Medcial System is Dysfunctional!

Type 1 and LADA
21

I live in Nashville, TN. Here is my game plan.

I have a following of 150,000 people to my blog.
I will write this tory up and release it on my blog and to "Nashville Is Talking, run by the local newspaper.
Subsequently it will get picked up by AP and make the wires.
In turn the press is very likely to call his office for comments
In return I will have my attorney call their office to confirm names, addresses etc.

BTW, when I asked "Do you maintain relations with patients? They responded, yes but only to those that see us every three months. In other words, those that milk their insurance company to meet this Doctors requirements…go figure!

22

For me, there would better fights to fight than this one. Good luck with the battle you’re trying to win. I can’t help but wonder who might be willing to work for you next as an endocrinologist after so much negative publicity

23

I don’t have a problem with my primary care doctor, I have a problem with an orthopedic surgeon. He refusdes to believe that I did not have sugar before I was diagnosed in january and that I can no longer take anti-inflammatory drugs esp. Feldene since that is what caused my liver and pancreas to become fatty,(this from and endo dr,) and just yesterday gave me ascript for the feldene again. I took the new script to my pcg and he told me no way, you cannot take that! why do they not listen when you tell them things? I wm going to end up going to someone else to get some decent results. I am not giving up! The pain is just too intense to have to live like this, everyone is entitled to a decent pain management.

24

Jay I understand how you feel but that’s the healthcare system. Like you I am a veteran but have learned to play the games to get what I want and need. It is important to at least see your Diabetes specialist twice a year. Remember just keeping a1cs within range is important but there are other things that blood test can tell them. Since our disease has a way of effecting other things that are essential to keep our bodies running well, blood test are needed.

I have lived with D for 50 years and know how important our healthcare visits and tests are. Recently my doctor found that my blood count was low and I am now receiving iron infusions. This is not the first time I’ve had to have iron boosters since childhood off and on I’ve had this problem.

Since using the internet thru the years, I have found that iron deficiency and thyroid problems at times plague those of us with D, among other deficiencies we have. So hopefully this information will help you understand why doctor visits are important and not just for a1cs.

25

(I had left a message on your page, but figured this would be a better forum for my comment :slight_smile: )

I had a similar experience with an endocrinologist about half a year ago. As a bit of back story - I was working in an office that really frowned upon taking time off. Every so often I would have to rearrange my appointments or cancel them all together because I was told that I was needed at the office. I didn’t want to fight it because I didn’t want to run the risk of getting fired and losing my insurance - crazy I know.

I had let them know about my work situation when I first started seeing the endo in question and assumed that it wouldn’t be an issue. However, after a few months of being a patient with this endo. I receive a letter from them stating that I was no longer considered a patient of theirs because I wasn’t following the ‘plan’ they laid out for me. I was outraged! I had only been with this group for a few months and only saw my actual doctor once. The rest of the time I was shuttled off to the nurse practitioner. No changes were made to my medication, but a pump (which I couldn’t afford at the time) was suggested. So outside of having to reschedule a couple of times (with due notice) and not getting a pump…I failed to see how I didn’t live up to my end of the bargain.

I had to rush out to my PCP after I got that letter (a letter mind you, not a phone call) to get prescriptions written for my diabetes medication. Luckily my PCP is very understanding (and was shocked by this treatment) and was willing to write them out for me, as well as do an HA1c for me until I found a new endo.

I realize that it screws up doctors when people don’t come in or have to rearrange appointments - but this is medication that I need to live. It’s amazing how unmoving they are on their office policies – policies that are often not disclosed until it is too late to prevent negative out comes.

26

This seriously sounds like more of an insurance issue than anything (asides from the drs office’s attitude). Do you have an HMO? That may be why the endo has their hands tied.

I do believe that most primary care physicians (average everyday sneeze and sniffles doc) can write scripts for insulin. Even if it is just enough to get you to your next endo appointment. HMOs require this type of doc to give referrals to specialists like cardiologists and endocrinologists. It is a bunch of red tape bureaucracy that just makes me ill at the thought of it. I have had to deal with it plenty having two chronic diseases.

Is there anyway your cardiologist could write a script for you?

I’m sorry you are having to go through heck for something you desperately need.

27

I have yet to find an endo that I can stand for more than two minutes. I love it when they point to a high gluocose reading and say, “oooh…see right there…that one’s a little high.”

Hey, you’re right…298 is a little high. What was I thinking? Here’s my wrist so you can slap it. Can I have my prescriptions now, or do you want to show me what a low reading looks like too? Tell you what, why don’t you tickle my feet again and we’ll call it a day.

I’ll find my endo-soulmate one day…

28

Truth be told, the full price of regular insulin is less than the co-pays for most analogs anyway so you may actually find it cheaper. To top it off, several comprehensive meta analyses (see IQWiG, Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen; “Rapid-acting insulin analogues in diabetes mellitus type 1: Superio…”; 06 Jun 2007 for details of a fairly recent study done in Germany, another was done in Canada last year which found the same result) have proven that rapid-acting insulin analogs do NOT deliver superior glycemic control even though many people swear otherwise – I’m starting to believe those who claim that its a drug company scam – I’ve tried every rapid-acting analog and I think they’re all basically no better than regular, although might differ on claims against long-acting analogs, but just realize that “your own diabetes mileage may vary” with every insulin). The bottom line is that yes, the medical system is quite dysfunctional, but you can deal with it by using over-the-counter meds and start realizing that rapid-acting insulin analogs are one of the biggest drug company scams going!

29

Oh brother, what a mess! Today, depending on your insurance you don’t necessarily need a referral from a primary to see an Endo and get prescriptions for refills. Clearly their office policy needs revamping. They should have at least given you an emergency prescription to keep you supplied till you could get into see them. But with their attitude, I would find myself another doctor.

30

I am going to go out on a limb here. I am sorry but if I was a diabetic for 47 years then I would hope that I would know by now that I need to see my doctor at least 2 times a year. There is no excuse for what happened and the ability to get diabetic supplies. The system isn’t as dysfunctional as many have written. Take personal responsibility for your actions. Bottom line it was your fault for not seeing the doctor and everything else that happened wouldn’t have if you were managing your diabetes properly.

I haven’t been diabetic for even 3 years yet but I see my Endo every 4 months because I don’t want complications and I don’t want to die earlier than need be. I invite anyone here to move to Canada, England or France and to write how your overall care is better than what you get here in the U.S.A.
I understand that all insurance plans are not created equal and there are many hoops to jump through. I would rather jump through some hoops then spend what my insurance company has paid out for my pump, strips, CGMS, insulin, medications, infusion sets, needles, blood tests and doctors appoinments. The post that started this mass discussion would have been a non issue had personal responsibility taken place. This of course is just my opinion!!

31

David,

I agree that personal responsibility for our diabetic care is VERY important!

So I don’t disagree with you, but I would just like to share my experience as someone who DID move from the USA to Hungary in Central Eastern Europe (which is a developed country BUT by no means as wealthy as the USA). The Hungarian system still needs a lot of reform-- so I don’t claim that it is perfect, but I would like to share my experience as an example that the system CAN be different if we CHOOSE to make it so.

When living in the USA and going to college, I had a (minimal coverage) health insurance plan. This was what I could afford then and as a healthy 20 year old, it seemed sufficient (just in case I broke a leg or something).

Then I was diagnosed with type 1 diabetes… with one year of college left to go. All of a sudden, my insurance plan with a $2500 deductible and no prescription coverage did not seem to be nearly enough. Though the generous support of my parents, doctors, diabetes educators, I got all the supplies that I needed. But I was worried about how I would enter the “real world” and still be able to afford all of this.

I had already applied for a scholarship to study abroad in Hungary. When I found out that I got it, I decided that I didn’t want diabetes to be the reason that I didn’t go. So I went through a lot of insurance paperwork and found a way to go to Hungary. But I had to keep my US insurance plan so that once I moved back to the USA, my diabetes would not become a pre-existing condition. Thankfully I had family to support me financially through this time. Otherwise it would not have been possible.

Four years later I am still here in Hungary, now married to a Hungarian. Because of this, I qualify to be in the national health care system for the price of 30 dollars a month. When I applied for my national health insurance, they asked me for a lot of papers (passport, marriage license, residence permit, etc). These things determined that I qualified to be part of the Hungarian health care system. NEVER ONCE DID ANYONE ASK A HEALTH RELATED QUESTION. They gave me my national health insurance card without even knowing that I have type 1 diabetes.

WHY?

Because it doesn’t matter to them. I qualify for the health insurance, not because I am low risk or won’t cost them too much, but because I am part of society here now and that means that I should be included in the health system too.

Now, I pay 1 dollar a month for insulin. On the receipt, I can see that the Hungarian government covered 99% of the cost, paying the market rate for insulin. I pay 10% of the market price for insulin pumps and pump supplies. Free doctors visits, blood tests, medical exams,…

The system isn’t free. But the decision is made that taxpayers should cover the cost of medical care for all. Because it is one society and there is greater security in knowing that all will be taken care of.

What are the disadvantages?
There is greater limitation in the supplies that are covered by the government-- so I can choose from 3 pumps and 6 meters (though some insurance companies have the same problem).
They are slightly behind the technology available in the USA-- CGMS probably won’t be supported by the government for a while (though some insurance companies have the same problem).
Taxes are high. Some reforms to make health care more efficient could significantly reduce that problem though.

I personally like the security of knowing that I can get my diabetes supplies at little to no cost no matter what my situation will be (employed, unemployed, disabled, stay at home mom,…). And I like knowing that there is a system that is concerned about taking care of others with health problems, not a system that only benefits the healthy. I have high-quality health care (equivalent to what i received in the USA) and affordable supplies to manage my health.

I know that many in the USA are terrified of the inefficiencies of nationalized health care. For me, this is a reason to build a nationalized health care system that has some measures to increase efficiency. I think we’ll find that government spending on health care might actually decrease, once all those in our country who rely on the ER for health care are able to get sufficient preventative care. Until this nationalized health care system is in place, I think that I’ll stay in Hungary.

32

That is a great response to my challenge. While you may not being paying much up front as you said the taxes are quite high. I think it is great that you are getting all those options under a national health care system. Three pumps is plenty and six meters is more than enough–even in the USA CGMS coverage has just begun.

As I mentioned and you agreed with personal responsibility as diabetics is ours. Most of the posts in this thread are about why are system is dysfunctional yet the reason it is dysfunctional is because the person chose not to manage there diabetic situation properly. Even being in a foreign country you have sought out and found a way to manage your situation. Thanks for an honest post. Dave

33

I am not saying our system is perfect but it isn’t dysfunctional. I did not post my reply to take on every persons opinion on insurance in the USA. I am just saying that our system is pretty good, perfect NO–Dysfunctional NO as well. I am just advocating personal responsibility when you are diabetic and you have insurance that if you need to see your doctor at least once a year to keep your scripts active and you don’t that is your fault. Bottom Line.

34

While I see your point, I also can see others points about it being dysfunctional. Not all the doctors know what they are doing and that puts you at a higher risk for complications. I live in a small town and the closest endocronologist for me is about 3 hours away, which is a pain for me. So my GP oversees my care which means if I have to go to the e.r. I have no specialist to rely on and I have to rely on the ignorant Dr’s there. Recently the Dr at the e.r. refused to listen to me when I was going to low and I ended up in a coma. Now that is no fault of my own due to the fact that I did tell them and they refused to listen to me. They informed me I was to calm and coherent to be low. When they finally checked my sugar I was in the 20’s. Thankfully I have found a wonderful GP who listens to me when I come in with new research and listened to me when I said I wanted to start the pump and fought with my insurance company for over a year to get me one.

35

Cody, I totally agree with you that there are doctors that have no clue. My primary care physician is always overly concerned with my feet. I manage my diabetes very well and at this point my feet are lower down on my list of concerns. I just see my PCP when I need referrals. My Endo is fabulous and spot on. My response to the original post was not directed at ignorant doctors just that our overall health care system was pretty good which it is. There will always be doctors that are not experts when it comes to dealing with specific diseases especially diabetes. Before I was diagnosed I was clueless about diabetes. I knew basic but certainly no specifics. I am still learning…day by day!!

36

I’m inclined to disagree with the “over all our health care system was pretty good” statement. I think there are a lot of problems with the nature of our current system i.e.: letting insurance companies bar people from shopping rates because of pre-existing conditions, etc. In the case of the original poster it was an office policy that tripped him up - I have only had one endo. with such hard and fast rules regarding how things are run and I was “kicked out” for rescheduling a couple of times.

I also have to say that we don’t know why the orginal poster waited a year to go see an endo. In my case I had to reschedule a couple of times because of work - they had actually written me up for taking a couple of days off for diabetes related illness and for taking doctor’s appointments. So, in fear of getting fired and being left with no insurance at all I rescheduled the appointments to space them further out, so rather then going every three months I would go every five. The endo didn’t like that and dropped me in mid-2007 from their practice stating “non-compliance”. Which wasn’t true - I just didn’t want to get fired! I had even told them about the situation I was in, letting them know that if my workplace continued making it hard for me to take days off then I would be quitting after my wedding and look for employment elsewhere.

But they dropped me, I continued at working at the same place for the duration of 2007 and quit once I was married in December of that year. During half of 2007 I went to my PCP for prescriptions and researched endos to move on to. I’m with a good group now, and am glad that I was dropped from my former one. I need a diabetes team that can work with me as well and if you’re going to drop me for merely rescheduling (with more than a couple of days notice mind you!) then you’re not going to work with me on my diabetes.

37

Very true, I don’t know why he did not see his doctor for over a year. However any PCP will give you a script for diabetic supplies. My PCP which I just have for getting referrals is open several days of the week from 8am to 8pm. My Endo has Saturday hours. There will always be situations that prevent people from seeing their doctors (like you not wanting to get fired) but I don’t believe that a year can pass by where there wasn’t at least one opportunity to at least go see a PCP. I am just advocating personal responsibility.

38

I totally agree with you on the personal responsibility - don’t get me wrong. I was just playing the devil’s advocate for a second and pointing out that we don’t know the complete story, just what information he has chosen to share with us.

If worse came to worse he might have even been able to get insulin from an after hours walk-in clinic. I personally have bought over the counter during vacations when I miscalculated how much insulin was remaining and how much I’d need for my time away from home. So there are options, of course. :slight_smile:

39

I share the concern that the government is not always the best provider.

But I also don’t feel that private insurance companies are set up to oversee the best health of the patients.

Also, while taxes may be higher in a national health care system, the personal expense of health care insurance would be gone.

A nationalized health care system just looks at health care from a whole new perspective and says that health care is a right, not a luxury. And a person should not pay based on how much he/she uses the health care (except co-pays to reduce overuse), but on how much income he/she makes.

In Hungary, you pay 7% of your income into a separate national health fund that pays the health care expenses. That means that the higher your income, the more you pay. NOT the sicker you are, the more you pay.

Next to that you have to rely on good education to influence personal choices for things like smoking, poor diabetes control, etc.

This is a democratic society (which the USA used to be and hopefully will remain!), so they cannot intervene in personal decision about health. Only educate and hope that people make healthier decisions.

For me it is just a whole different philosophy for health care. One that says health care is a right that shouldn’t be given only to those who can afford it, but rather to those who need it.

I don’t know how realistic a similar system in the USA would be, which is a much more individualistic (or even selfish?) society than what i have experienced in other countries. But the health care reform proposals that I have heard would be extremely costly if implemented. Even just leaving things the way they are cost our governments a lot of money.

The city that I know the best is Detroit, where numerous hospitals have closed down because they went bankrupt. There were too few paying customers and too many people showing up in the ER, where they must be treated. These people cannot and do not pay for their treatment-- so one of two things happens:
(1) the government pays for it
(2) the hospital closes

So the government is forced to be involved.

Yes, ours is a system that takes care of the well off, the people who can be sure of employment with health insurance for life. For those people, reform in the system doesn’t seem necessary. But i like to remind myself that I did not choose the life that I was born into and the opportunities that were presented to me. Inequalities in the USA are significantly higher than any European country-- so we cannot argue that people have equal opportunity to employment and equal access to health care. If you saw an inner city school in Detroit, it would be obvious…

So we need to find a way to keep individual freedoms (as Shannon correctly emphasizes!!) and a system that says that the health of our society is important. I know that I am expecting too much by wanting the wealthy to pay higher taxes for a socialized health care system. I know that our society doesn’t work that way. I just wish that it did. Certainly some changes need to be made to confront the problem of uninsured in the USA.

I open to other ideas, but nationalized health care is the only one that I can imagine that would really make a difference!

(Sorry for the ranting, this was one of my passions even before I was diagnosed with type 1 diabetes!)

40

I am just playing devils advocate here-So if you pay 7% of your taxes into the health care system why should someone who makes more be required to pay more? Just currious