xDoctor Appointments and Tips

Annual Schedule for Doctor Appointments
As part of the Death to Diabetes Wellness Program, we recommend that you meet with your doctor(s) on a regular basis.

You should ensure that you set up the necessary doctor appointments during the calendar year as specified by your doctor (Primary Care Physician).

If possible, try to schedule your appointments during the same time period each year.

The following is a list of the key doctor visits that you should complete during the year if you are diabetic.

Visit	Purpose	Frequency
Primary Care Physician/ Endocrinologist	Check blood glucose, hemoglobin A1C, kidney tests, nerves (foot exam)	Every 3 to 6 months
Primary Care Physician	Physical exam; Other tests: blood pressure, cholesterol, kidneys, liver	Annual
Ophthalmologist	Eye tests for retinopathy, cataracts, glaucoma	Every 6 months or annual
Health coach; Dietitian/Nutritionist	Wellness planning; Nutritional planning, etc.	As required
Dentist	Cleaning of teeth and gums, dental examinations	Cleaning: every 3 mos. Exams: annual
Podiatrist	Examination of feet for nerve damage	Every 3 to 6 months or as required

You should visit your primary care physician and/or endocrinologist on a regular basis to review your progress, your blood glucose readings, corrective actions, and other notes – at least until you have your blood glucose level under control. Depending on your health needs and your health goals, you should get a complete physical and set of blood work every 6 to 12 months to identify any trends that may be getting overlooked, especially if you’re not making any significant improvements.

Depending on your health needs and your health goals, other members of your diabetes care team may include one or more of the following: cardiologist, neurologist, nephrologist, physiotherapist, naturopathic doctor, or psychiatrist. Other members may include a wellness coach, diabetes educator, pharmacist, community health nurse, or social worker.

If you really want to get more out of your doctor appointments, read the following guidelines and tips for things that you can do before, during, and after your appointment.

Before Appointment

Research any medical conditions or concerns you may have, by gathering information from reputable websites. Generally, government health websites and those maintained by medical associations, large nonprofit groups dedicated to a single medical condition, and university medical centers have the most trustworthy, up-to-date medical information.

Make notes and write down any questions. However, don’t hand your doctor a huge sheaf of printouts and expect her to respond to them during your visit. And don’t try to diagnose your symptoms or self prescribe your remedies. It’s still up to your doctor to do that.

During Appointment

One of the best ways to manage your diabetes is to develop an effective working partnership with your doctor. Your doctor’s role in this partnership is to provide medical advice, offer treatment options and recommend resources. Your role is to monitor your symptoms and blood glucose readings, report them accurately and do what you can to manage your disease on a day-to-day basis.

Doctor appointments are very important, but most people come ill-prepared to take full advantage of the time with their doctor. Then, they complain about the doctor not taking enough time with them.

Or, they don’t ask the doctor any pertinent questions; or, they don’t bother to take any notes and forget what the doctor told them. The doctor could spend more time with them, but they must first take full advantage of the time that they have with their doctor.

Then, they will be pleasantly surprised how well their doctor responds when they take a more active role in their health.

The following is a set of guidelines to help improve the effectiveness of your appointments and the relationship with your doctor. If you are unable to establish a better partnership with your doctor, let him/her know your concerns. If there is no improvement, or you have a concern with taking drugs, consider talking with a doctor in the field of alternative medicine, e.g. a naturopathic doctor (www.naturopathic.org); or, work with a diabetes wellness coach who has a medical background.

General Planning

Take responsibility for your own health. This may include making necessary lifestyle changes, eating healthy foods, getting enough exercise, maintaining a healthy weight, stop smoking, stop drinking alcohol, and stop using recreational drugs.
Ensure that you understand and are completely comfortable with the doctor’s diagnosis of your health, your diabetes, and any other disease/ailment that you may have at this time. A proper diagnosis will enable you to focus on the proper actions that need to be performed to improve your health. An improper diagnosis will lead to incorrect actions, frustration, doubt, and eventually hopelessness. Ensure that you have obtained all the necessary medical diagnostic tests that will provide a correct diagnosis.
Key Point: Ensure that the treatment is being designed to repair your body, specifically, the defective sick cells in your body – not just to treat the symptoms of high blood glucose levels.
Post the phone numbers for your primary care physician, endocrinologist and other healthcare professionals by your telephone, along with a list of your current medications, other medical conditions and allergies. Call the doctor right away if you experience a sudden change or your symptoms get worse.
If possible, have doctor appointments and the applicable tests performed at regular intervals to prevent confusion and complications. If you have not had a specific test within the recommended interval, ask your doctor about it.
You should bring your records to the appointment. What if the electronic medical record is down? What if we can’t find your chart? What if you see a doctor in a different system? Although exceedingly rare, problems do occur.
Your family doctor will manage most of your diabetes care, but you may be referred to other medical specialists when necessary. For instance, you may be referred to an ophthalmologist for a dilated eye exam or a podiatrist for foot care. You may be referred to an endocrinologist if managing your diabetes is particularly difficult. Your family doctor and other medical specialists work together as a team. Don’t hesitate to ask for a referral if you think it is necessary.
Work with your doctor to set reasonable goals for your blood glucose levels, A1C, blood pressure, cholesterol, and homocysteine (if applicable).
If you need to find a new doctor or you need information about your doctor or local hospital, go to one of the following websites:

Contact information for your state’s board of medical examiners (address, phone numbers, website): www.fsmb.org/members.htm
Information about the rating and performance of doctors, hospitals, and nursing homes: www.healthgrades.com
Government and nonprofit health and human services information, with links to 1,500 health-related organizations: www.healthfinder.gov

Doctor Appointments

The relationship between you and your doctor is a special one based on trust and mutual respect. It is important to ask questions that concern you — up front. It is normal to feel uncomfortable about discussing certain topics, but, if you don’t tell your doctor, he/she can’t help you.

During the appointment, become an active participant in your health planning. Communicate your health goals and concerns at all times. If you show interest, your doctor will be more inclined to provide more help and information. But, if you don’t show a vested interest, why should your doctor?

Be honest about whether you’re following recommendations about diet, lifestyle and taking medications. Your doctor can usually tell when you’re not telling the truth. Also, your doctor can suggest strategies to help you get on track.

Start with your major concern first. Waiting until the end of an appointment to discuss an important problem may mean it won’t get proper attention.

Be specific about your symptoms and pay attention to details. Things that don’t seem important to you may be important to your doctor. The American Society of Internal Medicine has concluded that 75 percent of correct diagnosis depends solely on what you tell your doctor.

Speak up but be respectful. Make sure from the outset that your doctor knows you have questions and concerns and expect to be listened to. Don’t be afraid to be an active and assertive patient. If you don’t understand a word, idea or direction, ask your doctor to explain.

Ask specific questions. You can’t make good health-care decisions if you can’t understand the information provided or aren’t given enough information. If a question is crucial, ask politely but firmly for an answer before you leave. At a minimum, you should ask your doctor the following questions:

What is my diagnosis or what is my current state of health based on my physical exam, blood work and other health information?

Note! If you have multiple diseases/ailments, ensure that your doctor has taken that into account concerning your diagnosis. For example, a person with high blood pressure and high triglycerides should be evaluated for root causes that are common to both ailments instead of being given separate drugs for each ailment.

What are the root cause(s) of my current diseased health state? (It is very important to understand what is causing your health problem!)

What specific corrective actions do I need to take to improve my health through natural means (without drugs/medications)?

Note: If you decide to take drugs, ask your doctor how long you have to take them and what are the long term effects of the drugs.

What is my prognosis? In other words, what is the doctor’s projection of your future health state given his knowledge, expertise and the corrective actions you plan to take or have been taking?

Request additional tests if your doctor is puzzled with your health state. For example mineral tests, hormone tests and hair analysis tests (although controversial) can be invaluable in many cases involving fatigue, chronic pain, cognitive/memory, emotions, hyperactivity, violent behavior, learning disabilities, attention deficit disorder, high blood pressure, cardiovascular disease, osteoporosis, arthritis, neurological disorders, weakened immunity, hypoglycemia, diabetes, weak finger nails, and unhealthy skin and hair.

Ask your doctor to be honest with you about what you can expect to happen over the next few weeks, months and years.

Ask your doctor to tell you the three most important things you can do to manage your health condition.

Work with your doctor to develop an effective treatment plan. There may be times when you just don’t think you can do what your doctor advises. Don’t walk out in frustration and ignore it all. Work with your doctor to find an alternative that is acceptable to both of you.

Bring all your medications including over-the-counter drugs, vitamins and other supplements to your next appointment. To avoid drug interactions and over-medication, make sure that your doctor knows about every drug, vitamin and other supplement that you are taking.

Before you leave the office, know what you should do when you get home. It’s difficult to recall everything a doctor tells you, especially if you’re nervous or worried. Ask your doctor to write down the important points. Know who to call, and when to call, if you run into any problems.

Ask for copies of your lab results at your visit. This way, you can keep an accurate health history.

Understand how well you are progressing and what actions to take, based on your doctor’s diagnosis.

Don’t forget to follow up with your doctor after the appointment, especially, if there was something that you didn’t understand.

If this isn’t working to your satisfaction, don’t sit around and complain about your doctor. In most cases it’s not your doctor’s fault, so make sure that you are doing everything in your power to improve your health. Discuss your concerns honestly with your doctor. If you are doing your part, and the relationship with your doctor has not improved, or your health is not improving, then, find a new doctor.