September 29, 2014
Correspondence after the ADA Blog
I was expecting the harsh emails telling me that I should not be saying the points I made and that the American Diabetes Association had their guidelines for a reason. The emails are now almost 2 to 1 in favor of my points. Most are people with diabetes, but two are doctors. One doctor did chide for my saying one-size-does-not-fit-all, but explained that there does need to be a starting point on which to base a line of treatment.
Then she said that she agreed with me about assessing each individual and their desires and abilities for diabetes management. Dr. Sharon (not her real name) went on to explain that she normally has a printout of valuable websites for her patients to visit and a few pages of information that she has written for them to read. She does email this information to those that give her an email address. Then she schedules them of a second appointment within two weeks from giving them a diagnosis. Before she lets them leave from the diagnosis appointments, she has several blood samples taken to make sure that when they have the second appointment that she has the correct diagnosis, type1, type 2, or possibly LADA.
Being in a very rural area, she is happy that many of her patients do have internet access and she uses some emails and video conferencing since the insurance companies do reimburse for the video conferencing. For Medicare, she has to pay a nurse practitioner to be present, but by sharing a nurse practitioner with other doctors, this is not a problem. I was pleasantly surprised about the number of doctors that are cooperating to provide a wide range of services for patients.
What Dr. Sharon told me next was a shock. She said that the doctors cooperate by sharing offices and using their internet facilities to provide video conferencing for patients they don't serve, to prevent long trips for the patients. She said this networking has made for happier patients.
Back to the diabetes side. Dr. Sharon said that she is the only doctor among them serving patients with diabetes. The doctors in the network all provide services for each other with the responsible doctor receiving the lab results and sometimes the doctors confer among each other when a diagnosis is questionable.
She commented that she only has three patients that have A1cs over 7.5% and they are in a care facility and are frail patients. She said that even she is surprised with the number of patients that are maintaining A1cs near or below 6.0%. If and when she uses video conferencing with me, I may have more to write. Because of state line issues, I will not become a patient of her office.