Type 2 Can I refuse to have a particular person present at my reviews?

Yesterday: Three Monthly Review. Present: V (newly trained DN) and J (Diabetic Dietician) seen at 1st Review 2 Apr 14, where I disagreed with her & DN's dietary recommendations. Had spent days since diagnosis on 25 March, on DCUK and became informed as to the reality of the NHS Healthy Plate. I had already started implementing LCHF, and BG had dropped from the blood test result of 20.3 on 25 March to (fasting) finger prick test on 2nd April of 17.7. J DD had done an HbA1c in the surgery, and had whispered the result of 113 to the DN, which I had just managed to hear. At my next review I asked my DN to confirm what it had been; she admitted it wasn't on the computer and she didn't know. She contacted J DD who also had no record of it.

Okay, back to yesterday. J DD took control from the start, saying she was there to aid V DN in her diabetes training. Like at our first meeting she said she worked for a private company and would I sign a document as I had done the previous year. I did read it but to be honest didn't take it all in, but noted that it said no personal information would be used and I signed it.

J DD asked why I had increased dose from 1 to 2 Metformin - I her told her because during January to early April I was experiencing same symptoms I had when I was first diagnosed. Did the Doctor increase the dose? No, I did it myself. She got a bit uppity - I explained that when the DN had prescribed Metformin last year, to be taken 4 x once per day! Instead of increasing them slowly. I was terribly ill for four or so days, and cut back to 1 x twice per day. DN on next review accepted this. I then decreased to 1 per day and on next review DN happy with that, as BG was coming down. A look of distain crossed her face, and I ended up saying it was my body and I would do what I thought was best for it. Out the corner of my eye I saw V DN smile and nod.

Then J DD asked me what I ate for breakfast, lunch and dinner. Looked skeptical when I said no bread, rice, pasta, potatoes. and for fruit, only berries and occasional small pc of apple; what I drank; when I took my tablets and so on. Then asked if I had been on a course (I think it is D.E.R.E.K) She was supposed to set it up last year, but, the like the retinopathy test, it too never came to anything. Took three more attempts by three doctors, to eventually get one in October, even though I had said at the outset that I had had a sudden eye problem! Anyway, she then asked if I would like to go on it. I said no, having read some comments on here where folk found it to be geared to the NHS Healthy Plate, and with that V DN laughed out loud and said, I have three more patients who have all said the same thing. J DD was not impressed, but still she asked me again and received my refusal. Had she bothered to look at my HbA1c's she would have been fully aware that I was doing pretty well. 2014: May - 81, Aug - 44, Nov - 40, 2015: Feb 15 - 41, May - 42. I then said to her I am using Low Cab High Fat.

I then questioned the fact that my TSH level has risen from 2 mIU/L last March to 5mIU/L in May this year, and the FT4 level had dropped from 13 to 10 pmol//L. My weight has started to rise and was seriously disturbing me, and I wanted to know if this was the reason. She sort of started waiving aside my concern, then asked if it ran in the family, to which I responded no, neither does diabetes. She then said see the Doctor and get him to do the test again.

I then said I test regularly, which brought forth an indrawn breathe. I responded with how else am I to find out which food spike, especially as I don't eat the exact same meals, constantly changing them. I already buy my own strips as 50 is totally inadequate. Response. Well 'we' ? don't give meters and strips to those only on Metformin as it doesn't lower BG levels. I gave in.

In fact J DD made no mention of any of the latest blood test results! There was a lot more about food, drink and exercise, but enough is enough, as it is already long winded, and I am sorry for that.

She (J DD) has set up to see me again in 3 months time ... and because I really don't feel comfortable with her, do not want her present again at any further review.

So here is my Question: Can I refuse to have her (J DD) present at all future reviews?

Wow! Thank you all for your quick responses, I am most grateful.

I was totally take aback at her presence, but even more so at the fact that she stated that she was aiding in my new DN's training. I had been told by the receptionist that V had taken the Diabetic Nurse training and had assumed that she was now, albeit newly qualified, our DN. Whereas J DD neither last year nor yesterday, stated or even intimated that she was a fully qualified diabetic nurse.

My main problem is that I have a severe hearing problem, and my hearing aids which should have received maintenance or replacement last year have been failing which make for awkward situations, especially when I get a bit stressed. Unfortunately the sight of her sitting there yesterday made my stress levels hit the top. Problem was she kept talking to me whilst I was trying to read the form.

I am not usually such a dill-brain, but just her presence sent my brain on vacation.

I have taken all your advice on board, and decided I will try and speak with my DN first and let her know that I do not want J DD at any future reviews. If she is unable to agree to this, if it is outside her remit, I will speak with a doctor, which by itself is not going to be easy. Our doctor retired last year, and the PCT have given the practice over to a Federation of Doctors who operate on a non-profit policy (Hm! Really!) However, so far all we are getting are locums, and it is impossible to build any form of rapport.

Normally I am more than able to stand up for myself. I don't get loud or shout, I just politely persist. Last year for example, the pharmacy changed the brand of my Metformin, but didn't say a thing. When I got home I discovered the change and immediately went on line to check them out. Turned out these generic tablets contained 12 substances, 7 more than the original. In both, three were for the tablet, the rest were excipients which enable the 'drug' to go through the machinery! The pharmacist refused to provide original and tried to embarrass me in front of a shop full of people. I quietly refused to back off and eventually she took me into a small room and did her best to talk me into accepting the new brand. When I asked why they had changed, she eventually admitted 'Because they were cheaper and the only way they would change them back was if the doctor wrote the original brand name of the prescription.'

Well the doctor (another new one) refused, we had a long argument. In the end I said, okay, if it were you, would you accept putting 12 substances into your body, when you need only put five. He, very angrily, typed out a new prescription.

Mrs Puddleduck ... Hi Sue, I honestly cannot recall who actually took the blood for the HbA1c last year. The then DN did a finger prick which released a very large blob of blood, to show me how to use the meter she was giving me, and it is possible that J DD then used the same blob for her machine. Unfortunately, I was experiencing extreme brain fog at that time.

Again I thank each and every one of you for your replies and support.

Have a great day tomorrow ... Carol

mrspuddleduck said:

Carol. I really hope you get this sorted. Sounds like your doctors are in a complete shambles. Try asking for the Practice Manager rather than the locum staff. They should at least log your concerns in your records and hopefully sort something out. Sue xxxx

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Thanks Sue,. I have just checked on line, and found the name of the Practice Manager, but I think it would be polite to have a word first with my diabetic . As regards doctors, the site shows 'GPs at this practice ... 0 male and 0 female GP. ' ... Oh Happy Days .

Have a wonderful day, and here's hoping the sun continues to grace us with its presence .... Carol

@satindoll ... It's quite odd really, I get on well with most people, but last year when she 'sat' ln on my first review, having got me to sign a form, probably the same as the last which at that time I also had no idea what it was all about. But my gut reaction then, as this time, was the same, be wary of this one. I was very specific before anything was said, that I had a serious hearing problem and that the hearing aids I have were not brilliant. During that review, both she and my DN held several conversations in quiet voices, but one thing I did manage to hear was, that it was her that recommended that my then DN should put me on Glicazide for a month then onto Metformin. Fortunately I get on well with my new DN and she is a sweetie, so I feel confident that she will listen. I suppose it is possible that J DD is also a Diabetic Nurse. I will insist of being informed as to her actual qualifications when I speak with the Practice Manager, preferably before I tell her I don't want the lady at any future reviews.
@Heathen Lass ... Everytime I speak with the receptionists, I tell them the same thing ... and point to each hearing aid, and yes, you guessed it, they start off speaking clearly and always end up mumbling. Well, they are not really mumbling, but that is what is sounds like to me. Hopefully next week I will be looking forward to some new aids.

The funniest thing is, I used to be quite a fiery person, but since my hearing became so bad, I suppose I lost confidence that I was hearing correctly (many times I don't), and generally I have become much more laid back, must be something to do with nearing 70 going on 16.

Thank you all again, and I will let you know how I get on. Kind regards ... Carol

satindoll said:

@Humblebee
If this DD is part of a course like EXPERT then I believe she gets paid for how many people she sees and signed forms she hands in, so of course she will want to be there, I have some hearing loss though not as yet needing aids but it has sent me the other way, I now insist on reading things before signing anything and if I don't understand it say I'm going to get someone else to look at it first, I always ask people to speak up and stop mumbling, but then I'm a well grumpy old bird and refuse to let the so and so's get away with anything.
Looking at your numbers, I think your doing really well and she is needed like a hole in the head.

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Hi Satindoll, maybe I should start getting grumpy too, not saving it for my poor hubby all the time . Many thanks for your heads on possibility of EXPERT being involved, if they are, I won't be caught out now. I have to make an appointment in the next week or so, but as I have a couple of appointments this week, hearing and eyesight, I really want them out of the way. I tend now to sit back, reflect on things, then write out what I want to say. Précis until it becomes a list, and when happy print or write it out. Then, I will hand over a Copy so there is no possible misunderstanding.

As for my bloods, unfortunately it rose to 41 in February and to 42 in May. I am sure that two packets of Metformin had no drug in them. Stopped once for 8 days, then went back on for around a month, then stopped again for a month using diet only, readings were the same as being on Metformin. I then started on 1st May taking 1 per day and then 8 days later, to the last tablet in the packet together with one from a new packet, and the next day what a change - that was far too quick surely for it to have kicked in. Since then I have been taking 2 a day after evening meals, and generally BG's have been stable, unless I try out different foods to see what happens. Sometimes they are still good, sometimes they go up too high - but you have to try and you have to test, regardless of what the NHS say.

Have a lovely day, hope yours is warmer than ours ... regards ... Carol