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Trainee G.P.

  • Thread starter Thread starter catherinecherub
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catherinecherub

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Saw a trainee G.P. today and grabbed the opportunity to ask about Type2.

She was of the opinion that nobody, herself included, can tell people what they can and cannot eat with the exception of refined carbohydrates. Even then some people can manage their diabetes and eat them.

When I asked about testing for Type2's she said that it would be near impossible for a Type2 to gain control in the early stages without testing. When I asked why some newly diagnosed are being denied them she replied that any Dr. who considers it is in the patient's best interest can override any PCT dictatum.

She thought the problem was that there are a large number of Type2's who do nothing to improve their control and yet still want unlimited test strips and their results have been the main bugbear of the limitation on strips. She also said that appointments with Surgeries/ Hospitals and Dietitians are often not kept, all adding to the cost.

I asked her how she would treat a newly diagnosed. She would educate them in the use of test strips, allow them for six months and during that time she would see them on a monthly basis. After that she would cut back the amount they were allowed but would make sure they had enough during times of sickness, if other health problems limited their control and if they were on insulin or meds that needed more testing. She said she knew by talking to other Drs that there are a large amount of Type2's who do nothing to control the condition and expect the G.P. to have all the answers even though they have been educated about what needs doing. Excuses like, I cannot give up chocolate, sweets and crisps, I like takeaways,, I cannot change my diet, my husband/wife does the cooking and I don't want to offend

She also said that there are patients who are in control but still carry on insisting on the same amount of test strips as when they were first diagnosed and it seemed to have become an obsession with some people. Some even know roughly what the result is going to be but still think it is their right to test repeatedly.

She also said that people cannot see the damage being done when they do not try and control the disease but if they could see it then they may take it more seriously. She remembers a double amputee in Hospital who said that he wished he had listened to his G.P. and taken steps towards better control of his condition. Looking back he felt that he was invincible and nothing was going to happen to him.

All in all I thought she had some good points to make and it shows that although the forum members try their best, there are many people out there who do not want to be helped.
 
I agree with virtually all she says. In fact, if youread our petition for T2s it IS what we say. Strips for all, but with education, and probably less after a while (implied according to meds)
 
The trainee's opinions and attitude were quite refreshing indicating that her mentors may be changing for the better.
 
She's going to be a great GP when she qualifies. She already is.
Hana
 
All sounds good and lets hope there's many more like her on their way to become GP's :thumbup:
 
After reading this and Dillingers encouraging post a few days ago regarding his enlightened 'Blue sky thinking' GP,In my mind the Worm is turning,albeit slowly,but turning nonetheless.
 
great visit and great new doc. Totally agree with her points.

Well done her, refreshing. Hope she might read this forum/thread and glow!

Mary x
 
previous posters wrote
Dr. who considers it is in the patient's best interest
Hope she might read this forum/thread and glow!
Click to expand...

Have I stumbled upon some thread about a Time Lord and aliens ?? :lol: :lol:

Geoff
(off to bed before the daleks appear and attempt to exterminate me :crazy: )
 
Hmmm. But what of the newly diagmnosed who are not even allowed to see a GP, just the nurse and are not given any advice abou carbs and given no opportunity to monitor their own levels or even a hint that their is anythinhg they can do to help thamselves .
but
told to leave it all to Nurse? I am sure there are people who behave as described and I agree his trainee appears o have the right ideas BUT why assume people will waste strips and not change their behaviour without giving them the chance to do so?

Some assumptions here. I can well understand why some diabetics do not ake the condition seriously I don't think the NHS ake it seriously. You cant tell patients on one hand , to leave it all to Nurse and then castigate hem for doing so when maters deteriorate.

if each surgery had one GP, at least, overseeing the Nurses and if there was one universally recognised qualification for those responsible for diabetes care I could believe the whole thing was being taken seriously .
 
Did she give you any literature? Is there ANY printed info out there that advises carb restriction?
 
IanD said:
Did she give you any literature? Is there ANY printed info out there that advises carb restriction?
Click to expand...

Dear Ian,

If you read my OP, she was very clear cut about dietary advice. The only thing she offered in carb restriction was refined carbs. We all seem to agree with that regardless of how we manage our diabetes.

My surgery has always allowed me test strips, (diagnosed early 2003), but they do offer less once you have good control. We did get a letter when PCT's started making moves on restricting test strips. We were asked if testing was making us nervous etc..., all the arguments that have been put forward for not testing and were asked if we preferred to test or not. Our answers to the questionnaire was the deciding factor if we continued to have them prescribed. I only know of one man locally who did not want to test. I often wonder how many opted out of testing.

I was never given any leaflets in the early days but was given several printed pages about the G.I. diet and book recommendations and a one day local course explaining about Type2. It was quite simplistic but I think that can suffice in the early days. It was given within the week of diagnosis which is the best time IMHO. We were given a meter at the course and did some testing there, before and two hours after lunch. Then it was explained how the choice of the lunch we had eaten had affected our levels. Some had opted for steak pie and chips, beef casserole,or tuna pasta bake. I had tuna salad and a couple of new potatoes and my reading came back lower than before lunch. We kept the meter and were prescribed test strips for it.

It was a very informative day and not as some describe the courses they have been on. I often wonder why some get good advice at diagnosis and some are treated so badly. Without this forum I would have assumed that everybody had access to good information when diagnosed. I know from talking to other diabetics that this method is still used at my surgery as is the free meter.
 
I think you were and are quite fortunae catherine. I was diagnosed in 2007 and although there was a specialist diabetes doctor in the Practice - and I am convinced he knew a great deal about diabees- he was also very PC and many of his comments were very cryptic and only understood in the light of further experience.
In faact he was so averse to answering questions hat I preferred o see another P in the Practice. I was given test strips but by the nurse who did not know how they should be used .
After the initial consultation with the Dr he only wanted to see people at the annual review. I was given an informaion pack which contained a sheet entitled "healthy shopping for diabetics" I contained he most appalling dietary advice i had ever seen. For anyone let alone diabetics. Some time later I discovered it had been writen as a sort of "halfway" advice sheet for a certain section of another community ". It was for those who had an appalling diet and no idea of how to change it. As many just could not be expeced to change to a healthier diet by themselves {mental and other problems ] this sheet was the firs stage in helping them swith to a sklightly less appalling diet . The sheet had been obtained from a neighbouring area and placed in the pack o pad it out. The drs were unaware that this was being given to patients .
No education was ever offered or suggested.

My brother in law was diagnosed last year in another area. he never saw a GP but was just given a bag ful of medication by the nurse with no inforamation and told to go back in six months. When he did so the nurse said all was well . so he proptly stopped taking the pills and continued to eat large quantites of bread etc and large blocks of chocolate. his job involves very irregualr hours.
My sister despaired of his diet a long time ago. Neither of them ook much notice of what i tried to tell them. The nurse said it was OK so what did I know?

Next time he went back his test revealed some kidney damage .he had a scolding from the nurse but was told it was easily reversible if he took some more pills. still no dietary advice. he hen started taking the medication , lost some weight with the metformin and according to the nurse there has been some improvement.
Now I know they regard me as a fanatic but I really worry about what will happen once he sops losing weighht and when he probably gains some on his imminenet retirement. he has NEVER had any dietary advice and thinks i am crazy for testing .
Apparently its olf fashioned noone does it now!
My sister says that he is buying cake and other sweeet things more and more often as she doesn't keep any in the house.

despite the signs he is not a stupid person - just trusts the HCPs .
I consider he has been let down by them. His eperience is quite common i believe. As he has faith in his practice he would probably take their advice. he goes to great lengths to keep his appointments and takes his pills now he knows it is essential.

If the newly diagnosed are not given the right advice it is a missed opportunity for the patient and the HCP.
he was not even given any printed information to absorb in his own time. It was all "leave it to us" which of course, mpst people are only too happy to do.

We realluy need to have initial advice and treatment of the newly diagnosed standardised.Considering that the treatmnment is a one-size -fits -all system it seems that different sizes are being used in differen parts of the country.
I am sure that patients in my current practice are treated in the same way as my brother in law.
 
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