Shocked by MD care of my patients

allnurses Guide · May 13, 2015

That's more than a little scary! My general experience as a patient and a physician has been that both NPs and MDs not directly involved in diabetes care do lack an understanding of current treatment options. Our fast track where I work is staffed by NPs (that is how I ended up on this forum) and they tend to have lots of questions for me regarding my pump and CGM. MDs should graduate from medical school with a solid understanding of diabetes care but it is a major problem if that is not happening. The USMLE is supposed to ensure that so it is very concerning that residents are not comfortable with the DM education they have received. That said, I personally prefer the use of CDEs for diabetes education because that is what they are trained to do and they tend to have longer appointment windows to provide more in depth education and support.

In my experience most residents, novice physicians, and novice NPs/PAs can all provide adequate DM diagnosis and treatment. I do think that many NPs, especially experienced RNs, do a better job with the teaching aspect with patients. I think this is why the outcomes studies on DM demonstrate favorable outcomes.

greygooseuria · May 14, 2015

That's more than a little scary! My general experience as a patient and a physician has been that both NPs and MDs not directly involved in diabetes care do lack an understanding of current treatment options. Our fast track where I work is staffed by NPs (that is how I ended up on this forum) and they tend to have lots of questions for me regarding my pump and CGM. MDs should graduate from medical school with a solid understanding of diabetes care but it is a major problem if that is not happening. The USMLE is supposed to ensure that so it is very concerning that residents are not comfortable with the DM education they have received. That said, I personally prefer the use of CDEs for diabetes education because that is what they are trained to do and they tend to have longer appointment windows to provide more in depth education and support.

I agree with all of this. During NP school, I had lots of connections with docs so I was able to do inpatient rotations, ICU, cardiology, etc. and I was able to do 2 semesters with an ANP who is also a CDE doing ONLY diabetes management and I also did a semester in pediatric diabetes. I can manage pumps in my sleep and love when patients have them. I prefer them to injections. We had lots of type 2 diabetics on them plus all of the type 1s, but they seem to scare a lot of people. The NPs I did these rotations for were amazing; they managed all of the diabetics in the practice, and all of the MDs loved them because they had everyone's A1Cs under control (which is easy to do when the practice lets you have 40 minute to an hour long visit with each patient).

Edit to add: Diabetes is the thing I am most passionate about clinically so I came off a little snippy in this thread and anti-MD perhaps, which is off for me since I LOVE the docs I work with (well...most of them...the ones that attended a US medical school, but that's another topic for another day). My experience has been that many providers just don't educate patients well. I sat down with a family this week to explain why their relative who had never been on meds before was now on 6 post-MI, and nobody in the hospital had explained what any of them were, what the physiology of the heart was like post-MI and why these were needed. It took me 2 hours, but after that, they GOT it and were fully on-board whereas before they wanted to stop all meds and take them home.