Though it may not seem like it, making the transition from your pediatric endocrinologist to an adult provider is a big step. CDN has compiled a list of actions to take during the transition process to ensure that you have the best experience possible at your new doctor, and that YOU are getting the most out of your appointments and your health care team. (You can find the printable version here.) Don't worry - you'll be fine!
REASONS TO BEGIN LOOKING
- You attend school hours away from home and are unable to see your health care provider(s) as regularly as you would like.
- You’ve aged out from your pediatric provider.
- You feel guilty and/or not empowered after leaving appointments.
- You feel your health care provider doesn’t understand or is unable to help you.
HOW TO FIND AN ADULT PROVIDER
Finding the right provider, especially when you are transitioning from pediatric to adult care, can be a lot like dating. Personality types, approach to diabetes management, priorities, and location are all important points to consider. Talk to your doctor about what adult providers he/she thinks would be good for you based on your personal diabetes care, personality, and interests. Read reviews of health care providers online. Ask friends. Make a decision. Schedule an appointment.
The awkward first date
Here are some questions that you should ask your potential new doctor.
- How much time do you spend in an appointment?
- Do you have a team that you work with? CDEs, exercise physiologist, nutritionist, psychologist, social worker, etc?
- What do you focus on in appointments?
- What do you think are the most important parts of diabetes care?
- Do you volunteer at any diabetes camps/programs? If you haven’t, would you be willing to?
- How much personal experience do you have with Type 1 diabetes?
- How open are you to new technologies and research?
- Who is on call when you are not available?
- How available are you between scheduled appointments and can I stay in contact with you remotely?
*Six Until Me has a great blog post on this topic. Check it out.
LAST MEETING WITH PEDIATRIC/FORMER PROVIDER
Discuss any concerns you may have
During your last appointment with your soon-to-be former care provider, talk to him/her about any concerns or questions you may have regarding transitioning to a new doctor.
Transfer patient information
Make sure your former provider’s office transfers your medical records to your new doctor.
FIRST MEETING WITH ADULT PROVIDER
Find out what you’ll need before the appointment
Some doctors require you to have lab work done prior to your appointment, while others do it in office. Since it’s your first appointment, you’ll probably have paperwork that will need to filled out and mailed back before you get there. Make a call to your new doctor’s office and find out exactly what you need to do before getting there.
Write down all your questions/concerns, and topics to bring up
It’s easy to forget, but your doctors exist to help YOU. Below are some questions that you can ask yourself to try to help you figure out what exactly you WANT from your healthcare team.
Another way to do this is by writing a letter. Whether you actually give it to your provider, or just keep it for yourself, the exercise of writing the letter can provide insight into what you want/need from the relationship. Here are some ideas on what to include in a letter to your healthcare provider.
- Here is my diabetes perspective, and this is how I think about , approach, and talk about diabetes…
- These are the questions that I would like you to ask me…
- These are topics that I would like to discuss with you at some point (maybe not right away, but down the line… Pregnancy, Preconception planning, Sexual satisfaction, Exercise, Weight loss/management, Alcohol, New technologies that are available)
Bring everything you need
That includes all of your diabetes supplies (meter, CGM, and pump), your insurance card, and any other paperwork that the doctor’s office requested.
Ask questions & discuss your concerns
Bring up everything that you wrote down on your list. In addition, here are some questions that you may want to tell your doctor to ask you.
- What is the most challenging time of day for you?
- Are there any activities that you are struggling to manage blood sugars with?
- How does your A1c seem in comparison with how much work you are putting into it?
- What are the social barriers to managing your diabetes right now?
- What motivates you?
- What are your goals?
Bring a friend or family member to the appointment with you
They can be your support system before and after the appointment.
Be open and honest with what you want and expect from your relationship
That might be a kick-in-the-butt, or acknowledgement and support. Either way, BE ASSERTIVE!
Make any/all adjustments that your doctor has prescribed
It’s easy to leave the doctor’s office and forget about the changes you said you’d make. Program all of the technical adjustments into your pump as soon as you leave* (or during the appointment!) and make sure everything else (equations, ratios, basal rates, etc.) is written down for future reference.
*If you are finding you are hesitant to implement their advice, it might be a red flag to look into other providers who better align with your management style.
EVALUATING YOUR FIRST VISITS
Did you like your new doctor?
Do you feel more empowered about your diabetes care than when you walked into the appointment? Did the doctor help you to address the questions and concerns that you brought to the table? These are really important questions to ask yourself. If the answer is no, then find another doctor. Having a doctor you connect with is essential to your diabetes management – and no one deserves to feel worse after seeing their endocrinologist.
Schedule your next appointment
Whether with the same doctor, or a new one, schedule your next endocrinologist appointment ASAP so that you don’t forget. Write the appointment down somewhere that will help you remember it – maybe your phone, Google Calendars, or your school assignment pad. (You can always reschedule later if you need to.)
"My school is in a rural area, I don’t have a car, and the endocrinologist is hours away”
- Ask your friends with cars if they’d be interested in going on a road trip.
- Schedule your appointment around the same time as another Chapter member and carpool together
- Schedule appointments to take place while you’re at home for breaks or holidays.
- Explain your situation to your doctor and ask if they can do virtual check-ups.
“I know that my HbA1c is not where I want to be and I don’t want to feel worse than I already do about it.”
- Your doctor’s job is to help you better manage your diabetes and identify what’s not working. If your doctor is making you feel guilty, consider finding another who supports you.
"I don’t have enough data for a constructive appointment. (e.g. I don’t check frequently)"
- Again, it’s your doctor’s job to help you better manage your diabetes and identify what’s not working. A good doctor will help you figure out how to get back on track. As you know, diabetes isn’t just all about the numbers. You should be able to have a productive appointment with your doctor, even if you’re lacking a large amount of data.