Monday, April 14, 2014

Professionally Insulted


There are only few moments in my life that I wish I could go back to in order to defend myself properly, or to shoot that perfect comeback, or to say what I was really thinking. I had one of those moments recently.

There is a teenage girl that I follow in clinic who has struggled greatly with the diagnosis of diabetes, among other things in her life. That slap-in-the-face feeling you get at diagnosis never quite left her. Her family is very supportive but her social situation is somewhat tumultuous given that she has many siblings, several of whom are struggling with their own medical issues. She always gives me the impression that she is flailing and unable to grab onto any lifesaver thrown her way.

I try especially hard to forge a connection with her at each office visit, because I know first-hand that difficulty in adolescence can create a slippery slope to long-term poor diabetes control. I chip at her hard exterior until I make a small dent, but there is never enough time in a visit to chisel all the way through. She sees counselors regularly, but I feel that we are losing her.

One day not long after one of her diabetes appointments, she and her mother argued over one of the many small details of diabetes and it quickly blew up into a screaming match. My patient ran away from home, though it seems more likely that she was just trying to run away from diabetes. The police soon found her, and they also found the marks on her arms where she had been regularly cutting herself. She was admitted to an inpatient psychiatric unit, at which point I was contacted by her mother. Her mother wanted me to discuss her diabetes care with the on-call psychiatrist because he was limiting what types of foods she could eat and had drastically changed her doses. 

I reached the psychiatrist, expecting to discuss technicalities of glucose measurements and insulin units, but the conversation went in a direction I was not expecting at all.

"Oh yes, Dr. Bialo. I've heard of you because the patient has mentioned you a lot. She likes you because you also have diabetes," he said.
"Oh, that is good to hear, " I responded.
"I also have diabetes," said the psychiatrist, "but I would never tell her that. She needs to understand that there are people out there that care about her well-being alone and not just because they have something in common," he said. 

His words took my breath away. Within seconds my emotions spanned shock, offense and anger. I realize that counselors, psychologists and psychiatrists have to meter what they share with patients because a deeper connection can actually harm treatment in certain situations. But that does not apply to my profression, at least not in the same way, and I took his explanation as mean and unnecessary. 

I ignored his comment and moved the conversation toward her medical treatment, but have regretted it since. In an effort to keep things professional despite his unprofessional comment, I feel I let both myself, my patients, and his future patients down.

5 comments:

  1. I don't know, Shara. Perhaps psychiatrists tend to see patients turn the conversation to be about the doctors and not about the patients, and this one doesn't want to see that happen. Or maybe he doesn't want the word of his diabetes getting out, and for other potential patients to (improperly) view it as a weakness. Maybe it's just the ethical code of psychiatry.

    I have really no idea if he should have said that, or if his words would ring true or not. It's definitely something to think about.

    But the way this patient responded to you, really liking you because of this commonality, goes to show that what may work for one does not necessarily work for another, and you can't just paint a broad brush -- an endocrinologic or a psychiatric one -- across all patients.

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  2. First of all, as a patient, I would always want my MD/DO/NP/DM/counselor/psychiatrist/whatever to tell me if they too had diabetes, and I think it's great that you do that in situations you consider appropriate. I do see the mental health aspect of it for the other physician, given they're trained that way, as you well know. I do think he was quite unprofessional in that he judged/insulted your own ability to decide what's best for your patient. In the end, you know what they say opinions are like ;)

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  3. There's a big difference between a doctor saying "I have diabetes too and have been living with it for 20 years" and "I have diabetes and sometimes I don't take insulin to help me lose weight even though I know it's bad for me and I have high blood pressure and I can't find time to exercise because my hours at the hospital are so crazy." (Or whatever personal problem.)

    Having an endo with D would be SO COOL.

    He sounds like a dickass. But maybe he meant it more in the spirit of "I wish I had not become a psychiatrist because I really, really want to talk about myself and I am struggling to hold it all in."

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  4. I am a licensed clinical psychologist and a parent to a T1D. Wow the psychiatrist was really out of line and acted like a real jerk. It's such an old-school approach, too, to be a "blank slate" and not disclose anything to the patient. There is no evidence to support that this approach is helpful to the patient, and there are ways to make appropriate personal disclosure that benefit the patient. Yes, we have to carefully consider what and how much we share, but it does not mean that we cannot or should not share anything at all. There are times when limited personal disclosure is extremely helpful to the patient. If I got a child/teen patient with T1D I think I would most likely disclose that I have a child with T1D.
    Also, typically psychiatrists see their patients for all of 15 minutes every few months. They hardly build deeper relationships with them. This guy was so full of it.

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  5. I remember being a teenager and hating having diabetes. Somehow, my control was actually quite good, but that doesn't mean I didn't have an attitude problem. And I will admit that I honestly don't think that having an endocrinologist with diabetes would have helped me any from a psychological standpoint - I just didn't connect with adults. What I do think may have helped was a diabetes camp, where I could connect with people my age with the condition. I think that my isolation, being the only T1D I knew was what really fueled my issues.

    But knowing me, someone would have suggested going to camp and I would have told them to eff off. I would probably have had to be forced into going....

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