Last week I had an appointment with my endocrinologist that was one of the most confusing and frustrating appointments I’ve experienced in my life with diabetes.
It had been a while since I’d seen my doctor due to some unusual circumstances. Before my last appointment, the endocrinologist had ordered some blood work and other tests to be completed. I got the tests done and anticipated finding out more about the results. A few weeks later, knowing my appointment was coming up but not remembering the exact date, I was thankful when I got the reminder phone call from the office. Or at least I thought it was the reminder call. It was actually to notify me that with barely 24 hours notice, the financial backers of the practice had removed their funding and the offices were closed.
Fast forward to last week, I finally made it back into the office. The previous office had an enormous waiting room with plenty of seating. The new office was a completely different experience.
When we finally went over the blood work from months ago, it was like the nurse practitioner was looking at each number individually without any thought of how they could fit together or the reasoning for any of them.
For example, I had lost about 20 pounds since the last time they saw me (remember this was last summer, so it was far from sudden or dramatic loss). She asked if I had done anything differently and I explained how I had made changes in my diet and overall felt so much better. She repeated that she worries when they see “unexplained weight loss.” If I offer an explanation right before you say that, I think that maybe you aren’t listening.
Next, the nurse came back in with my finger prick A1c result. I don’t trust those results on a good day, so I was already skeptical about the number. The only reason I let them draw it was because it had been so long since my last lab work. With me in the exam room was a full report with my meter download and a full Dexcom report. I use one meter and I wear my Dexcom 24/7/365. That is why I flat out told the nurse practitioner that the A1c result was wrong when it came back a full A1c point lower than my Dexcom average would suggest – which would be equivalent to about a 30-40 mg/dL difference in average BG results. That is a BIG difference!
Instead of questioning the A1c, she poured over my Dexcom reports finding lows to be fixed. Lows had to be artificially reducing my results, right?
It wasn’t until I was back in my car on my way to work that I was able to put the pieces together myself. One of my out of range lab results from months and months earlier indicated that I was anemic. If I have in fact been anemic for the entire time this A1c result was measuring, it isn’t took far of a stretch to assume that my A1c result would come back erroneously low, is it?
I have had good experience with this endocrinologist in the past; so at this point I am willing to let this go as a bad day in a busy “new” practice.
But I do think this was a perfect example of the many times when actually listening to a patient might be the best medical treatment available.