An article on health care blogs

Health ‘blogs’ are multiplying – thanks to Matthew Holt at the Health Care Blog for the link. And yes I am included, along with one of my more erudite comparisons!

Physicians and diabetes management

I received this question today:

I’m the Living with Diabetes blogger…

and something has come up on the insulin pumpers list, that needs to be commented on by a medical doctor, especially one like you who teaches other medical doctors.

Several people on the list are amazed, dumbfounded, etc. that both family care physicians and endo’s tend to treat diabetes fairly cavalierly.

For example, many endos won’t prescribe the pump, saying that shots are good enough. Of course the HMO’s LOVE that attitude, I’m covered by one of those HMO’s myself. However, those of us who have been on both shots and the pump can tell you that we feel better, have better control, and have better lives as a result.

We’re also dumbfounded by the doctors who treat Type 2’s by giving them pills, suggesting a life style change, and suggesting that they test once a day. In fact, I’ve had two sets of CDE’s that thought testing twice a day was good enough. Lots of us know people who are treated that way and who are also suffering a great deal with diabetes complications, that could be avoided if they were treated right.

Why do doctor’s have their attitudes? How can this be changed? It seems we’re only covering the tip of the iceberg with the so-called diabetes epidemic.

Well I cannot speak for all physicians. Therefore my rant will only provide opinions and controversy. Nonetheless, that has never slowed me down in the past, so here goes!

Diabetes (especially type II) provides a special challenge for physicians. The disease is extremely common, yet very difficult to treat well. Excellent treatment requires a motivated patient and a motivated physician.

Many physicians find few motivated patients. We plead with patients to achieve excellent control. We would like them to test their sugar regularly.

As I have blogged previously, quality diabetes care requires that one touch all the FLECKS. (Feet, Lipids, Eyes, Control, Kidneys and Shots). Diabetic patients have many issues to address. Our reimbursement system penalizes us for spending adequate time with patients. Let me repeat that sentence (it is not a mistake). Our reimbursement system penalizes us for spending adequate time with patients. Doing the right thing takes time. And time is money.

Many physicians try hard. They encourage patients to develop tight control. Yet most patients show little interest.

One would hope that patients could find a physician who matches their desires. We must accept the blame, even when we can explain why. Providing quality care is difficult. Yet it should always be our goal.

I apologize for talking around the question. However, I do not think the question is directly answerable. Most physicians just have no pump experience, therefore, they use the tools with which they are experienced. But again that represents and insufficient excuse. We should refer motivated patients to the appropriate experts.

On the economy class syndrome

Studies confirm risks of ‘economy class syndrome’

This report refers to 3 studies. Those studies show the following risk factors – longer than 6 hour flights, increased age, being overweight, birth control pills. The risk is very low, however, I would recommend (and when I fly I do this) getting out of your seat every couple of hours to walk and stretch.