September 16, 2011

Doctors Should Prescribe Lifestyle Medicine

Okay, there are no medicines to prescribe, just prescribed advice, but for some this may be a bitter pill for some patients to swallow. Healthy lifestyle should be the first advice received, regardless of the illness you are seeing the doctor for. The doctor presently will always take care of the illness first, but seldom looks at any of the underlying causes from a lifestyle side of things.

With obesity on the rise and diabetes going up at an increasing rate, doctors must start changing their priorities. Yes, treat the illness, but also set up treatment for the other causes that my be there – like obesity and obesity-related causes, diabetes, and other potential problems.

Why is there so much resistance on the part of physicians to prescribing lifestyle changes. The reasons are many and vary from one physician to another. Some but all of the following may apply: clinician lack of confidence, skills, and training; inadequate payment; insufficient time during patient visits; and lack of integrated office flow and documentation processes to emphasize healthy behaviors and lifestyle interventions. One of the large barriers is healthcare providers' perceptions of lack of effectiveness of office interventions, biases about patient motivation, lack of awareness of community resources, and resistance to change.

Are doctors going to be required to do lifestyle prescribing? Yes, if, and this is a big if, the current healthcare law remains the law. Doctors will be required to preform effective prevention services as a part of medical practice. The longer the doctors delay making prevention practices, the more difficult it will become to provide for these prevention practices and those that are part of ACOs will either be squeezed out or will need to find other places to practice medicine.

Surprisingly, the Leaders in lifestyle medicine, such as the American College of Preventive Medicine (ACPM) and the American College of Lifestyle Medicine (ACLM), is encouraging this and published a list if 15 core competencies as Lifestyle Medicine Core Competencies which is included in this article.

They recognize that lifestyle medicine begins outside the clinical setting by having healthcare providers lend their expertise and authority in the community by serving as advocates on behalf of health promotion policies. Next the clinicians need to bring lifestyle medicine into the office. To be successful healthcare providers need to lead and perform a full assessment of the patient and order screening and diagnostic testing according to national guidelines. They need to realize the importance of their role in promoting health behavior as first-line prevention and treatment.

Lifestyle medicine is a recently defined field and has the15 core competencies for this practice. This should give healthcare providers a plan to help reverse the chronic disease epidemic in our country. There are three key areas – reframing the clinical practice to prioritize healthy lifestyles for patients, the providers adhering to healthy lifestyles themselves, and leading change in the medical system and in the community to support healthy lifestyles.

This may be a tall order for some healthcare providers, but will be a necessary component under the current healthcare law. Next, how will we as patients adapt? Hopefully it will be in a positive manner and that we will be able to meet the challenge and for those that are physically able, we will succeed.

September 15, 2011

A Excellent Discussion About Hypoglycemia

Hypoglycemia – this word may put fear in your heart especially if you are a person with type 1 diabetes or are a parent with a child with type 1 diabetes. Rightfully so. Even those of us with type 2 need to be more aware of this than many are. Those of us with type 2 and on insulin need to be as aware as people with type 1.

Then we come to those with type 2 on oral medications and they think they are immune to this serious complication – wrong. It does depend on the medication or combination of medications that you are taking, but if your doctor has not given you any information about having hypoglycemia, take time to look up your medications on WebMD. Please look carefully and read all the information and especially if you are taking more than one oral diabetes medication. Look for effects of one medication when taken with another medication. Since I am on insulin, I have little knowledge here, but I do know that some oral medications can and do cause blood glucose lows – hypoglycemia.

Joslin has posted a blog on August 30, 2011 which is good reading for all types of diabetes. Please read it carefully as it does contain a lot of good information especially about blood glucose awareness training (BGAT) for those of you that may not feel the symptoms of hypoglycemia anymore. Be sure to follow their links to further information.

My blog on BGAT is here.

September 14, 2011

Insurers Still Skirting Mental Health Parity Law

Hopefully this problem will come to an end. It is disturbing that our medical insurance industry continues to sidestep the law and continues to discriminate against patients with mental illnesses. Some companies will cover some conditions with no problems, but for the majority of mental health illnesses, they will drop the coverage as soon as they can and many drop all coverage after a patient is diagnosed with a mental illness.

I am not saying this is the case, but it may go a long ways to explain why doctors are prescribing antidepressants without a diagnosis. I had not considered this when I wrote my blog here. The Mental Health Parity and Addiction Equity Act passed into law in 2008, but not taking effect until 2010 requires insurance to cover mental health illnesses.

Unfortunately, the guidance from parity regulators has so far not been specific or clear enough, allowing some insurers to hide behind a level of vagueness. Until enforcement of the parity law, and until there is an effective definition of what parity protections there are, it's possible that even under Medicaid insurers are free to delete some of these essential treatment services.

Many in the American Psychiatric Association say that there is too much not spelled out in the law and until the APA and Parity regulators determine a clear definition, some insurance groups will continue to interpret the law to their benefit. Are they right? Yes, as there are legitimate differences of opinion even among the APA and parity regulators that need to be resolved.

Until the federal agencies responsible for regulations of the parity law finalize clear definitions for the scope of services, insurance groups will continue down the path of their choice. At present there is no one that can definitively say that an issue in your health plan is clearly out of compliance, and that another issue may be in compliance. At present there is confusion at all levels.

So at present, the medical insurance companies will continue doing their thing and patients may suffer the consequences. Read the article here. There are some real problems to be resolved.

September 13, 2011

Types of Patients – Part 2

I have covered patient, passive patient, and proactive patient in the previous blog. Now I will cover empowered patient, e-patient, and patient advocate.

Empowered patients are those patients that have done extensive learning and are more than a little knowledgeable about the disease or illness they have and often about related diseases. They communicate with other patients and constantly add and upgrade the knowledge they have. They sometimes do controlled experiments from the knowledge they have received and do determine what works for them. They communicate with their doctors and often teach their doctors about their disease. Doctors are generally not intimidated (but not always) by these patients because they communicate freely and have much valuable information.

Read this blog by Trisha Torrey about being an empowered patient. Then learn the eight steps you need to know to be an empowered patient. These are necessary for many, because this separates you from other patients. After reading these, many will think they are part of this patient group. This can be very good, but read carefully.

Some will say that empowered patients and e-patients are the same. I disagree because of some differences. Some follow a different set of eight points that need to be learned, and most e-patients are even more diligent in their learning. While all patients can and do participate in online communities about their disease, it is generally the empowered and e-patients that are able to teach more information to other patients. Read this blog for another eight steps that some participatory e-patients use. Yes, both eight step guides can be used by either an empowered or e-patient.

Now to really set the e-patient apart, go to this link and look at the very top of the page. There are three sections - the center is blog which is where you are. The right section is Journal of Participatory Medicine which is probably new to most of us, but is a valuable resource. While most of the participants are not people with diabetes, much can be learned from them. Now investigate the left section - the Society for Participatory Medicine. This is patient participation beyond anything I have considered previously and I keep learning more.

Now that we have looked at the types of patients, yes, each person can be involved in parts of proactive, empowered, and as an e-patient. The similarities are there, but there are also some important differences in what each patient does and accomplishes. Unless you have desires to become a person of the last patient type, be proud of any accomplishment in being a proactive, empowered, or e-patient.

Patient advocates can be patients, but that is not their purpose. They have taken classes and often passed exams to become qualified as a patient advocate. Most, but not all, have received a diploma or certificate showing that they have been trained and have the knowledge to be an advocate. Most doctors and hospitals will recognize them, but a few do not like the fact that they are now between them and the patient. A few will reject patients that have hired a patient advocate. More states are beginning to realize the necessity of setting up standards.

if you are a person that is going to be unable to communicate because of an operation or increased problems because of an illness or disease, a patient advocate is an excellent person to have one your side. Most are knowledgeable about medical costs and billing, legal and hospital assistance and many other services. This can be especially helpful if you live alone and have no close relatives to give any assistance. Read this blog by Trisha Torrey and if interested follow several of the links to other blogs.

If you have followed all the links, I think you will have learned a lot. This can help you decide at what level you wish to participate as a patient, or if you are comfortable where you are. Hopefully, some of you will see the opportunity to expand your horizons as a patient.

September 12, 2011

Types of Patients – Part 1

In my research for another blog, I came across several terms I think need to be discussed. This is not a definitive list, but I think includes the bulk of patient types.

Passive patient
Proactive patient
     Above are covered in this blog
Empowered patient
Patient advocate
     The last three will be in the next blog

Looks simple enough on the surface, but when compared to each other, I have listed them in order of knowledge and sometimes education. That does not mean necessarily formal schooling as I have seen people without college degrees in each category. Many have more common sense knowledge and life experience knowledge than some medical professionals.

All of us have been patients. Everyone has to have been one at some time in their life, whether as a child or an adult. Another way of viewing patients is covered in my blog here, but I will let you read it later. This blog from May 10, 2011 on patient literacy and who is responsible for improving this shows that many in the medical community are ready for patients to step up. It is a shame that some physicians are taking a pass on what their associations are advocating.

Once you are a patient, then you normally decide what type of patient you want to be. Many people chose to listen and be led by their doctors and office staff and follow these people lock-step. As such they are making themselves passive patients. They seldom ask questions or disagree with what their doctor tells them. They seem to be disinterested in learning more about the disease or illness that brought them to their doctor.  If the doctor prescribes a pill or cure that heals them, that is all they are concerned about. If there is not a pill or cure, then they are at a loss and often seek out herbal medicine or quasi-medicine people promising a cure.

Proactive patients are people that attempt to learn all that they can about an illness or disease they have or are suffering from. They educate themselves by what ever method they can. Some utilize their local library, some get access to a medical library, and today, most use the internet to research and learn. Proactive patients attempt to ask knowledgeable questions of their doctors and other healthcare providers. They want to engage the doctors in their care, but may be ignored. These patients then may seek other doctors because they want knowledge and not being patronized or having fear thrown at them.

If they have doctors that answer questions and that talk with them to help them learn, they will try to expand their knowledge and work with this doctor to get the best care possible. Not that this will always be possible because of unforeseen circumstances, but they at least feel they have had the opportunity and are often more satisfied in the outcomes received. These patients are good people, but often overload their doctors with information that they are looking for help in deciphering some of the information.

Proactive patients often look to the next levels for aid and assistance for information they do not understand and to help sort out the relevant and helpful information. Where do I fit in this listing - I am not sure. I am a very proactive patient and am striving to become a more empowered patient, but I don't think I have fully reached this level yet.

I will continue the discussion of the last 3 patient types in part 2.