The Invisible Elephant In The Room

Meagan Esler

| Jun 2, 2014

Diabetes is the invisible elephant in my room on a regular basis. As a type 1 diabetic, I think about it frequently even if my friends, family, doctors, and the people I encounter daily don’t see it. While diabetes truly is an invisible illness, my blood sugars affect everything I do or even think about doing. My diabetes elephant is there all the time. That elephant doesn’t take days off or breaks. So when such an important medical issue goes unnoticed by a doctor after a lengthy visit, I see a red flag.

I was visiting my endocrinologist recently for a yearly checkup on my thyroid due to Hashimoto’s disease. Sadly, I’m not sure I’ll return to her. I waited for nearly an hour to see her.  During this time I filled the nurse in on the medications I take, including my diabetes medications and thyroid medication.    

When the doctor came in she kindly apologized for being late. Although the wait was not fun, I was okay with it. I was just relieved to finally be able to explain the Hashimoto’s symptoms I was still having. I hadn’t seen her in a little over a year since my first visit with her. She spoke with me for nearly an hour, for which I was thankful. I spoke about my other type 1 friends who also have thyroid issues and their treatment strategies that seemed to help them in hopes that they could possibly help me.  

She went on her computer to look up the blood work my primary care doctor had ordered so she could add hers to the system. She mentioned the additional tests she’d like to run. I continued to complain a bit about being tired all the time, and she said, “Oh, I think I’ll have them check your sugar level.”  I sat quiet and confused for a moment. Then I asked, “What do you mean, check my sugar level?” I mean, I check it each and every day already. She replied, “To check for diabetes.” I’m pretty sure the look of shock was all over my face as I said, “But I have type 1 diabetes – I’ve had it for almost 20 years.” She quickly replied that she had forgotten and that she doesn’t treat me for that so she simply didn’t remember.   

I was stunned. I know she’s human and that mistakes are bound to happen to all of us. I make plenty of them myself. Maybe I should have been clearer when speaking with her, but shouldn’t my diabetes “elephant” be visible to an endocrinologist? Shouldn’t a doctor who specializes in diseases of the endocrine system, including diabetes, catch the fact that I have diabetes? If not from the medications I take and the tests my primary care doctor had ordered, how about the fact that I had even mentioned “my friends that also have type 1, like me”?

I feel that diabetes should be a neon sign when it comes to medical care. Diabetes affects almost everything we do. The moments that make up our lives are ruled by how well or poorly our blood sugars behave in those moments. Diabetes makes everything more complicated in the medical world. Different treatments can affect our health and blood sugars.  

One person very close to me thinks I should give her another chance, while another person I’m close to thinks I shouldn’t. I’m torn. I like this endocrinologist, I really do, even though I felt like just another patient after that visit. Everyone is entitled to have an off day at work, perhaps this was just one for her?

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Categories: Blood Work, Diabetes, diabetes medications,, endocrinologis, Hashimoto, sugar level, thyroid medication, type 1 diabetic

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Posted by Anonymous on 3 June 2014

I think you should get a new endo, if possible. I mean, yes, people overlook things as part of being human as you said, plus there's SO many diseases and issues doctors have to learn about, but having Type 1 should be at the front of every doctor's concern, even when discussing a different/unrelated health issue. And she's not just a family doctor - she's an endo! I think you'll be able to find someone that's got it together better than this doctor.

Posted by jzaloom on 3 June 2014

I think that you should find a doctor who cares a little more about you. Usually a doctor reviews your file quickly before coming in the exam room. A quick glance should have told her that you are a diabetic. Your health is too precious for any screw ups. I know from experience. I had a doctor who never followed through with test results. I ended up with loosing 66% of my blood hemoglobin and could hardly walk ten steps without stopping and resting. That will never happen again to me.

Posted by on 3 June 2014

Have you ever taken one of those online vision "tests" where you focus on some object, and another object just disappears? There's a strong chance the Endo was focusing recall on everything she knows about Hashimoto's and the alternative treatments you mentioned, to the exclusion of patient data. If she treats you for all diseases top-down starting with diabetes and sees you more frequently, she'll be more likely to keep it forefront. A short patient profile you print up yourself with diseases, treatments, telemetry and new symptoms (eliminating the chaff on medical questionnaires) may help also.

You might find a book titled "Thinking, Fast and Slow" to be of interest. It has given me great insight to understanding the mechanics taking place behind other people's eyeballs. And my own. Fascinating, fun and entertaining...

Posted by Anonymous on 3 June 2014

Without a moments hesitation I'd kick her to the curb. Like you said, just from the meds you take she should have known.

Posted by Anonymous on 3 June 2014

To me, when someone essentially has your life in their hands, they have a certain responsibility to be aware of what's going on around them, no matter how many patients they juggle in a day. There is no room for bad days at work, and I would forget how much you might like her. Your life is not worth the risk, Meagan. I myself want to keep reading your story.

Posted by Anonymous on 3 June 2014

Did Megan ever have had an ultrasound of her thyroid ? It looks very enlarged!

Posted by Anonymous on 3 June 2014

Although I appreciate the difficulty of waiting and the shock of a specialist not recognizing that you already had diabetes, I think this MD deserves a second chance or at least kinder thoughts. All the problems you cite tell me this is an overworked MD - not her fault but a system problem. I was very disappointed when a client (I'm a therapist with Type 1 for 53 years) reported her MD's seeming lack of care about the impact on the family of her treatment for cancer. But a MD colleague/friend pointed out to me that these were signs of MD burnout. If the MD showed other signs of not paying attention, then I'd sure give feedback, but I am cautious about blaming the victim of an often dysfunctional health care system.

Posted by Anonymous on 3 June 2014

Unfortunately situations like yours are nothing new in today's medical environment. You don't say if you have managed care or if you're privately insured. My experience within my managed care system has been that I have to speak up about my ongoing condition(s) with any new doctor I see or even within established medical relationships. It's frustrating as hell, but I've been told to my face that the doctor simply has a overburdened patient load and can't be expected to remember individual details. So I've now become the final repository of my medical history & care - which on one hand is what it should be, but I still would like my medical advisors (which is how I now view doctors) to be rather more conversant with my medical specifics at/during appointments.

Posted by Anonymous on 4 June 2014

My Endo recognizes me out in pubic and remembers that I have Type 1 Diabetes. You mentioned that this is your yearly check up, but not how many years you've been seeing this particular doctor. I agree with the previous statements that all doctors have your medical information on your file. Most MOA's list the reason for your visit, so the doctor knows why you made the appointment. You appointment time is based on your annual check versus a prescription renewal (one hour). Hashimoto's is proven to be a related condition with Type 1, so the two conditions need to be worked out together.

Based on your detailed story, I would try one more visit. Why, because once my primary doctor was running late and my visit was rather vague like yours. I know this was not her usual visit behavior and remembered all the other good visits. When I returned the next time, everything was back to normal. Your Endo's blood sugar might have been low because she did not have any breaks and was working on an empty tank of energy. I find that it is easy for me to forget that normal people can experience lower blood sugar if they've been too busy to eat properly throughout the day-- it is not totally a diabetic problem.

If your second visit is similar, well then, yes, I agree, find another Endo!

Posted by Anonymous on 4 June 2014

Meagan, you are depending on this endocrinologist, to support you in managing your health. If she has missed something as important as your diabetes, what else may she have missed?

No doctor can assess a patient, with a narrow focus.

Of course, you can still like this lady. She is probably very pleasant. But you need more from your doctor than a pleasant personality.

I think you should move on from her.

Posted by on 5 June 2014

"Managed Care" - ha. WE are the managers. I suggest that as educated patients, our needs and expectations from specialists differs from the norm. FIRST, we want specialists to provide to us, an array of options for a specific issue/symptom/illness all on its own merit, drawing from their specialized focus and greater experience in that area. And then SECOND to whittle that array of options down in consideration of each of our other issues/symptoms/illnesses. Making sure each item on our list gets punched is where we as care managers come in.

I'm uncomfortable either way; with a doctor voicing incorrect assumptions and with (me) making assumptions that a specialist considered me holistically. But at least when mistakes surface during a consultation, I know a relationship of honesty and candor exists; this doctor thinks transparently and teams with the patient. I avoid the alternative - the arrogant, doctor knows best...

Posted by cpiteira on 5 June 2014

I suggest you to get another doctor. But the life is yours.

Posted by mandabell on 7 June 2014

For me it would depend on how apologetic she was and if she recognised what a terrible boob she had made and if you felt you had a good human relationship with her.....but probably not much good on these scores, in which case I definitely agree with the majority! However it is just possible, that if she's the right sort of person and was also experiencing a VERy bad day that day, her error might make her much more attentive in the future...

Posted by Anonymous on 10 June 2014

We are talking about your health, your body, your life! While your endocrinologist may have just been having a "bad day", that is no excuse for such a blatant error. Type 1 diabetes is a very dangerous illness/condition. It must be properly managed. And for goodness sake, it must be part of a medical workup. Red flags go up in our lives, we should take heed of those flags. You got one from your doctor. Now you should get another doctor.

Posted by Anonymous on 14 June 2014

I had an endo in Phoenix who would not listen to me when she had her mind determined on one type of treatment. I ENDED UP IN A COMA FOR OVER 6 HOURS LYING ON THE COLD GROUND FROM 2 a.m. to 8 a.m. when someone came out to go the work! My first and only coma in over 30 years!!! The ER doc said less than 30 min more lying there and my body core temp would have been so far gone along with my blood sugars that they could not have revived me EVER! It only took them 2 hours in the ER with 8 heating blankets and 4 D-50 doses to bring me around enough I could tell them what had happened! And that was after I had personally eaten 10 glucose tabs, 15 pieces of hard tack candy, and a large apple fritter trying to get from my car to my apartment when I registered 40 on my meter! Needless to say---I did not make the apartment! So, no, even if she is apologetic, burned out, whatever the excuse----IT COULD BE YOUR LIFE NEXT TIME THAT SHE DOESN'T REMEMBER YOU HAVE TYPE-1! Don't risk it!

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