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.