

[bulkbiker]

they refer you to a specialist

Except of course that that is about the last thing they ever do for Type 2's here in the UK

have different opinions and beliefs, medicine has conflicting ideas about the same problem and what works in one patient may not work in another

Which surely means that they should be aware of different options and explain those to the patient rather than just write a prescription?

However I notice that for many Type 1's there would seem to be far better medical care and support (not all but most), at least from my reading on the forum. Whereas for a lot of Type 2's they are just given a copy of the eatwell guide, a prescription for metformin and sent out into the world with little further support. I think we may well have had different experiences of UK healthcare.

 

[jlarsson]

I do not expect a GP to know everything about everything. I expect a GP to listen and to care. And I expect a GP and every other HCP to at least try to keep up with modern practice. For example, the Yellow Card system, less than 5% of GPs bother to yellow card a drug or treatment. How does this reflect on the listening skills of the other 95% ? (Source, Kendrick).

That's fair enough, just remember that they're still people who will not always be at their best, they will forget things, they will mishear or misread things, and so on. Doctors have a notoriously high workload.

Except of course that that is about the last thing they ever do for Type 2's here in the UK

Which surely means that they should be aware of different options and explain those to the patient rather than just write a prescription?

However I notice that for many Type 1's there would seem to be far better medical care and support (not all but most), at least from my reading on the forum. Whereas for a lot of Type 2's they are just given a copy of the eatwell guide, a prescription for metformin and sent out into the world with little further support. I think we may well have had different experiences of UK healthcare.

That may be true, I'm not a type 2 and therefore have no experience in how they treat you, I have only ever used my GP for referrals and prescriptions.
This is a diabetes forum so it's easy to get stuck in an echo chamber, but you have to remember that not everyone is diabetic, not every patient your GP sees is diabetic, not every conversation or meeting they have with their colleagues will be about diabetes, not every medical journal they read will be about diabetes, and so on.

 

[Gannet]

There is a fast food/sandwich shop up the road from me and for a few pounds they do a salad box with choice of topping ie tuna chicken or other meat. I was talking to the lady who runs it the other day and she mentioned they were going to start doing burgers soon I said very good but not for me being diabetic she said well we will do a bread less version for you if you like just have the burger and fillings and such thought that was very help full.

I went to a M&S cafe the other day. There was nothing suitable for me.
I mentioned this to the staff and was told there was a chicken salad. Oh great, I thought - then noticed it had quite a lot of potato in it. I ended up with a little of my husband's sandwich. (No Pret a Manger in the shopping centre, sadly.)

 

[archersuz]

then noticed it had quite a lot of potato in it. I ended up with a little of my husband's sandwich.

I would have thought that eating the chicken salad and leaving the potato was preferable to eating a piece of sandwich.

 

[Gannet]

I would have thought that eating the chicken salad and leaving the potato was preferable to eating a piece of sandwich.

The salad looked unappetising - a few limp leaves, chicken and potato. The quarter sandwich was by far the better choice from my point of view. I had a salad when I got home.