Physicians and diabetes management

Thanks for the fast reply. I sent a message to the insulin-pumper’s list and hopefully some of them will come too.

It seems in a way, we have a Catch 22 situation. If doctor’s don’t have time to motivate the patient, how do the patients get motivated?

In my case, I saw first hand what happens if you ignore diabetes. Yeah, that was 20 years ago, and there wasn’t anyway NOT to ignore diabetes, but I learned all the same.

I know lots of people who assume that I have diabetes worse than they do because I went to insulin every quickly — however, I could see the pill game was going no where fast, and that insulin had fewer side effects. I’ve never seen a happier doctor than mine when I suggested insulin.

Why don’t they suggest it?

In fact, I really wish the pump had been suggested to me sooner. Like the day I asked about insulin. It is much more convenient than shots when it comes to overall life style issues. (Okay, carrying around 5 pounds of just in case supplies is not convenient).

Why is the pump the option of last resort, rather than the option of first resort?

Could this be yet another pharmacutical issue? Is it because the drug companies have the market cornered on insulin mixes? The mixes are QUITE expensive, and the pump companies don’t have the resources to compete.

I recently received a package from the folks that make Novolog insulin and the pump was barely mentioned. However, several pages were devoted to how wonder their insulin mix was.

Now I am starting to think like a conspiracy theorist

The questions posed are why are some doctors and patients motivated and why are some negligent?

The simple answer: Human nature being what it is, every doctor and patient is different and motivations and interests vary, as in all walks of life. Research shows, if I recall corretly, that about 37% of patients are empowered and self-motivated to have a say in their care. A much larger percentage depend on their physicians to make all the decisions and tell them what to do.

We employers and co-workers know that some people are self-starters and obey orders, and some are unable to think creatively or strategically or be organized or systematic, and they stumble through life. Why would they be any different when it came to their health care? Bad habits are hard to break, ask any smoker, substance abuser, whoever.

Physicians, believe it or not, are human. By definition they’re more motivated than the average person, because you have to be to get into and through medical school and residencies. But they have their interests, and diabetes isn’t always their primary interest. They may be more interested in their incomes, families, churches, hospital politics or special projects. And they act accordingly.

A physician friend and I were chatting at a party recently about changing physician’s prescribing patterns. And she strongly believes 90% of physicians are set in their ways are aren’t about to learn new prescribing patterns or consider alternatives to how they practice medicine. I have a bit more faith in the creativity of most physicians and hope, if not believe, that given better information, many will try to make better decisions.

But as Medpundit explained about her encounter with a diabetes patient the other day, some are more interested in the next meal than about taking good care of themselves. This discourages physicians and it’s understandable that they give up after awhile.

What’s the answer? Patients have to educate their physicians and make them aware of their expectations. And they have to be willing to shop physicians until they find docs whose styles fit their own. It’s important, I think, for the diabetese patients in a community to exchange notes and identify the docs who like to work with empowered and motivated patients and those who don’t. Play reporter. Call a bunch of people, including primary care docs. Ask for names and numbers, exchange information, and do what will help you survive and thrive.

Don’t let do-nothing patients or doctors hold you back. There are people who will embrace your determination to take advantage of best practices and make the most of your lives.

I’m not a diabetes patient or physician, but I’ve been a patient for years for other reasons, and I think it’s important to apply experiences in other fields to the business of personal wellness and health care.

Hope this doesn’t look like preaching.

Hmm, well, I just emailed one of our Endos who says he does, indeed, use insulin pumps in Type II DM. I plan to talk to him and get further info. Still seems counter-intuitive to me though.

(said the dumb primary care doc.)