16 September 2013

Some Doctors Don't Care About Patients, Only $$$

Apparently some doctors that are members of the Society of General Internal Medicine (SGIM) really do not care about their patients with diabetes, only the money that they can receive for helping patients develop the complications. Rather sad that doctors will work so hard to cause harm to a group of patients. Don't get me wrong, as some of the doctors that are members of the SGIM do not agree with their policy listed in Choosing wisely.

I will continue to vent about those that do support "Don't recommend daily home finger glucose testing in patients with Type 2 diabetes mellitus not using insulin.” This tells me that they don't feel that the progression to complications can be stopped and they do not want to continue trying to educate these patients. Just including this on the list of choosing wisely shows they don't care about these patients.

I have had an email from one of the doctors that has peer mentors expressing his concern for how limited this will make his work. I emailed him a copy of my blog that will appear on http://bobsdiabetes.blogspot.com/ on September 17 and he agreed that he sees this as true, but admitted he did not think insulin will be the only answer. He did think that insulin will be one of the solutions. He is concerned that test strips will disappear as a tool to assist in the management of diabetes for those on oral medications. He is also concerned about his fellow doctors and why they voted for this item.

I did email him back saying that these doctors will be considered doing harm by me. His comment back was that I was on insulin and why would I be concerned. I said because they are still people with diabetes and deserve advocacy even if they don't realize the problems coming at them. He does agree with the ideas that most type 2 patients on oral medications do need more than one test strip per day and people on insulin do need more than three tests strips per day.

He commented that he will not prescribe any of the sulfonylureas for people on Medicare or Medicaid that are limited to one test strip per day. He will not be responsible for causing hypoglycemia when the patient cannot test often enough to correct the episode. He does ask patients to notify him immediately after if they have hypoglycemia and correct it. He has his peer mentors reinforce this in the education and works with these patients using email to discover why they had an episode of hypoglycemia. He needs to use a telephone for three patients because they do not have internet service.

I did ask him if it may be a case that most doctors that are members of SGIM did feel that diabetes was progressive and this may have caused them to vote this way. He admitted that most of them probably do think this, but have caused this by their attitude and not doing any education. He felt that since he started using peer mentors for education, the patients of his are doing significantly better in managing their diabetes. He had been very uncertain about using shared medical appointments (SMAs), but the fact that he has peer mentors doing education while he sees patients individually in another room is working very well and he has had only one patient that walked out of a SMA. He concluded that he will carry on the good cause and work to prevent his patients from being denied test strips.

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