The article is right, the economics of the health care system in the US today is based on prescriptions written, tests ordered, and procedures performed. The doctor doesn’t get paid for keeping her/his patients well.
A large majority of the diabetes lifestyle changes I’ve made were inspired and based on peer communities like this one. The biggest factor in my blood glucose control is the way I eat. When this issue arises in a medical context, doctors reflexively refer patients to dietitians. Unfortunately the dietitian advice rarely helps produce good consistent blood glucose levels. They’re stuck in a carb-up shoot-up rut. If the patient is not using insulin, the knee-jerk reaction is to add more meds.
The big breakthroughs for me was adopting a lower carb way of eating, exercising every day, and closely monitoring my blood glucose levels. Doctors don’t get paid to provide that counseling. And the medical establishment (including the payers) does not provide effective long term social support to sustain these beneficial lifestyle changes.
Maybe we need to rethink the whole current situation. I don’t need to see my diabetes doctor four times per year but Medicare requires that frequency so it will pay for my insulin pump supplies. I’d be happy with one solid annual face-to-face visit supplemented by one or two Skype calls. Phone and email are other acceptable doctor visit supplements for me. But I’d also like the doctor’s attention when I’m having troubles.
The current situation’s complexity and entrenchment make it difficult to change. Going forward, I hope that the patient perspective be factored into any proposed changes.