March 14, 2017
Many Doctors Cause Non-Compliance
Yes, I said this and I know this happens. Why, you ask. Because the doctor is in a hurry to see the patient and only half listens and decides quickly what is best for the patient to be able to move on to the next patient. It is rare to find a doctor today that listens or even asks questions for their understanding.
Most doctors will not even consider insulin as a first line treatment, but do consider it as a treatment of last resort. They often use the threat of insulin as a way to force their patients into working harder to manage diabetes using oral medicines. Instead, they prescribe regular metformin or one of the Sulfonylureas. Then the doctors are upset when patients complain if nausea from metformin prevents them from eating and they stop taking it. Then for those on a sulfonylurea the patient suffers an episode of hypoglycemia and this scares them into stopping this medication. They then label these patients as non-compliant.
Instead of prescribing metformin ER (extended release) that often is better tolerated, they tell the patient to take their medicine or find another doctor. When this happens, the patient might be better served to find another doctor, but the search could be futile because many doctors are the same and would rather label a patient non-compliant than do what might be of help for the patient.
The other issue is of food plans. Most doctors tell patients to eat more carefully or hand them a food plan with no explanation. These doctors will not refer the patient to someone that can work with them in designing a food plan that will help manage diabetes and explain the reason for the changes needed. In addition, they can help direct the patient to finding the needed foods that aren't always expensive.
Most doctors will not refer patients for diabetes education or to work with other professions that might provide assistance. They also will not do anything to find out about family, work schedule, or even lifestyle that can be changed. Many doctors prescribe one or more medications and have them scheduled for another appointment. No instructions are given for times when medications cause problems and no instructions about calling if there are problems. In other words, the attitude is here are your prescriptions and don't bother me until your next appointment.
This is why I will continue to support doctors in several states that are training peer mentors for education of diabetes patients they serve. Several of the doctors have agreements with a few nutritionists that are not registered dietitians or members of the Academy of Nutrition and Dietetics (AND). They also work with the diabetes patients to educate them about food and work with them in areas of nutrition for levels of carbohydrates they wish to consume.
I have heard from two of the peer mentors that I correspond with and they are very happy that the patients are gaining a benefit and most are doing quite well in managing their diabetes. I have even had correspondence from two of the doctors thanking me for finding two nutritionists, which led to three others. One of the doctors has found a CDE that will work with them and not against them like so many have in the past.