April 8, 2014

When Are You Not Getting Enough Medical Care?

It is true that many people are receiving too much medical care. However, many people with chronic diseases/illnesses receive far too little medical care. This has not always worked this way. Until just recently, people with cancer were on the front line of medical care and all stops were pulled out to see that they received the best care currently available.

Today, the reverse is true and cancer patients are being denied care. I speak from experience that two friends have been denied care under their new medical insurance policies required by the law of the land – the Patient Protection and Affordable Care Act, aka ObamaCare. Now I need to wonder how many other diseases will suffer the same fate.

Diabetes has been suffering a similar problem as I discussed in my blog, the medical community turns against people with diabetes. The people with type 2 diabetes not on insulin are beginning to feel the full effect of this. More doctors are not referring patients for diabetes education, not prescribing or talking about people testing their blood glucose, and pushing the more expensive oral drugs on patients.

Another problem has manifested itself in the last few years and this is the activities of the certified diabetes educators (CDEs). Some of their activities have existed for decades, but the lack of good diabetes education for people with type 2 diabetes has accelerated recently. Doctors that are attempting to use shared medical appointments are finding that most CDEs will not participate. These doctors are discovering that they only desire to work with one or two patients at a time and are giving anything but diabetes education. Mandates, mantras, and dogma seem to be their preference.

Three members of our support group are talking about people they know that are being prescribed the SGLT2 inhibitors without consideration for existing renal problems. Their one friend would not be able to take metformin because of kidney problems, yet was prescribed Invokana. This tells us the doctor is not knowledgeable about the medications he is prescribing. They had their friend call his insurance carrier and in turn was recommended to another doctor. When his situation was explained to the new doctor, the doctor immediately told him not to take the medication and asked if he would consider insulin.

Once this was decided, the doctor set about determining the starting dose and informed the patient to reduce the amount of carbohydrates he consumed and to find exercise he enjoyed and could do. The patient said he had not gotten to counting carbohydrates, but he had friends that would help him. The doctor asked who and after hearing the names, agreed and said he would get a good education.

Therefore, when having a doctor start prescribing medications, make sure you ask:

#1. What Do You Think My Best Treatment Should Be?
#2. What Evidence Exists Suggesting This Treatment is Beneficial?
#3. What are the Potential Side Effects?
#4. What are the Contraindications?
#5. Is Watching and Waiting an Option?
#6. What Other Treatment Options Do I Have?
#7. Is There Education Available from Reliable Sources?

Number 5 above is often not an option, but sometimes the answer might surprise you. In the early stage of diabetes and even pre-diabetes, some people are able to manage with nutrition (diet) and exercise.

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