June 30, 2012

Hospitals Now Are More Monopolistic

Medical practice is nearing a crossroad and not the road everyone is talking about. This is the legal mess of monopolistic medicine that many patients are starting to wonder if this is in their best interest. While it is true that we will continue to need hospitals, the size and dictatorial power they will possess may not be in the best interest of medicine. A hospital monopoly combined with the insatiable appetite for profits may create problems in patient care with too many patients being ignored and euthanized to preserve the almighty profit.

Hospital CEOs will demand higher and higher salaries and bonuses and as such, it will become second nature to end life for patients needing care that is more expensive. This drain of financial expenditures will be unacceptable for these hospitals and we know what this will mean for the patient. If you want an example, read this article of what is being allowed in Britain. Follow the link provided for the chilling details. Don't wonder how or if this will happen in the USA, but be concerned about when.

Under the Patient Protection and Affordable Care Act (ACA), the rising cost of medical care will become a priority and euthanasia will become a fact of everyday cost cutting.  When the ACA was first enacted, it was thought that physicians and hospital accountable care organizations (ACOs) would be approximately proportionate. I don't think the early prognosticators had counted on hospitals having almost the entire lock on ACOs. It is now speculated (unfortunately no official studies) that doctors were not creative enough and lacked leadership skills to organize ACOs. Hospitals were willing to seize the opportunity and take advantage of doctor indecision to hire a majority of doctors. Hospitals thereby garnered most doctors leaving too few capable of forming ACOs.

Up until June 28, 2012, there was more speculation than fact about what would happen to ACOs, but now we know which way the arrow is pointing. I suspect there will be many lawsuits trying to break the monopolies that hospitals will be creating. We have seen hospitals also merging and becoming larger and larger. Size and scale will create some savings, but not enough to make up for the increase in expenses and inefficiencies generated by bloated overhead and massive referrals internally.

In addition to the mandate to cut expenses (creating more euthanasia), we will soon see the medical insurance industry supporting euthanasia as a method of keeping their profits on the rise. These two profit minded organizations will be able to eliminate many costs but supporting each other and still have the financial ability to fight the lawsuits bound to happen for unwarranted euthanasia.

A study that is going to create some controversy around the country is this one. I am seeing some of this in my own community and surrounding communities and if people could read about this study, many might not be so happy. Yes, there is some need in Iowa's rural communities for better medical care, but are we really obtaining it. In many cases, much of this may go unnoticed because to the protection that is being given ACOs from antitrust and other benefits. The current administration is promoting the formation of ACOs and shielding them from antitrust laws.

The further I get into some of the new law and the discussions, blogs, and articles that I read, the more I have some real concerns about the impending abuse and fraud that will accompany the Accountable Care Organizations. I am now even more concerned because of the Supreme Courts action.

Because of all the concern being raised, we will have of course more abuse and fraud as the different departments, the Department of Human and Health Services, the Federal Trade Commission, and the Department of Justice, under the direction of the White House, have been and will be granting more waivers, safety zones, and guidance to providers.

It is unclear if the law, the Affordable Care Act provides for waivers and the legality of these waivers. An ACO, as defined by ACA, is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare patients for whom they provide the bulk of primary care services. With hospitals having all but eliminated private medical practice in some areas of the country, they will continue their efforts in the rest of the country.

Although I have seen no discussions yet on the independence of the different medical associations, if a majority of doctors are hospital employees, does it not seem reasonable that the hospitals will soon be making their agenda felt in the medical associations. I think we have seen this in the quick response of the American Diabetes Association to the Supreme Court decision.

I have pulled many different areas together for this blog. I am working on more now that the Supreme Court has ended the ambiguity.

June 29, 2012

Enhanced Glucose Control – Means …?

Another study refusing to state just what methods were used for type 2 people. They want us to believe that people with type 2 were given insulin, but they stop short of saying this. They leave us with this statement inferring that insulin was the drug of use.

The researchers examined data from six studies involving 7,897 individuals (1,228 people with type 1 diabetes, 6,669 people with type 2 diabetes), who received enhanced glucose control treatments including diet changes, drugs for treating diabetes, and extra insulin injections. This statement leads us to believe that oral medications were used along with extra insulin injections. So was the hypoglycemia concern for the type 1 participants or did they overdose the type 2 participants with insulin to cover poor study results and the stacking of oral medications.

It seems that the bigger the cocktail of medications for people with type 2 diabetes, the happier researchers are. While this was a compilation of six studies, it seems that the researchers do not wish to make it known what medications were taken by type 2 participants on the list of oral medications and the inference is left for every one to think that it is insulin.

All oral medications will increase the risk of hypoglycemia when combined with insulin, but when by themselves, most oral medications will not cause hypoglycemia. If they are promoting more studies to determine target levels for glucose control that will balance benefits and side effects, more transparency will be needed for people to have faith in these studies. More junk science will not get us there.

June 28, 2012

Doctors and Patients Both Need to Listen

Human interactions can create funny happenings and tragic results. It is small wonder with all the different types of personalities we encounter on a daily basis that most interactions are constructive and positive. Doctors and patients also fit in this category, especially when they are in a room with each other. Add to the equation that the patient is ill and the doctor has no idea the cause. This may lead to several possibilities.

If you think every story has two sides, you would be correct. Only sometimes there can be many factors leading to several sides and this is when both sides can become very confused, frustrated, anxious, and angry. This blog should really make you think and appreciate a little from both sides. Back on May 18, 2010 I wrote this blog and I am still surprised how much is applicable today. Then on July 16, 2010, I wrote this blog about my appreciation of what Dr. Rob Lamberts wrote in his blog.

Again I need to show my appreciation for a blog written by Dr. Lamberts on January 29, 2012. Yes, it has taken me awhile to write about this; however, I have had this on the list of to do blogs since he posted it. Plus sometimes things do not fall into place as neatly as we want. I get started and then something interrupts and says write about me first.

Dr. Lamberts lists ten things he uses in the process when he approaches a patient with a problem they want solved. I will let you follow the link in the paragraph above and read the list and his explanation to keep this from becoming a lengthy blog. He follows the first list with seven tips of advice for patients. I sincerely wish more doctors would have the same doctor-patient philosophy.

His list is more constructive and easy for a patient to understand. If more doctors could even come close to following this list, we would not need to be so proactive in our care and at times a pain in our doctor's backside. When a doctor tunes me out or goes on auto-pilot with me, I do have a way of bringing the doctor back to my world. I will not say how I do this as I have to vary the method with other doctors. As it happened with one doctor, he actually stopped and said thank you for bringing him out of auto-pilot. We did discuss this and how easy it was to recognize when he started on auto-pilot. It seems he has some words that when a patient uses them, he tends to go there, but did not realize how recognizable they were to patients.

It is great to see other doctors blogging about listening to patients and that they see the need to let others know how important this is to patients. Please read this blog by Dr, Peter Pronovost. His blog is about patient safety and how doctors and hospital staff can sometimes do the simplest of things right when needed. Then at other times, can cause harm because they ignored a piece of key information because they do not listen.

The third blog is by Dr. Peter Elias about his experience of not listening to a patient and the lesson he learned. I admit I admire him for his forthright admission and how he handled it with grace after being shown the error of his ways.

For doctors to be blogging about listening to patients is encouraging for patients to read. Hopefully, more doctors will heed their advice. I admit I like doctors that talk with me and explain what they would like to see happen. This gives me the opportunity to ask more informed questions and make sure I understand what is expected and what my responsibilities are to make it happen.

I admit I am old enough to be crotchety and bold when a doctor talks at me. I normally go into a bad mood and start badgering the doctor to be more specific and throw questions to wake the doctor up to the fact that I am a person that does not appreciate being talked at or about. Only one time have I had to stop a doctor and tell him that I was leaving to find another doctor because I did not appreciate the fact that he would not discuss things that I was asking questions about and was talking at me instead of with me. He stopped long enough to say the pharmacist could explain the medication. To this I said it would be too late as I had an allergy to an ingredient in the medicine and was trying to tell him that the medication was wrong for me. I flipped the prescription slip on his desk and said he would be directed where to send my medical records.

About three days later, I did receive an apology letter admitting he had not looked at my allergy list when he prescribed the medication. I did respond saying I had saved him a lawsuit by rejecting the prescription because I felt he might remember the lesson more by being told how wrong he had been. Handing things over to his liability insurer would not have taught him anything. In the years since, we greet each other and talk occasionally. He does remember and asks me if I have had any more problems like him since. So far, I have been able to say no problems like him.

June 27, 2012

Hot!, Hot!, Hot!!!

Now I will find out if the advice I have handed out in the past saves me. The air conditioner decided to quit about 10 days ago and I have rounded up my cooler and put an ice pack in one end and my test trips, daily use insulin in the other end. Just can't see losing my test strips to heat or any insulin already in use. The fans have been cleaned and are all running.

The temperature is already at 93 degrees outside and is it near that inside. The refrigerator is stocked with cold water and I am staying hydrated. The prediction is 97 degrees today and with the humidity starting rise, the heat index is predicted to top 100 degrees.

I can feel sorry for several people that are not as mobile as I am and that don't have fans. I have provided one couple with two fans and made sure they are using them, have a supply of water and are still okay. If you are in the areas where the heat is becoming oppressive, I hope that you will check on elderly neighbors and do things that will help them survive this heat whether they have diabetes or not.

Group Diabetes Education One Time Not Good

Do you feel stressed, irritated, or downright angry when you read some of medical news headlines? I do and I have to read something else to get control of my run-a-way feelings. One of my favorite things to read is the introduction titled “Joyful?” by Will Ryan for his blogs. Then I go into my positive attitude routine and soon I am feeling like tackling the offending article again.

Such was the case of this article. I could see all sorts of negatives when I first read the title “Doubts Over Long Term Impact Of Group Education For Diabetes Patients.” I had visions of more studies like many of the rigged studies of self-monitoring of blood glucose (SMBG) where they purposely excluded anyone interested in SMBG. I could see this as a rigged study as well.

I feel better about the study after reading it completely. The first paragraph helped when it stated, “that there are no long term benefits from type 2 diabetes group education programs that only take place once.” That is totally understandable as most education is so loaded with information that most people do have trouble absorbing it in one session, to say nothing of retaining it all even with two sessions.

Then they raised some more questionable reasoning about how the study may have been pulled together. You also need to question what the level and detail of education may have been that would cause the following statement to be made - “Lifestyle and biomedical results at 3 years were the same with the intervention group and the control group, but the patients’ beliefs about illness seemed to have improved.”

I may be in total error, but if the patients in the intervention group were given quality education and reinforcement for the three years, they should have been much more efficient and knowledgeable in their management of their diabetes than the control group. Of course, the well-trained healthcare professionals may not have been quality instructors capable of educating the intervention group.

The article does quote from “an accompanying editorial that the outcome of the trial is discouraging and that we should focus again on the setting of appropriate targets by professionals who care for patients with diabetes and the patients themselves." This seems to nail the crux of the problem and properly put the results on the professionals who may have known the topic, but were not able to communicate with the patients.

This seems to be true in so many cases where the professionals may know the material, but lack the essential communication skills to assist patients.

June 26, 2012

People with Diabetes Are Being Scammed

This happens daily and people part with their hard-earned money and don't understand why they are the victims. What causes this? Is it carelessness? Or, is because they believe there is a cure and their doctors are not telling them about it? When it comes to type 2 diabetes, there is likely a large combination of factors and my last statement is probably a leader. Many people do believe that their doctor is concealing something from them. This makes them very susceptible to being taken advantage of or scammed.

Elizabeth Woolley at About dot com has a different perspective and I agree that her take is very probable. She also points out some common scams, and I know several people that have been approached by the Medicare scam, but knew that Medicare does not do this type of calling. I would suggest reading her article

Her tips for avoiding problems are worth repeating and I quote,

Protect your social security number, Medicare number, and financial information. Your social security number could be used for identity theft and your Medicare number for someone else to get medical care under your name.

Be wary of providing your email address to a website that is not well known and respected.

Check your Medicare billings and notices. Look for items you did not order and for multiple billings. This is one check you can do! This is also a way to check if your doctor is over billing Medicare.

Send back or refuse delivery of items you did not order. Take note of the date and the sender's name and notify your health care provider and the Office of the Inspector General if you suspect a scam.

If you suspect fraud, go to the Office of Inspector General website to report fraud. You can report online, by phone, fax, TTY, and mail.”

These are good tips and should be printed out and referred to regularly to remind you of what to do.

Scams on the internet are common and some are very convincing. However, please remember that stores in your own or nearby towns may be running scams of their own. They can be more subtle and because you are face to face with the person, they can be very convincing. They will say almost anything to help separate your money from you and into their pockets. They understand the people are looking for the magic pill to help them cure diabetes and they will claim great things for pills they have. They will generally stop short of proclaiming a cure, but if you infer this, they will not correct you. They will use this inference to sell you anything they can.

Please remember that there is not a cure and if they do cross the line and use the word “cure”, then leave the store as soon as you can get out the door.

June 25, 2012

Problems in Personalizing Diabetes Education for Type 2's

So, this is what they want to call it when those of us with type 2 diabetes don’t allow ourselves to be where certified diabetes educators (CDEs) want to pigeon hole us. They think we are round pegs and they want to put us in square holes. The author does admit that they don't take people's style or personality into account when recommending treatments. Maybe it is time to take the glaze off the eyes of CDEs and others, and let them know who we are.

Yes, those of us with type 2 diabetes do know this and this is one reason we avoid sessions with CDEs. We are individuals and want to be treated and respected as such. We do not like the one-size-fits-all category you try to put us in. You say the treatment for diabetes is not very flexible. Is this because of the professional organizations that wield unbending power and you don't dare vary from the mantras they promote? Yes, for a great majority of type 2 diabetes patients, it requires taking medications, testing our blood glucose, and often eating on a schedule. The need to have a consistent amount of carbohydrates at each meal is where we come to a parting of ways.

I don't understand why it is that CDEs and for that matter registered dietitians (RDs) need to be so set on doing more harm than good when dealing with type 2 diabetes. Yes, I said more harm than good. Some diabetes patients are able to consume the awful number of carbohydrates with low fat you recommend, but there are others of us that do better on much less carbohydrates and more fat. That is because all of us are different and have different needs where foods are concerned. Then when you happen to have someone that is successful in controlling diabetes with exercise and diet, you go ballistic and say they can't be in compliance because they are not on medication. The truth is these people know how to manage diabetes without medications and have the A1c's to prove it. They are not the aberrations you want to tag them as.

We know that those with type 1 diabetes are helped by you and you do good work for them. When it comes to those of us with type 2 diabetes, you are an anathema for us, promoting whole grains at times when they are not appropriate for some, low fat when many of us need moderate to high fat foods. The one-size-fits-all approach is not what works for many of us. This is why you are disliked by many. You come at us with your mantras and expect us to follow them. You do not teach us self-monitoring of blood glucose (SMBG) because you feel we might actually learn what your low fat, high carbohydrate mantra is doing to us. Because you are also convinced that oral medications has to be our medication and not insulin, you will not teach people with type 2 diabetes how to count carbohydrates.

Those of us that have learned to eat by what our meter tells us and how to use SMBG are a thorn in your side because we understand that we may be able to consume more carbohydrates in the morning and not in the evening while others have the opposite problem. We do not believe the pronouncements of the USDA that are trumpeted by the American Diabetes Association and followed by the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND).

When you complain that breakfasts are not carbohydrate equivalents, maybe you should stop and realize that this is what this person needs and they just might have learned how to adjust their medication to prevent having to eat the carbohydrates you try to mandate that we must eat.

When you ask “how do we help the round pegs?”, please know we are not asking you to change your personalities, just leave us alone since you refuse to give us the tools needed and shove mantras, mandates, and platitudes at us. I have learned more from other patients in an informal peer-to-peer setting than any CDE or RD has been able to teach me. We are also fortunate to have some honest to goodness nutritionists still available to help us that are more concerned about nutrition than the number of carbohydrates we must eat for each meal. Yes, they do suggest ideas, but in general try to balance our nutrition for what we have found out via our meter works for us.

Thank goodness, we have some free spirit type 2's that have learned how to count carbohydrates and calories. They have learned to ignore some of your recommendations from your blog here. They know that the fixed dose of insulin forces us to eat a set number of carbohydrates so they know to ignore this. Even the sliding scale is ignored by many as unworkable although some of us use a type of sliding scale in our correction dose of insulin. Most are quietly learning how to adjust their insulin dosage to carbohydrates they will consume.

Another reason we can be free spirits is that for many of us, our pancreas hasn't completely crapped out on us and by avoiding the oral medications that force our pancreas to work overtime, we often can have the hope of some functionality for many years. More people are slowly waking up to the idea of using insulin earlier on to preserve some pancreas functionality. Granted, this may make our computations of carbohydrates to insulin ratio vary, but we will learn to adjust.

I will continue to support other round pegs and free spirits that have found the tools we need and are advocating to others to learn what they need is available from other sources. We have no organization looking over our shoulder or licensure contentions to prevent us from saying what works for me, may not work for you, your mileage may vary, and we are not locked into mantras and unworkable mandates. We can honestly look people in the eye and tell them about SMBG and how important this is to learn how different foods affect our blood glucose levels.

We are not afraid to tell people that the doctor is there for guidance, but we have to become our own lab rat in our own science experiment to discover what works best for us. Once we have this knowledge, no CDE or RD will again be in a position to bully us into following them down the path to destruction.

I am enthusiastic about working with the round pegs and free spirits that reject the advice you hand out to square holes and want people with type 2 diabetes to follow blindly. Even some doctors and endocrinologists are discovering that your advice does not work, especially for people that have found the paleolithic lifestyle or the low carbohydrate lifestyle. There are other types of living lifestyles that are working for other people with type 2 diabetes and doctors are learning that good nutritional information is more important than mandates and mantras.

Some of these same doctors and endocrinologists are also beginning to understand the importance of many of the tools CDEs and RDs continue to ignore and do not teach to people with type 2 diabetes. Fortunately we are a very diverse group and don't fit the square holes you insist we should fit into. Maybe it is this diversity that puzzles you so much because we don't fit nicely the patterns and established rules that you work with for people with type 1 diabetes. We know that you don't like us becoming our own science experiment because then you know we will not adhere to what you preach. Viva La Difference!