December 28, 2013
Are Our Doctors To Blame?
I have a few friends in the medical profession and one of them asked me to write this blog. I had to do some research, but it did not take as much time as I thought it would. When medical groups like the Society of General Internal Medicine (SGIM) and many other medical groups decided to participate in the “Choosing Wisely” campaign, some unintended consequences became rather apparent.
First, we as patients learned that some medical organizations were not concerned about doing what is in the best interest of patients, only their income. Many medical groups are using this as tool to avoid education of their patients. I can be thankful that some doctors are listening to their patients and taking positions opposite of their own medical organizations.
Other doctors are saying their own medical organizations are not taking a strong enough stand in their guidelines and putting patients in their place. Then they muddy to waters with their terminology to confuse patients even more. “Meaningful use” and “patient engagement” are the latest buzzwords for patients and how this is supposed to make it more meaningful for patients. How quickly doctors have forgotten that communication is what they are required to do, but most doctors have forgotten how to communicate. They talk at us rather than with us to arrive at the best treatment for what ails us.
When doctors order patients to do something, it is almost a crime when they don't understand the consequences of their orders. Twice in the last five months I have had doctors order me to take a certain number of units of my long acting insulin. Both times I have had to refuse because I was below 100 mg/dl and had no food in my system. The first time I was already at 72 mg/dl and when I refused the doctor came to my hospital room to observe me take my insulin. Since I was required to fast because of a procedure I would be undergoing the following morning, I ask the doctor if he was going to allow me to break my fast when I went below 60 mg/dl. When he answered no, I told him that I would be near that without taking the insulin and I did not want to remain in the hospital another full day while they allowed me to recover from a low. I refused to take my insulin and when tested in the morning I was at 59 mg/dl.
The second time I had completed the surgery and was not allowed any food until the following morning and then it would be only sugar free jello and broth. I was already at 79 mg/dl and I told the nurse I would probably be at or below 60 mg/dl by morning without my insulin. Actual blood glucose reading at 6:00 AM was 65 mg/dl using their meter.
Both times (at different hospitals) I was told I was doing things against doctor's advice and being very non-compliant. The second time I was not where I could reach the bedpan or it would have been used for target practice at the doctor. It would not have been very useful as it was only plastic and not what they were several years previous when they were porcelain covered steel. I could almost forgive the first doctor since he was a general internist, but the second doctor was my own endocrinologist. My next appointment this month could be rather heated.
The appointment went smoothly as the endocrinologist was busy with other patients and my nurse practitioner did not call him to the room at my request.