The Last Word on Diabetes
My, my, my, but didn't my little rant start a pissing contest!
Many thanks to all who commented. Obviously I appreciated those who agreed with me, but to those who didn't (specifically those who questioned my treatment of diabetes) let me say this about the disease in question:
Diabetes is the ultimate lifestyle disease. Despite the terminology of doctors "treating" or "managing" it, diabetes is a condition truly managed by the patient. Sure, doctors can prescribe and suggest (and cajole and persuade) but in the final analysis, diabetes control is pretty much completely in the patient's hands. (Which is why P4P measurements aimed at physicians are so unfair; but I digress.)
I have patients maxed out on three oral medications plus insulin who still run A1c's in the 8's, 9's and 10's. Every single visit includes treatises on the virtues of diet and exercise, along with the dangers, perils and hazards of non-compliance/uncontrolled diabetes. Sometimes it works, but -- NEWS FLASH! -- sometimes it doesn't.
I know how to teach patients to manage their own diabetes. How well they do it is up to them. It's just like a little secret I learned years ago: despite all the medical talk about "managing" pregnancy, women manage their own pregnancies. They listen to the doctors, then basically do what they want. (Don't get me wrong! I deplore it when they then refuse to take responsibility for their actions and blame the docs for anything they think went wrong.) Contrary to what the lawyers have everyone fooled into believing, medical "management" of most conditions doesn't amount to more than just a bunch of suggestions. Patients then do whatever they want.
(And yes, I'm quite aware that the title of this post is an oxymoron.)