Showing posts with label Video conferencing. Show all posts
Showing posts with label Video conferencing. Show all posts

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.

July 21, 2012

Just Thoughts from the Last Few Months


Having computer failure and moving to a backup computer is not fun, but it is doable. Having lost many of my favorites and bookmarks is difficult to rebuild and I still have a quite few I have not recovered. I have noticed that many of my favorites are seldom posting blogs. Yes, they post, but not as frequently as they had in the past. I have found some activity on Facebook and Google+; so much of the activity may have gone where they get more immediate response, which can be more rewarding. I say good for them, I will miss them.

I do have accounts with both, but cannot find time for participating. I admit I am tired of receiving invites to play the games on Facebook. I would much rather play one game of solitaire which will be over shortly, and not waste a lot of time I see wasted on Facebook games. I enjoy researching and reading more than playing these games. There are so many good sources of information, some very interesting, and a lot of garbage is published trying to pass itself off as something important.

Part of what irritates me is the small studies done that mean nothing more than a call for more money to do larger and even less meaningful studies. Yes, I am venting. Then I get tired of all the rodent studies that herald a breakthrough. Yet we seldom see much beyond these rodent studies. Why? Because so much just won’t translate to the human body. Then there is the type of studies blogged about very accurately by Tom Ross here. This alone has me wondering how these get by peer review and how they are funded in the first place. It also raises questions about data committees and who else passed the buck. These researchers need to have criminal penalties imposed and do some prison time for their fraudulent use of research funds.

Now back to bloggers. I know bloggers come and go. Some I do miss and wonder what I could have done to encourage them. Others, well I hope you learned something while you were here and nothing serious has caused you to leave. I know from experience that sometimes a thick skin is needed and at other times, you can get emails for help that you cannot answer. Blogging can be very rewarding and at other times, you wonder if you are reaching anyone with something informative.

Then there are times when you receive both good comments (I receive mostly emails) and negative emails. I have been very surprised by what blogs get responses. I have had several over the last couple of months. Were the blogs that good? No, I can honestly say for a couple, I missed a lot and will write more later for some of them. At the same time, I at least opened the door for further discussion and I am learning a lot from one doctor, and for that, I am very thankful. I am also thankful for some of the contacts I have been making. Being a patient does have some advantages and at other times garners some sharp criticism. If I can continue to learn from some of the criticism, then I will have gained.

Several professionals have answered emails and we have started good discussions. A couple have contacted me and their discussions have been even more productive. I have been surprised at the questions and information they have requested and the responses to the information. You never know when something you blog about can open avenues for conversation.

Another activity that has been brought to my attention in the last few months is the use of peer mentors. I was a little shocked when I learned this, but after talking with a doctor using peer mentors and two of the peer mentors, I have learned a lot. The doctor stated that the nearest certified diabetes educator was over 150 miles distant and the closest registered dietitian was over 200 miles distant. The doctor had attempted to use the computer for video conferencing, but could not work around their schedules.

The doctor said he had two patients that he knew spent time researching on the Internet about diabetes and decided to have them in for a session of questions and answers just with him. He was pleased with the interaction with both, but one was not interested in peer mentoring. Therefore, he started with just one person and the first few sessions with patients went very well. In the meantime, both he and his peer mentor looked for others that would be capable. Over the next six months, they found and interviewed six more people, ending up with four peer mentors.

How did I end up being in contact with them? One of the peer mentors had read one of my blogs about shared medical appointments (SMAs) and made the doctor aware of this. The doctor was not sure if this would work for him, but was interested in exploring the topic. Over the last four weeks, we have corresponded about this. The doctors admits he does not like my stance on the American Diabetes Association, but is pleasantly surprised about the alternatives I do present.

My opposition to a one-size-fits-all mantra also got his attention, as did the discussion he had with his mentors about this. He knows that many people do not have the ability to afford the extra test strips to eat to your meter, or to discover how the different foods affect their bodies at diagnosis or at different times afterward. After discussing programs that a few of the test strip manufacturers have, he is now on a mission to see what can be done for his patients. Two of his mentors are writing on his behalf to see what can be accomplished. The office has gathered the numbers of each different meter used by his patients so that they can use this for volume.

He has asked about having SMAs with 5 to 9 people only as this about all his office can hold in the reception area. We have talked about having them at 4:00 PM to avoid interruptions. He does feel this would be workable, and if necessary he can see them going past 5:00 PM. Since he has the computers and equipment from attempting to set up with the CDEs and RDs, he seems willing to try this. His office is now surveying his patients with type 2 diabetes to find out how many would be interested. He is aware from reading my blog that secrecy for some may be an issue. He is investigating the frequency of having the SMAs, but in the beginning will start with quarterly.

He has used the video conferencing with me and has said he hopes I am not disappointed by not being asked to mentor for him. I said no, as I was writing my blogs and would be starting with two other doctors in the coming weeks as a peer mentor for them. I did email him copies of my twelve-blog series and the dates to be published and that if parts of them were useful then I had served as well in supplying education topics. He has forwarded them to his mentors and one has thanked me for them.

I have supplied him with the names of several people with nutrition degrees in his area and he said he was not aware of them, but would be in contact with a couple to see if schedules could be worked out. I have to thank my contacts for the names I sent to him.

Even if I have no other contacts like this, the last few weeks have been very rewarding for me. Complaints aside, I have learned a lot and even one that was especially critical has given me a valuable lesson in how to approach a couple of topics.