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GP versus Diabetic Nurse

Discussion in 'Ask A Question' started by KittyKatty, Dec 6, 2015.

  1. KittyKatty

    KittyKatty Type 2 · Well-Known Member

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    I feel that my appts with the DN over the past yielded little or no benefit. Because she told me so little about diabetes management I was forced to seek dietary advice online (including on here, the support has been fantastic:D) so I started going straight to my GP for the latest Hba1c readings. That way if there's complications, I won't have to make another appt to see him 3 weeks later and take more time off work or wait days for a prescription (as happened before)

    I explained this to my GP when my last hba1c results were read out to me but he said I really should see the DN next time. He explained how great she was (I'm sure she is to some patients), she can give me any advice I needed (not the case before, unfortunately :sorry:) and she could also weigh me (I have scales at home I use each week).

    But am I being pig-headed having a 5 minute consultation with a GP for heart-of-the-matter results rather than a 30 minute consultation with the DN for results and 25 minutes of time-filling, unproductive chat? I have my retina scan once a year, my hba1c's done regularly, a very informative website here and apart from that feel fine. Also, the DN appts take place middle of the day. It means as I work miles away I have to take lots of time off rather than just be an hour late for work from an early morning GP appt.

    Since my last GP visit I've had a letter from the DN stating that I need to see her to help maintain my health. But I've sort of maintained my health myself. I really needed her when I was diagnosed hence my discovery of this website to fill in the gaps of knowledge!

    I don't want to sound dismissive and superior; I'm sure the DN is a great help to many of her patients, especially if they have a lot of side complaints. Should I bite the bullet and entrust my care into her hands again, despite the dent of my confidence in what she can do for me at this time?
     
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  2. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    The choice of who you see is up to you.
    If I had a letter from the practice nurse like that I would have written back asking for a detailed explanation as to how she felt she could help maintain my health.
     
  3. sally and james

    sally and james Family member · Well-Known Member

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    My husband had a letter recently asking him to spend 30 minutes with the the practice nurse (who got given the "diabetes" badge when the last DN left). He has declined. He can weigh himself, measures his own blood pressure, can inspect his own feet, test his own blood sugars, interpret an HbA1c result, isn't going on statins under any circumstances (so why measure cholesterol?) and certainly isn't taking dietary advice from an obese nurse. He is well, very fit, takes no diabetes medication (all thanks to low carb) and has his eyes checked by a specialist. There is no need to see a nurse.
    No, @KittyKatty you are not being pig headed, just not wasting your own time or that of a nurse. If you feel you need medical advice, you need to speak to a doctor.
    Sally
     
  4. Daphne917

    Daphne917 Type 2 (in remission!) · Well-Known Member

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    To be honest it looks as though you're doing a great job on your own and I don't see why you shouldn't see your GP if you'd rather. I've not seen my GP re my diabetes ( in fact I've not seen her about anything for about a 18months) but my DN gives me 'guidance' on low fat eating which includes way more carbs that I currently have, we have the statins 'conversation' and, after i point out to her the graph on her screen showing the correlation between me taking them and my hba1c increasing from 48 to 54, discuss why I will not take them again and I'm also asked why I test my BS because I'm well controlled ( hba1c 36) and it's checked every 6 months anyway - apart from that my review goes ok and I just carry on as normal!
     
  5. Prem51

    Prem51 Type 2 · Expert

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    @KittyKatty So it was your DN who was giving you a blood test then the results every 3-6 months. I think in a way you were lucky.
    After my first 3 month test I was told by GP I didn't need to be tested again for 12 months. My practice nurse doesn't write to me or tell me when I need to come in for a blood test, neither does my GP. I needed regular blood tests prior to my diagnosis with T2 as I have hyperthyroidism, but it is left to me to remember to make an appointment for the test, then to make an appointment with the GP to get the result.
    I would quite like to get more regular tests. But there again I am retired so have the time, and my GP surgery is only a couple of hundred yards away.
    From your results you seem to be managing your condition very well yourself so if you feel you don't need tests more than once a year you should just ignore the letter, or maybe phone the nurse to explain why you don't think you need regular testing and 'advice'.
     
  6. SunnyExpat

    SunnyExpat Prefer not to say · Well-Known Member

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    It you don't need medical advice, and feel you can manage all the possibilities that could arise from diabetes, and can organise all the appointments, blood tests, podiatrists, diet, drugs, etc, and simply feel you need to touch base with your HCP once a year, and your surgery agrees to you seeing your GP for this, that's the way to go for you.
    It's doubtful the GP would agree though, as it's undermining the people he employs.
    You could maybe request the practice nurse takes your blood, and you collect a print out of your results, but you may have to agree that you don't want any input from them regarding your treatment to be put on your notes.
     
  7. SunnyExpat

    SunnyExpat Prefer not to say · Well-Known Member

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    Personally, I find nurses would be reasonably insulted if you told them 'If I want medical advice, I'll speak to a doctor'
    and, to be fair, if you said it to my doctor, it's 50/50 he'd throw you out for insulting his staff.
    Either way, I doubt he'd be that supportive of your opinion of them.
     
  8. numan43

    numan43 Type 2 · Well-Known Member

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    When I first seen DN at doctors after many years of attending clinic at hospital she hinted that if she didn't see enough patients then the diabetic service at surgery couldn't be sustained, maybe its a numbers game.
     
  9. britishpub

    britishpub Type 2 · Well-Known Member

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    I have no idea what a Diabetes or Practice Nurse is.

    Never seen one, don't even think there is one at my surgery.
     
  10. Daibell

    Daibell LADA · Master

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    Hi. The DN is following NICE and DUK guidelines which includes a list of 14 things including being weighed. In my opinion unless you are pretty incompetent about your health some of the 14 items are a waste of time for many e.g. weighing. My DNs have been quite sensible and tend to rush thru these things to just tick them. We then spend time talking about more useful things such as medication, cholesterol LDL, HDL, Trigs and of course HBA1C. Try to politely take control and show that you know about diabetes and health but be tactful. I have never asked for diet advice and have luckily escaped the NHS nonsense on this. DNs do have time to chat and listen whereas GPs tend not to listen and can be more arrogant like my Diabetes GP.
     
  11. Mep

    Mep Type 2 · Well-Known Member

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    that's interesting.... we don't have to see diabetic nurses here. I just see my GP for all my health issues and see my specialists as needed which includes my endocrinologist. I get letters from my surgery asking me to come to a diabetic appointment (whatever that is) but I have never gone because I get proper treatment from both my GP and my endocrinologist. I also have access to a diabetic educator and dietician.
     
  12. AndBreathe

    AndBreathe I reversed my Type 2 · Master
    Retired Moderator

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    I think you have to have a clear picture in your mind of what you want from your appointment, and who might deliver it.

    Since diagnosis, I have seen one nurse regarding my diabetes - four months after diagnosis (although I was out of the UK for that period), by which time my HbA1c had reverted to non-diabetic levels, and I had become very slim, so she had little to discuss with me.

    I have spoken to my GP several times about my lipids, but that has been quite positive as we both learned a lot on that journey. Personally, I wouldn't expect any specialist diabetic care from my practise these days, but early days, or if I had ever required medication, it might have been useful.

    As I say, the key to whom, if anyone, you see to discuss your HbA1c, is up to you, but be clear about what you want, and be prepared to express that in a polite manner when setting the scene in your appointment. Like most business meetings, I find preparation is the key.
     
  13. SunnyExpat

    SunnyExpat Prefer not to say · Well-Known Member

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    If I remember from one of your recent posts, wasn't the result of the 'business meeting' that your GP agreed to remove you from the diabetic register, without scheduling another meeting?
    A parting of the ways may not be what the op has in mind, and may prefer to keep more options open.
     
  14. zand

    zand Type 2 · Master

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    ????? What the previous poster said was "be clear about what you want....." Nothing was mentioned about the 'parting of the ways'
     
  15. AndBreathe

    AndBreathe I reversed my Type 2 · Master
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    I have an agenda and preferred outcome for every meeting, and evert appointment I attend, however related. That I have been removed from my practise diabetic register doesn't mean I have fallen out with anyone, or that I am no longer under that GP's care.

    In the interests of truth and transparency, the GP suggestion to remove me from the register was immediately contingent on my agreeing to continue with an annual HbA1c test, as to quote her, "you will always carry a higher risk than Joe Public", and I was very happy to agree to that. I didn't fancy having to negotiate periodic tests.
     
  16. SunnyExpat

    SunnyExpat Prefer not to say · Well-Known Member

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    As above really.
     
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