A study about the unreliable internet as a source for information about diabetes has surfaced. And a doctor has blogged about it. While he loves the study, he says that patients will continue to ignore him and believe what they read on the internet.
If, and I say if, he was taking a positive attitude about the internet and his recommendations, more of his patients would listen to him. Rather than denouncing the internet, he should take the time to find some of the excellent sites for his patients and recommend they read them. This may be difficult for him as he seems to fail in understanding the dynamics of his patients. It certainly is not the internet as he makes use of it with some success.
Where I do agree with this doctor is the unreliable sites selling “snake oils” and “cures” which we know have only short-term benefits if even then, There are many such sites and when they are called into question, they just change their name and internet service provider and are back in business. I wish there was a way to regulate them, but that is not likely to happen. So the best we can do is ignore them and let people know when they ask about this or that site, how wrong that site is.
I would also agree with the doctor that there are a lot of very misinformed sites and sites putting out very poor messages. These can do almost as much damage as the “snake oil” sites.
Then there are some sites that do not follow the American Diabetes Association's guide and are varying in the recommendations to work for HbA1c's below 7.0 or the American Association of Clinical Endocrinologists recommendation of 6.5 for A1c. Often these sites encourage people with diabetes to work toward a goal of 5.0 or lower. They also tend to encourage more frequent testing of blood glucose levels which the doctors discourage and the medical insurance industry will not reimburse for. I even take this tack and am doing this myself because it has helped in my control. I know why and the reasons behind what I am doing and not blindly following some ideas. I have adjusted for my age and how my body reacts. This is what people need to understand.
This encouragement of more testing is done for the purpose of aiding the patients to understand how foods and other conditions affect their own body to help them develop healthier eating habits based on their own body chemistry. This can be an excellent tool for people to overcome the initial fear of what they can eat and to settle into a variety of foods generally more healthy than they have been eating.
There are many excellent sites on the internet about diabetes, but everyone needs to be aware of the charlatans. Read about the study here to get more information.
Showing posts with label Physicians. Show all posts
Showing posts with label Physicians. Show all posts
16 March 2011
03 March 2011
Key to Medication Adherence Is Education
This is very interesting, one group saying medication education is the key to adherence and another group saying that limited literacy may reduce medication adherence. Both are saying basically the same thing.
One group is calling for education as a tool for patients to understand their medications and how they help the condition for which they are prescribed. But will this work in the real world, that is the big question. Yes, the Skaggs School of Pharmacy and Pharmacotherapy at the University of California, San Diego says that pharmacists and other health care providers need to assess the patient and include this education as part of their services.
The other study describes the problem of how the way physicians write the prescription and the pharmacist puts the instructions in the package for the patient. The two can often conflict and the patient is left wondering whether the doctor or the pharmacist is correct. They are calling for standardization of the prescription instructions.
Between the two studies, it appears that education needs to begin with the doctor and proceed to the pharmacist and then to the patient. This will require the manufacture to provide an update to the doctors of prescription requirements and possibly allowing the doctor the opportunity to print the prescription instructions for the patient. Most of this would be using standardized formats and then the pharmacist would be able to do the education of the patient. Actually a little education could be done by the doctor, but the bulk of the education would be by the pharmacist since they should be aware of all medications and where conflicts might arise.
In either study, it should be noted that education can be the key to adherence and this should be the emphasis. Read about the study at the University of California, San Diego here. Then read the other study at the University in Chicago, Illinois here. This should be a wake up about the problems that can arise.
One group is calling for education as a tool for patients to understand their medications and how they help the condition for which they are prescribed. But will this work in the real world, that is the big question. Yes, the Skaggs School of Pharmacy and Pharmacotherapy at the University of California, San Diego says that pharmacists and other health care providers need to assess the patient and include this education as part of their services.
The other study describes the problem of how the way physicians write the prescription and the pharmacist puts the instructions in the package for the patient. The two can often conflict and the patient is left wondering whether the doctor or the pharmacist is correct. They are calling for standardization of the prescription instructions.
Between the two studies, it appears that education needs to begin with the doctor and proceed to the pharmacist and then to the patient. This will require the manufacture to provide an update to the doctors of prescription requirements and possibly allowing the doctor the opportunity to print the prescription instructions for the patient. Most of this would be using standardized formats and then the pharmacist would be able to do the education of the patient. Actually a little education could be done by the doctor, but the bulk of the education would be by the pharmacist since they should be aware of all medications and where conflicts might arise.
In either study, it should be noted that education can be the key to adherence and this should be the emphasis. Read about the study at the University of California, San Diego here. Then read the other study at the University in Chicago, Illinois here. This should be a wake up about the problems that can arise.
24 February 2011
Another Reason for Talking to Your Doctor
There is a growing epidemic in this country and it is on two fronts. Many people are not talking to their doctors. And at the same time doctors are not talking to their patients. These are not what I am referring to, but are part of the epidemic.
Medical situations arise every day and people think they can handle them without talking to their doctor. A brief article the other day made a excellent point about the need to talk to your doctor. Some people will disagree with what I am going to say, but they are the ones that will end up in the emergency room and the hospital or even the local mortuary. Yes, it is that serious.
When people come down with the common cold or also develop problems with mucus plugging their nose, they head for the nearest store or pharmacy to get a decongestant. If you are healthy and have no known medical problems, chances are that no damage will be done.
But if you have any of the following health conditions, doing this is not advisable. These health conditions are heart problems or high blood pressure, glaucoma, thyroid problems, diabetes, or prostrate problems. With these conditions, it is wise to consult with your doctor. Most over-the-counter products like decongestants are clearly labeled with a warning for high blood pressure but little else. Some do say they will raise blood glucose levels.
Most people will demand privacy and other grounds for avoiding what I am proposing, but after seeing a friend in the hospital last week for just the above situation, I think for the sake of safety, all over-the-counter drugs that require a warning, should only be available through a pharmacy and be kept behind the counter requiring either a prescription if they have health problems or must be handed out by the pharmacist.
This may be an unnecessary burden on doctors and pharmacists, but in this day with computers, this should be workable. Some patients will go to extreme measures to avoid this happening and shop pharmacies to avoid the need for a prescription. They will do anything to step around the system. The dangers of doing this are there and people still want to ignore them.
This is the reason that I only have two pharmacies and and all my doctors know which ones to deal with. If I am looking for an over-the-counter medicine, I talk with the pharmacist after I have read the label. Often the pharmacist suggests another product that does not have the dangers. Occasionally I am told to not take any and go to the doctor. I respect the pharmacist for this and this is one reason you do not want many pharmacists to deal with.
I find that these relationships work for my better health care and as a result, the doctors are more confident in what I do. Plus the pharmacist is more willing to answer questions and even supplies me with additional information when it is felt that it will be of value.
Read the very brief article here.
Medical situations arise every day and people think they can handle them without talking to their doctor. A brief article the other day made a excellent point about the need to talk to your doctor. Some people will disagree with what I am going to say, but they are the ones that will end up in the emergency room and the hospital or even the local mortuary. Yes, it is that serious.
When people come down with the common cold or also develop problems with mucus plugging their nose, they head for the nearest store or pharmacy to get a decongestant. If you are healthy and have no known medical problems, chances are that no damage will be done.
But if you have any of the following health conditions, doing this is not advisable. These health conditions are heart problems or high blood pressure, glaucoma, thyroid problems, diabetes, or prostrate problems. With these conditions, it is wise to consult with your doctor. Most over-the-counter products like decongestants are clearly labeled with a warning for high blood pressure but little else. Some do say they will raise blood glucose levels.
Most people will demand privacy and other grounds for avoiding what I am proposing, but after seeing a friend in the hospital last week for just the above situation, I think for the sake of safety, all over-the-counter drugs that require a warning, should only be available through a pharmacy and be kept behind the counter requiring either a prescription if they have health problems or must be handed out by the pharmacist.
This may be an unnecessary burden on doctors and pharmacists, but in this day with computers, this should be workable. Some patients will go to extreme measures to avoid this happening and shop pharmacies to avoid the need for a prescription. They will do anything to step around the system. The dangers of doing this are there and people still want to ignore them.
This is the reason that I only have two pharmacies and and all my doctors know which ones to deal with. If I am looking for an over-the-counter medicine, I talk with the pharmacist after I have read the label. Often the pharmacist suggests another product that does not have the dangers. Occasionally I am told to not take any and go to the doctor. I respect the pharmacist for this and this is one reason you do not want many pharmacists to deal with.
I find that these relationships work for my better health care and as a result, the doctors are more confident in what I do. Plus the pharmacist is more willing to answer questions and even supplies me with additional information when it is felt that it will be of value.
Read the very brief article here.
08 February 2011
Assessing the Value of Medical Interventions
This article raises some very ethical questions and in addition may make some barriers to medical care rationing fall. There can be some very cost-effective medical interventions that are also thrown out. And if in the process, doctors consider that the cost-effectiveness is not applicable, what are we as patients to do?
It is true that our views as patients will vary and often differ from the medical professions perspective, but there needs to be a common ground that is not evidence-based (pure theory) in the decisions.
The American College of Physicians (ACP) published the guidelines in the February 1, 2011 issue of the Annals of Internal Medicine. They have outlined key steps to assess the value of medical interventions. Such measures could help to lower the cost of healthcare by eliminating low-value interventions and preserving high-value interventions. The challenge will be to decrease costs while preserving high-value, high-quality care.
Even they have concerns about restrictions on healthcare spending that will lead to more rationing, but they seem locked into cost-benefits analysis. What I get is that this analysis effort in itself can be expensive and is not always allowed in the expense of making the determination.
They have some examples which I am sure will meet with resistance, but much of this will probably be difficult to determine. Also the factor of third party intervention, that is the medical insurance industry, will they work with this and allow for some procedures that have high benefits at lower costs. We know that Medicare will not always be on board from some of their policies. See this about Medicare.
Not mentioned is preventive care which could have very high benefits and low cost. I am talking about screening for diabetes and working with these patients to delay the onset of full and costly diabetes. This may be part of the picture, but it is doubtful that the medical insurance industry will allow for this even though it could be very cost effective for them as well. Presently, it the diagnosis is prediabetes, there is no medical reimbursement. This needs to change as well.
Will the medical community work for these benefits? At present, this seems very doubtful, even if there is a lot of call for this.
Read the article in full here.
It is true that our views as patients will vary and often differ from the medical professions perspective, but there needs to be a common ground that is not evidence-based (pure theory) in the decisions.
The American College of Physicians (ACP) published the guidelines in the February 1, 2011 issue of the Annals of Internal Medicine. They have outlined key steps to assess the value of medical interventions. Such measures could help to lower the cost of healthcare by eliminating low-value interventions and preserving high-value interventions. The challenge will be to decrease costs while preserving high-value, high-quality care.
Even they have concerns about restrictions on healthcare spending that will lead to more rationing, but they seem locked into cost-benefits analysis. What I get is that this analysis effort in itself can be expensive and is not always allowed in the expense of making the determination.
They have some examples which I am sure will meet with resistance, but much of this will probably be difficult to determine. Also the factor of third party intervention, that is the medical insurance industry, will they work with this and allow for some procedures that have high benefits at lower costs. We know that Medicare will not always be on board from some of their policies. See this about Medicare.
Not mentioned is preventive care which could have very high benefits and low cost. I am talking about screening for diabetes and working with these patients to delay the onset of full and costly diabetes. This may be part of the picture, but it is doubtful that the medical insurance industry will allow for this even though it could be very cost effective for them as well. Presently, it the diagnosis is prediabetes, there is no medical reimbursement. This needs to change as well.
Will the medical community work for these benefits? At present, this seems very doubtful, even if there is a lot of call for this.
Read the article in full here.
07 February 2011
Are Physicians Sometimes Rotten Apples?
This is an unusual blog post for Trisha Torrey, but I agree with her on this one. We do have to many doctors that are bad apples and they are spoiling the basket for the rest. The state boards that constantly refuse to oust them and take away their licenses also need review, but Trisha does not cover this.
I had thought to pass on this until an article from Medscape made the scene on January 28, 2011. This article is from an investigation in Philadelphia, PA in which a Pennsylvania grand jury returned an a verdict that is bound to have the medical community shaking in their boots. Talk about a rotten apple doctor, to say nothing about the state offices and city offices that let this continue because of their inaction. This is officialdom at its worst and hopefully people will be dismissed for their lack of action.
Sad to say, this is probably just the tip of the iceberg and there are many other doctors that should have had their licenses revoked or suspended for investigation across the US. So while Trisha's blog was timely, it is articles like Medscape's that may get some federal and state agencies off their backsides and into action.
This is another reason for patient empowerment and better whistle blower laws to have people ready to report more of this without fear of losing their jobs. This also points out another case on Texas where two nurses are finally having their day for whistle blowing and county officials having to pay for protecting a doctor. And this time it is the doctor who is also in trouble.
This is one time Trisha has my full support in her call to weed out the doctors that are creating a bad name for their profession. Even the good and caring doctors should be behind this and want them out of practice. We have too many good doctors that are being tainted by the news of these horrifically bad physicians.
Please carefully read Trisha's blog here. She makes some astute observations about the catch-22 situation and how to work out of it with dignity. My take is even though she is talking to the doctors, some of this can apply to the patients in realizing how they come across when they have had bad experiences with one doctor and are very reserved of the doctor they are now seeing.
Read about the Pennsylvania doctor here and the Texas case here. Like I said earlier, I believe this is just the tip of a much larger problem within the medical profession.
And Trisha is not finished – on February 1, 2011, she has more information about the doctors of questionable character. So enjoy reading and this is educational and if doctors and state boards and others do not act, then it is time for us to speak with our checkbooks.
I had thought to pass on this until an article from Medscape made the scene on January 28, 2011. This article is from an investigation in Philadelphia, PA in which a Pennsylvania grand jury returned an a verdict that is bound to have the medical community shaking in their boots. Talk about a rotten apple doctor, to say nothing about the state offices and city offices that let this continue because of their inaction. This is officialdom at its worst and hopefully people will be dismissed for their lack of action.
Sad to say, this is probably just the tip of the iceberg and there are many other doctors that should have had their licenses revoked or suspended for investigation across the US. So while Trisha's blog was timely, it is articles like Medscape's that may get some federal and state agencies off their backsides and into action.
This is another reason for patient empowerment and better whistle blower laws to have people ready to report more of this without fear of losing their jobs. This also points out another case on Texas where two nurses are finally having their day for whistle blowing and county officials having to pay for protecting a doctor. And this time it is the doctor who is also in trouble.
This is one time Trisha has my full support in her call to weed out the doctors that are creating a bad name for their profession. Even the good and caring doctors should be behind this and want them out of practice. We have too many good doctors that are being tainted by the news of these horrifically bad physicians.
Please carefully read Trisha's blog here. She makes some astute observations about the catch-22 situation and how to work out of it with dignity. My take is even though she is talking to the doctors, some of this can apply to the patients in realizing how they come across when they have had bad experiences with one doctor and are very reserved of the doctor they are now seeing.
Read about the Pennsylvania doctor here and the Texas case here. Like I said earlier, I believe this is just the tip of a much larger problem within the medical profession.
And Trisha is not finished – on February 1, 2011, she has more information about the doctors of questionable character. So enjoy reading and this is educational and if doctors and state boards and others do not act, then it is time for us to speak with our checkbooks.
03 February 2011
Patients In ICUs at Greater Risk
The arguments are being played out and the patients are the ones who will not benefit. Not that the doctors or residents (in training) will fare that much better, but the biggest loser may be the hospitals. They may force both doctors and residents out as they try to keep costs down in that area while raising daily charges for ICU rooms and supplies used in ICUs. Plus hospitals seem to be encouraging doctors to over prescribe medications when patients are dismissed from ICUs.
Now that the Supreme Court has spoken on residents hours and the OSHA is about to make other rules into regulations, if hospitals do not hire more doctors for handling patients in the ICU, the hospitals will lose doctors and patients and may not be able to recover from the downward spiral. Not only will people not trust the ICU but doctors will not want to work there and patients may start requesting to be taken to other hospitals.
That is what is causing the headlines like the article that got me on this topic. Yes, I agree attending physicians are probably putting in far too many hours to the detriment of the ICU patients. But really, where does the fault lie. Doctors are human and start making mistakes after working too many hours. Again, why are they working these long hours?
It is because the hospitals have restricted the number of doctors in ICU. All the studies done will not convince me otherwise. Also most of the physicians are blaming the curtailing of resident hours (or interns) for the problems of working more hours themselves. I realize that the physicians are not going to bad-mouth the source of their pay check, but someday they may be forced into this by rules and regulations.
Hospitals need to realize that if they don't adequately staff ICUs and other places, lawsuits may soon be directed at them and not the physicians. This seems presently to be a no win situation for patients in ICUs. This needs to end.
Read the Medscape article here.
Now that the Supreme Court has spoken on residents hours and the OSHA is about to make other rules into regulations, if hospitals do not hire more doctors for handling patients in the ICU, the hospitals will lose doctors and patients and may not be able to recover from the downward spiral. Not only will people not trust the ICU but doctors will not want to work there and patients may start requesting to be taken to other hospitals.
That is what is causing the headlines like the article that got me on this topic. Yes, I agree attending physicians are probably putting in far too many hours to the detriment of the ICU patients. But really, where does the fault lie. Doctors are human and start making mistakes after working too many hours. Again, why are they working these long hours?
It is because the hospitals have restricted the number of doctors in ICU. All the studies done will not convince me otherwise. Also most of the physicians are blaming the curtailing of resident hours (or interns) for the problems of working more hours themselves. I realize that the physicians are not going to bad-mouth the source of their pay check, but someday they may be forced into this by rules and regulations.
Hospitals need to realize that if they don't adequately staff ICUs and other places, lawsuits may soon be directed at them and not the physicians. This seems presently to be a no win situation for patients in ICUs. This needs to end.
Read the Medscape article here.
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