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From Ontario, California, USA:

My three and half year old daughter, diagnosed with typeá1 diabetes three months ago, has a diabetes team, but we seem to have problems with communication. I was told to make changes and to call back on three days later to report the blood sugars, which I did. The following day, I left a message since I did not get a call back, and then left a not-so-nice message the next day on the voice recorder after which someone returned my call two hours later.

Is it unreasonable to expect a return call from the team within 24 hours? I realize that my daughter is not the only patient, but I am getting increasingly frustrated and am considering looking for a new doctor. What is a reasonable amount of time to expect a call back when I leave a message reporting blood sugars?


This is difficult to answer as it hinges on the number of staff in the doctor's office (the number of doctors or nurses available at a certain time), and certainly the number of patients they have. As an example, in my university practice, I have one MD associate, no Certified Diabetes Educators in the office, a part-time nurse, and another nurse who works primarily with the state-supported child health services. I would love more help, but the university has a budget. We care for nearly 800 children with diabetes children, in addition many more with other problems. My associate and I see patients generally everyday. I presume that your daughter's diabetes team may have similar circumstances. So here is our approach: If families are simply reporting glucoses and are not really asking anything specific other than "are these values all right?", then we don't call back with the family's understanding that "no news is good news." If we don't like the glucose pattern, we call. The potential problem is that you don't know if we actually received the message.

Ask your daughter's team if they would be willing to fax back or e-mail a comment, if you sent data those ways, but with the understanding that your child's data may not be secure from others as there is a risk of loss of privacy. Of course, you could not take advantage by flooding someone's e-mail account.

Certainly, if you have a pressing question, and relay it as such, I think a response within 24-48 hours is very reasonable. If it is even more pressing, you can probably call after hours, as I imagine someone is on-call. If there is a very urgent problem (e.g. high glucose with ketones and vomiting), and you relay that in your message (I'd ask you leave it with a person and not a machine), you should expect a response with an hour or so. If there is an emergency that you think can't wait, then call your primary care doctor or 911.


[Editor's comment: It has always been my practice (and that of many of my colleagues) to have parents of newly diagnosed children call daily for at least a week or so after initial instruction because blood glucose values and insulin requirements are rapidly changing. In addition, given the time constraints and stress of diagnosis, there always seem to be many "forgotten" or misinterpreted concepts that need reinforcement at that time. Eating habits also seem to change quickly, so a phone call or two with the dietitian can also be helpful. These reasons do not even begin to address the myriad of questions and amount of support all parents of newly diagnosed children desperately need.

It is extremely important for parents to feel comfortable with their child's diabetes team. Since diabetes is a chronic disorder and requires regular, on-going attention, a comfortable, working relationship must be established at the outset. It seems to me that especially if your daughter's diabetes team asked you to call, there should be no reason for you not to expect a call back within 24 hours at most. I hope that you expressed your frustration and concern.

At the large center where I used to work, we would actually have "call-in times". Perhaps you can establish this type of practice with your daughter's diabetes team. If they seem unwilling, you will never feel comfortable and should seriously consider changing programs. SS]

Original posting 24 Mar 2002
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