Dr Michelle - GPs or Endocrinologists (Endos) ?

Dear Dr Michelle,

In Reality Check's new column, our favourite GP, who just happens to have diabetes, Dr Michelle ponders some of the stuff they didn't cover in med school.

This month she answers a reader's question:

I have Type 1 diabetes and I just use my GP for scripts and any questions I have. He's a really nice guy and it works fine for me.

But I hear that I should be seeing an endo? Why's that?

I don't know what an endo could offer that my GP doesn't?

OK.... Basically, the difference between a GP (General Practitioner) and an Endo (Endocrinologist) is this:

• A GP has done about 6 years in medical school at university (depends on state and country), then 2 or more years in general jobs in hospitals, then about 3 years working in general practices before sitting an exam. So they know a bit about everything - some know more about diabetes than others, depending on past and personal experience and interest. I was crap at diabetes until I got it myself - so try and find a GP who has the same disease/s as you!

• An Endo has done about 6 years in medical school at university, then 5 or more years in public hospitals, first in general medicine (anything but cutting) which sometimes includes some time overseas. They do exams in general medicine then decide to specialise in endocrinology, which isn't just diabetes, it's the study of hormones or slow chemicals that float around the blood- one of which is insulin. Maybe they have done some research in endocrinology too. Then some of them specialise in diabetes or in thyroid problems or maybe sex hormones, etc.

  An endocrinologist should know a fair bit of detail about diabetes and similar problems but nothing about snotty kids, operations, plastering your broken leg or how to deliver a baby!

So if your understanding of diabetes is pretty good, your control is OK (HbA1c under 7), and you are happy with your GP, then stick with it.

But if you find you have questions that your GP can't answer in detail, or you want extra help fine-tuning your control, or you want to know the latest and greatest treatment and research news, then go and see an endo too.

I emphasise too as you will still need your GP for prescriptions of insulin from time to time, general advice, and any problems that don't involve insulin.

Your GP may also suggest you see an Endo if they need some help sorting out your diabetes control or if you need someone else to whip you butt! Or of course if they are not sure of all the answers themsleves or of course if they just don't like you and want you out of their office!!!

You will also need a GP to write a referral letter to the Endo so that Medicare will pay for most of your Endo appointment costs.

So, how do I find an Endo?
You can go to the Endo outpatients (not a person in a hospital bed - which is an inpatient of course) clinic at public hopsitals but you might see a different Endo each time or an Endo-in-training, called a registrar - who are still pretty cluey. This should not cost you anything. To make an appointment, look up your hospital in the White Pages and call their appointments department.

I think it is easier to see the same person each time. You can try your luck and ask at outpatient clinics to see the same doctor you saw the last time, but you can't be sure they will be there that day or you might have to wait longer than normal. The easiest way to see the same person is to go private. Reality Check has a list of endos to get you started, or ask your GP. You will probably have to pay at the appointment (ask the receptionist when booking how much it will cost) but you will get a fair whack (about $40) back from Medicare pretty quickly.

Anything else I need to know?
Have a think about a diabetes educator (usually a nurse who has specialised in diabetes advice) or a dietician - someone who has studied nutrition and is not usually a doctor or nurse.

But the best person to control your diabetes is YOU! So hit the books, ask lots of dumb questions, check you sugars!! And write them down with other info like exercise and what you ate so you can figure out a pattern to your readings and eventually it will all make sense and you can get most of your sugars in the brilliant level of 4-6!

All the best,

Michelle

Published March 2006

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