Training a new Doctor

[Grazer]

So, at a wedding this weekend I had a long chat with the son of a very good friend. He is a fourth year medical student. As such, it won't be that long before he's sitting in the GP chair advising us diabetics, and diagnosing new ones. He is young, bright and passing exams with flying colours. He has "done" the diabetes bit already, so the knowledge he now has is how he will advise us.
SPOTTING DIABETES
Although he knows the criteria for formal diagnosis, he has been taught that with a random one-off blood test, anything below 11.1 is "normal". I explained that it would be extrememly rare for a "normal" non diabetic to be at that level, even after a full OGTT it is the max, and certainly requires further investigation. He has also been taught that a one-off fasting BG up to 7 is normal.
PRE-DIABETES
He has been taught that people are either diabetic or not, there is no such thing as a "bit" diabetic and therefore pre-diabetes isn't really a condition. It's simply a symptom of being overweight. Bet you all like that one!
DIET
He explained to me that a normal healthy diet was all that was required. I explained that the GDA for a non-diabetic is 300 grams carbs per day for a man. I asked "as its "GDA", it's presumably healthy, so is that ok for a diabetic?" Answer was yes, but of course I'd tell them to lay off all fats.
TYPES OF DIABETES
There are only really type 1 and type 2. Difference is that type 1's are autoimmune with failure to produce insulin. Type 2 is purely insulin resistance.

Accepting that he hasn't passed his exams yet, (but almost certainly will) and that what he has been taught is "hearsay" (but probably a fair reflection), what chance do we have? This is our new generation of doctors being taught this. The bright ray of hope in this was that he was incredibly and genuinely interested, accepted my points, could see and accept the arguments about carbs, wanted to know more about "types" of diabetes and "normal" BGs etc - until he returns to the arms of the brainwashers? We'll see.

 

[mehdave]

That is very very disapointing to say the least if that is really what the future generation of GP's are being taught around the country and really makes you want to bang your head against the wall as they clearly are not listening to all the recent developements and ways that we can prevent further complications with catching pre diabetes early :cry:

 

[dawnb64]

Very disappointed with this news and so glad that the GPs at my practice obviously don't work on these figures!

My impaired glucose tolerance was picked up with a fasting reading of 6 and a two hour level at 10.1, so presumably in his eyes I would not have any problems? I think that would mean that I'd be a long way off finding a reason for my unstable eyesight prescription.

From the printouts I got from my doctor, the healthy range appears to be 3.9 - 5.8 for a fasting BG. Not sure what advice I'll receive if/when I get within these limits but I can clearly see from the limited readings I've taken so far that there are some foods that cause more of a problem than others and quantities play a large part too. I can see that testing, even when 'normal' will be important as I experiment to see whether my intolerance has reversed.

Completely forgot on Friday that the bank holiday weekend would disrupt the post! Ran out of test sticks after breakfast on Monday so have been very careful over the last couple of days to try to avoid any spikes. These have now been delivered so I can start monitoring again.

 

[thrivebodybalance]

Unfortunately doctors are quite under educated in many regards, especially many chronic and autoimmune diseases, and anything at all relating to nutrition. The schools are generally quite out of date or following generally incorrect but long standing traditional positions. I've found the best doctors are those who continue studying hard on their own through their careers and see themselves more as diagnosticians than prescription writing wikipedias, to put it all in semi-dramatic terms. With the age of mass information and social media, more than ever we both need, and are able to educate ourselves and thats probably going to be our best option for health.

 

[SamJB]

I had a similar experience recently with my girlfriend's sister who got 90%+ in her doctor exams. She recently congratulated me on my hba1c, but told me to watch my cholesterol.

It annoys me, as a doctor of science (PhD), that doctors call "lipoproteins" (LDL and HDL) "cholesterol" when they are entirely different things. Lipoproteins carry fats and cholesterol around the body and into cells. Cholesterol definitely has nothing to do with heart disease, that LDL/HDL do is still debatable in my mind. It was all on deaf ears unfortunately and was told to pipe down by my girlfriend!

I find it staggering that doctors advise people on such matters when they dont know the basics themselves.

 

[Daibell]

I totlally agree that many GPs are out of their depth. Quite apart from out of date training there is no way they can be very busy generalists and then be experts in each area they come across. It's a nonsense but not about to change. When I lived in the USA, whilst there were GPs, many people selected their specialist doctor from the Yellow Pages and hence directed themselves to an 'expert' from early on. You didn't need to be referred by a GP to approach a specialist.