Diabetes Self-Management Blog

This is a tough topic to write succinctly and coherently about. And no doubt I’ll hear back from some readers both agreeing and disagreeing. I am interested in what you guys have to say. So, up front, I apologize for any incoherence. I may be all over the map on this topic.

OK, I get a lot of my news from a lot of different sources. I have RSS feeds for my home page that trickle in from major media outlets such as CNN, CBS, The New York Times, and nearly a dozen others, as well as places such as The Huffington Post and The Daily Beast and The Daily Dish (have you gleaned my political leanings yet?). I also listen to NPR on the way into work.

Lately I’ve been inundated with news about our health-care system. Now, no big surprise there, given that health-care reform is one of the major political issues in Washington these days. However, the reason I want to bring up health-care is because one of the issues I’ve heard quite often regarding this nation’s health-care system has bothered me.

In a nutshell, what concerns me is when I hear the discussion about “Are doctors doing too much?” Are they overtreating their patients? Are they prescribing too many treatments, procedures, medicines, specialists, etc.?

It’s difficult to boil this down to a simple yes or no when I think about it on a personal level. Nationally, I’m sure, this is happening. I don’t doubt it. A month ago I read an article called “The Cost Conundrum” by Atul Gawande, and it was the first time I really started to think about too much medical care. The article explains pretty well the reasons it’s proliferating. And I agree, yes, it seems there’s too much.

Since reading Gawande’s article, I’ve been hearing more and more about this issue of too much doctoring — or, what’s more likely, I’ve been more aware of it. Legislators, health-care experts, other doctors… most people tapped to speak on behalf of health-care reform seem to mention this problem.

For my part, sure, I know the system’s broken, and obviously something has to be done.

But while the system may be broken, there are many places where it works, and there are many ways it’s working wonders on an individual level. For me, the “are doctors doing too much” question is one that I can easily answer: No.

As a person with Type 1 diabetes, it doesn’t bother me one bit that I have an HMO and a primary care physician who errs on the safe side by sending me to get an ultrasound to make sure there’s nothing wrong with my thyroid, or who will send me to the dermatologist when I am concerned that the sore on my forehead that won’t go away might be basal cell carcinoma.

If she — my PCP — can’t make a conclusive diagnosis from her examination, I don’t want her to think that, because the chances are it’s nothing, she should just send me on my way. I want her to do what she did and tell me that while she thinks the chances are it’s nothing, she’s not 100% certain and wants a trained specialist to evaluate it. In that same way, if my endocrinologist recommends a certain medicine, I’m probably going to go on it. If he suggests I see X specialist or Y specialist, I’m going to do that, too.

See, it’s different, because I have a chronic condition that affects every part of everything related to my health. I want my health-care team to do as much as they can. And yes, I have good health insurance (I’m very fortunate), and yes, it does get expensive to run here and there for this and that procedure or to see this doctor or that doctor. I’m covered, so while I think about the cost, I really only have the small co-pay to worry about.

And with that, I’ll finish the entry for this week. So much more I want to say…

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Comments
  1. Dear Eric: Thanks for a good article. I too am a Type I and I have been fortunate to have delt with Diabetic Specialists for over 45 years. If people would only quit complaining and do what their Drs. tell them to do and get tests done when needed they would be better off. We must take Diabetes and the complications seriously. I appreciate a Dr. who listens to me (if he doesn’t, I won’t stay with him/her very long.)I appreciate it when they are on top of conditions that I am not aware of and send me for tests. Over the 45 years there have been so many new things come out to help us live a longer and fuller life so why not take advantage of them and enjoy life until you are 100 years young!!That’s what I’m going to do. And yes, I too am fortunate to have good insurance. This is an expensive condition and I feel for those who struggle with the high costs- that is something that should be looked into for those less fortunate.
    Signed: A Healthy Diabetic

    Posted by Virginia Brooks |
  2. Dear Eric

    I am one of those unfortunate type 1 diabetics. I think that the major problem I encounter is that none of my doctors talk to each other. This lack of communication is really disturbing. When I end up in the hospital my general physician and my endocrynologist don’t talk about the best way to help me control the problem before it becomes a problem. The GP gets me better, treats me then leaves it up to me to tell the specialist that i was in the hospital.

    I worry because now I have been diagnosed with stage 2 kidney disease a complication of my diabetes being to out of control too many times. It could have been caught earlier if my doctor’s had been in communication and aware that I was having all the symptoms of kidney problems but now I have it and have to deal with this new problem add upon my old one. All because of the failure of Doctor’s to do something simple as talking to each other. I don’t need more doctor’s i need the ones i have to communicate with each other on a regular basis.

    Posted by Debbie |
  3. Overtreatment is a huge problem in our system. Some treatment is appropriate and some isn’t. When it isn’t, it’s usually because economics or cultural biases are influencing decisions.

    I recently lost a dear friend who spent the last 7 months of his life shuttling between ICUs and nursing homes. He hated the whole experience and just wanted to go home to die, but they wouldn’t let him. (The family kept hoping he would recover.) His final bill was over $1 million for care he never wanted. Government paid most of it.

    More doctors are buying their own MRIs and CAT scanners. To pay for them, they order more MRIs and CATs. And those often unnecessary tests for things like back pain often lead to unnecessary surgeries. But the doctors and hospitals profit.

    Drug companies press very hard to get docs to order the latest brand name medicines. Usually these turn out to be no better than older generics, only more expensive, and sometimes with dangerous side effects.

    Eric, I’m afraid you may be getting some inappropriate care also. You wrote, “if my endocrinologist recommends a certain medicine, I’m probably going to go on it. If he suggests I see X specialist or Y specialist, I’m going to do that, too.” Some of those referrals and drugs may be what you need, but I wonder how much is influenced by docs looking out for one another and drug company sales reps’ influence.

    Thank you for raising this important question.

    Posted by David Spero RN |
  4. Eric,

    Good post. I honestly find I’d prefer my GP to encourage/educate at least about more doctoring options. I of course think it’s the patient’s responsibility to then weigh options as to what will work best with the general mindset of what doctoring can I avoid while still maintaining optimum health. For example, I’m a pretty healthy diabetic with a little extra weight in his mid 30’s. My BP is within range but at the top of the ADA recommendations. If a doc were to recommend I go on an anti-hypertension pill, I would probably say no thanks as I’m trying to control better through diet and exercise and perhaps alternatives like supplements, yoga, breathing exercises, etc. If the blood pressure keeps rising though, I might start to listen to the doc and consider the options.

    I’ve been frustrated by needing to educate my GP on issues. My A1C’s over the last couple years have been roughly 6.6, 6.3, 5.9, 6.6, 7.0, and 7.2. As you can see the numbers were pretty good, had one that was real good and then I trended up and got to the upper limit for ADA and even exceeded it. My doc still has the mindset that well, that’s pretty good in comparison to other diabetic patients so let’s not make any major changes. I pushed for the pump and got that approved and have now been pumping for 6 months. I really don’t have any connection with an endo except for one meeting prior to getting the pump. That doctor also was of the opinion that I had a good understanding of pumping and really no need to follow up unless I wanted to.

    Anyway, as always the disease is my own, so whether the concern is too much doctor or not enough, ultimately I, as the patient have to take control of the decisions.

    Erik

    Posted by Erik |
  5. Dear Eric. I am a Type diabetic since I was 2 years old and I’m 52 now. At the beginning I only had one endocrinologist which basically took care of almos everything, but while time has passed, I’ve started to get some complications which are not threatening but I have a lot o doctors to help me take care of my conditions. And I have excellent doctors and I’m greatful for them. The only bothersome dituation is that medical appointments are too frecuent and it’s a little difficult with my job. But I manage to deal wth this quite easy. Thank God. I believe I will keep haveing al these doctrs to prevent further and more threatening complications. I do my best to follow all the nstructions I receive.
    Thank you for bringing this theme around.

    Happy to be alive person

    Posted by Irene |
  6. Eric,
    I am also type 1, have no insurance but get great care at my county hospital. I have a geat team of doctors, nurses, diabetes educator, dietician helping me. Most of my problem is ME, my attitudes & behaviors, habits. Perhaps because you have great insurance, they schedule “extra tests” to your insurance. I’d like to see healthcare reform, but the drug company lobbyist,the machines they use, should be tossed out of the discussion. Part of that reform should include health insurance companies - their rules & regulations that may deny a life-saving technique,machine or diabetic- lifesaving procedure.In my view, everything come down to money. How much will it cost? How long should it run? Are chronic dieases a drain on the capitalist’s view of investments. I’m not advocating socialism. There too many examples globally that say “it don’t work. England is a good example.
    i’m getting off my soapbox now. Thanks for rhe subject matter. Like Irene said, “Happy to be alive persn.

    Posted by mskitykins |

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