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Wednesday, June 17, 2015

On training future ophthalmologists

I am fortunate to have to opportunity to help train our ophthalmology graduate students at one of the top-two ophthalmology programs in the country! Very exciting!
In fact, training graduate students of all sorts is a typical job for postdocs like myself. In case you are not familiar, a postdoc is someone who just/recently received a Ph.D. and takes on a training opportunity (usually ~1-5 yrs. in a typically academic research environment) prior to pursuing a "real" job (such as a professorship or other). Also: postdoc = underpaid slave = TRUE

Anyway, as a diabetic I am especially interested in eye physiology/disease and especially on fostering connections/mutual understanding between doctors and patients as much as possible in order to improve the quality of care and help improve human health in general. Thus, last year, when I was offered a postdoctoral position in the college of optometry at a major state university, I did not hesitate to accept. But until recently, I never considered how working in an optometry clinic fundamentally connected me to diabetes/PWDs/people who know about diabetes. And specifically optometry students, who are already and will continue to be seeing PWD's for the better part of the 21st century. And I have a chance to make a difference in their training. On both a professional and a personal level.

Case in point: I shared my type 1 diabetes with my graduate student. Here's the biggest thing I realized as we discussed - the absolute lack of knowledge of how grueling the management can be. Here is a brief snapshot:

Him: Yeah, people who don't manage their diabetes - it's crazy - we've had people pass out from low BG - so we always have juice boxes on stock - and soooo many people don't even know what their HbA1C is! I am just happy to hear when my patient KNOWS what their A1C is because it shows they are managing their condition. The A1C gives so much more information than just the last number, you know?! Some of my patients tell me their last number and I sometimes wonder if they're lying. But if they know what an A1C even is, that means they really care so...  [he sounded so excited and knowledgeable... Yes, I know..]

Me:Yes, it's important to know your A1C. I also need to point out that the last number is not at all reflective of a person's care. Blood sugar swings are very common, especially in people who use insulin. Additionally, people can and do lie about their A1C. The thing is, sometimes when we see a doctor, we can feel very judged about our numbers, especially if we don't feel like the physician understands how much we care, and how difficult the management is.

(For instance, I once had a physician rattle off all the possible effects of having a slightly higher than "acceptable" last bg value/A1C. She did this in a very pedantic and accusatory way: "Oh, so you're an UNCONTROLLED DIABETIC??!!... Did you know that Diabetes is the leading cause of blindness??" Those were actually her exact words. I still remember her tone as she lectured me and handed me a handout of what my vision will probably look like since I'm such an uncontrolled diabetic... UGGHHH... [on the bright side, I learned a lot about how awesome the #doc is that day, as I tweeted about the appointment. I also confronted her; she apologized, and I can only hope I saved even a little aggravation and hurt feelings for her future diabetic patients.]

Him: Here's the thing. We HAVE TO tell you everything that can happen. We (the doctors) are paranoid. Did you know there was actually a diabetic woman who went blind and sued her eye doctor and won?! All because he didn't tell her the blindness would be permanent!!

Me: Wow, I did NOT know that.

The takeaway for me is that they have a long way to go in REALLY understanding - in particular - how difficult management is (sidenote: grad student has a t2 diabetic mother who is controlling with pills and diet currently, she was a nurse/professor of nursing!). The truth is there is a lack of empathy training. I don't know if it's all chronic diseases, or if it extends to oncology, etc. but that's the way it is.

Bottom line of their side is: They hear "diabetes", so they pull out a long checklist, and will rattle off all the necessary information not to get sued...

Sad but true. The good news is I am in position to make (an albeit) small difference - one at a time - and isn't that how it all starts? With anything?

On a completely different note - I am traveling to Europe this week - it's been calling my name for the last 5 years :) I will see you in July ["July - she will fly" - April, come she will by Simon and Garfunkel - lyrics below and if you're not familiar for the love of everything - YOUTUBE!]

Con mucho amor, como siempre

"April Come She Will"

April come she will
When streams are ripe and swelled with rain;
May, she will stay,
Resting in my arms again.

June, she'll change her tune,
In restless walks she'll prowl the night;
July, she will fly
And give no warning to her flight.

August, die she must,
The autumn winds blow chilly and cold;
September I'll remember
A love once new has now grown old.

1 comment:

  1. Congrats on the opportunity! Keep up the amazing work and enjoy your time in Europe!