October 26, 2012

What Is Going On at the Mayo Clinic?

This is one time I want to leave this alone, but the latest post on the Mayo Clinic website really has me wondering what the purpose of the blog about diabetes could be. Yes, they can say they are serving the diabetes population, but I now have to wonder if they really care. I have taken blogs from other sources and expanded on what I felt they weren't saying which occasionally gives me a good blog. This time I don't feel like this is a good blog going in because I need to be critical of the blog and the authors.

Since they have two authors for the blog, I have to wonder why they can't at least have one blog per week. Other medical organizations do much better in their support of the patients with diabetes and have two or three blogs per week. In addition, most are timely and while not the most detail with every one, they do make people aware of different topics. Joslin does put some news items in their blog and especially about personnel at Joslin, I can look past this as it it good to know for those getting treatment at Joslin Diabetes Center.

The Mayo Clinic Blog has had some excellent blogs, don't think I am criticizing them on this. I do wonder where they get some of the comments. This is highlighted in this post. I can understand an individual's personal computer having problems with date and time being in error, but a computer for the Mayo Clinic? I have to ask where the comments were gleaned and are they doing this to bloat the comments section. I have searched the entire blog list to see if I could find duplicate comments for the time periods with the comments, but to no avail. It is very telling to have comments dated prior to the actual blog post. Who are they trying to fool and why?

The second thing I have found is that people do ask some very specific questions in the comments, but the authors very seldom, I have found a few answers or author comments. Questions often go unanswered and occasionally another commenter will attempt an answer, but most questions go unanswered. For a blog linked with a highly known hospital and clinic, this rises a question of how much does the highly touted Mayo Clinic really care.

When I wrote this blog back in September 2010, I really thought that the Mayo Clinic was going to have a social media presence to be respected, but I could not be more disappointed. They are like many diabetes professional organizations – the AACE comes to mind – they can talk the talk, but they won't walk the walk and do anything of value for patients. Have I lost respect for the Mayo Clinic and other organizations?. With the exception of the Joslin Diabetes Clinic, I must admit I have. Yes, they say they are serving patients, but I have a difficult time in actually believing they are doing anything but serving their own agenda, but doing little for the patient.

The one comment I can make in favor of the Mayo Clinic is that if you are researching a diabetes topic, you can find good, and detailed information within the site, but forget about the expert blog or the social media section. These two areas show a lack of direction and purpose and hype will not solve the lackadaisical attitude shown in these two areas.

October 24, 2012

The Real Meaning of RD

Most of us understand that the acronym RD means registered dietitian. This blogger is trying to draw attention to her blog and states, “RD does NOT stand for “Really Dumb”.” Yes, Adele Hite is poking fun at herself and her occupation, but at the same time is very serious about the idea that her profession needs change. She uses an excellent example like the last link in her first paragraph referencing a very controversial article from the Huffington Post.

I am not sure why one of their own would take this provocative stance, but she has taken on her professional organization before and probably will again. I strongly agree with Adele that the Academy of Nutrition and Dietetics (AND) has gone too far in their attempt to become the only source of recognized nutritional advice. I even agree that this attempt is backfiring on them and some states are even considering (but to-date none have) stopping all licensing of RDs. My own State of Iowa is taking a hard look at the licensure of registered dietitians, presently now allowing them to expand their over reach.

Would I say that even current registered dietitians are rebelling against their own professional organization? Maybe, but a few people may be trying to reorganize it from within. This may be surprising, but if the current people remain at the helm, the organization will soon be a shell of what it was. Following the pronouncements of the American Diabetes Association (ADA) and the US Department of Agriculture (USDA) will not lead to good nutrition of any type. Many of her links do point out the fallacy being promoted by the AND.

The blogger speaks the truth about the AND putting restrictions on its members about avoiding even the appearance of a conflict of interest, but the Academy receives its funds from the food industry and the pharmaceutical industry and clearly has the appearance of solid conflict of interest. This is definitely speaking with forked tongue by a professional organization. Does “do what I say – not what I do” fit the situation.

Quoting from the blog an important point “On the other hand, the “party line” approaches for weight loss are so ineffective, the federal government (and many states) won’t cover many dietitian services to help people lose weight. According to Dr. Wendy Long, chief medical officer of TennCare:

There’s really no evidence to support the fact that providing those services [from dietitians] would result in a decrease in medical cost, certainly not immediately, and even in the longer term.”

This lack of evidence may be due in part to the (sadly) limited scope of dietetic education and practice. The AND treats the USDA as if it is a scientific authority and not a government agency whose first mandate is to “strengthen the American agricultural economy.” It limits the training of RDs to USDA/HHS-approved diet recommendations despite the fact that even mainstream nutrition establishment scientists feel that the current US dietary recommendations are misguided and inappropriate.”

Follow the links in her blog to read what is behind her statements. I can only say that it would be smart to read carefully her full blog and if you have interests in this, to follow and read many of the links within her blog. I will only say that I am thoroughly enjoying reading her blog at this time. I sincerely hope to do an interview with her in the future. I fully support her position and hope that she continues to enlighten us. As a patient with diabetes, there is hope that changes will take place and either AND will change (doubtful), or a new organization will emerge to give us the correct nutritional advice we so desperately need.

We can all thank her for pulling together a few of the people knowledgeable about nutrition and dietetics that are working to correct the misinformation being foisted upon us by AND, ADA, and USDA. It is sad that the RDs that work for the USDA must spout the whole grains/low fat mantra to keep their jobs.

October 22, 2012

The Under-appreciated Professions

The four occupations included in this blog are among the most under appreciated professions. They still can have people within the profession that are bad apples for the profession. Most are a credit to the profession and do their jobs effectively and efficiently. Physician's assistants, nurse practitioners, nurses, and pharmacists are the occupations for this discussion. All have national organizations for support and advocacy. With the looming shortage of physicians, these professionals will serve a vital role in medicine and seeing patients on a more active basis. Links to professional organizations will be the profession below.

Nurses, whether they are registered nurses or any of the 68 different types of nurses, they have a role to fill and in general do excellent in their profession. The list of 68 may not be inclusive, but shows many of the areas that nurses may become specialized for their profession. Under the physician shortages, they will need to step forward and learn how to handle an ever-increasing load. Those that can obtain some additional education quickly will be in line for promotions and work in this expanded need.

Nurse practitioners (NP) and physician assistants (PA) will find more physicians that are more willing to work with them and expand their roles under the physician shortage. They will need to be cautious, as there will still be some physicians that will not accept their role or even work with them. These physicians will do more to damage the medical reputation of themselves and those round them. Physician shortage will not be easy for those still practicing.

If some of the hurdles can be removed, nurses, nurse practitioners, and physician assistants will in some of the more rural areas, be spending more time visiting elderly patients in their homes and using video conferencing (telemedicine) or telephone if necessary. Except in the states that have passed laws requiring physicians to physically see the patients before they can issue a prescription, physicians in the rest of the states should be able to issue prescriptions with the assistance of nurses, nurse practitioners, and physician assistants. In a small number of states already experiencing physician shortage, there is some talk about amending the law to allow these medical exceptions when driving distance is an impediment to physically seeing a physician.

The position of pharmacist is still being discussed, but physician resistance for allowing any pharmacist to issue prescriptions is still strong. One state is considering situations where a pharmacist would be able to renew prescriptions especially for certain chronic diseases like diabetes. Another largely rural state is considering allowing pharmacists with certain qualifications to be able to work with physicians in a capacity like nurses. Pharmacists in hospitals, assisted living facilities, and nursing homes may be given more responsibilities and with continuing education expand their roles even further.

Some pharmacists are already expanding their own roles in some of the larger chain pharmacies and this should also be considered and supported. Too many patients do not utilize their pharmacists to prevent polypharmacy conflicts. I think that there needs to be restrictions placed on patients using one pharmacy for one medication and another pharmacy for a different medication. If nothing more, pharmacists need a technology system to be able to access by name and social security number all pharmacies within a certain parameter to search for medications being taken by a patient to prevent medications conflicts. It is not unreasonable to find patients using three or more pharmacies for prescriptions and I have a few acquaintances that use this to keep (supposedly) others from knowing what other doctors are prescribing. I suspect prescription abuse to be honest.

Depending on how critical the physician shortage becomes will determine much of the expanded role for nurses, nurse practitioners, physician assistants, and pharmacists. Those that are willing to seek additional education now will be able to capitalize later. I know of two nurses presently studying to become nurse practitioners. I have written about the role of pharmacists here and need to say that some of the questions have been answered, but not all have been explained to anyone’s satisfaction. Walgreens has even gotten even more secretive while other pharmacies have become more open and transparent in what they want for their patients. Some of this is good while some actions do raise more questions.

It will be interesting to see what happens during the upcoming physician shortage. How long will we need to wait to get an appointment, how long will it be between appointments, will emergency departments continue to exist in some rural areas, and how many minutes will we have available with the doctor during appointments? These and many more questions are clogging my brain. I can only hope that I am fortunate enough to avoid many of these problems.