11 Responses

  1. Scott K. Johnson
    Scott K. Johnson March 12, 2009 at 7:37 am | | Reply

    Sounds very interesting. I’m digging the quote about us forming better algorithms of care through trial and error!

  2. Elizabeth Joy
    Elizabeth Joy March 12, 2009 at 8:14 am | | Reply

    “Patients with behavior-intensive diseases can generally formulate better algorithms of care through trial and error than their physicians can.”

    Absolutely agree with this…I’ve never seen a CDE or nutritionist and (while I’m sure it’s helpful for new diabetics), after 36 years of diabetes I know it’d be a complete waste of time. But I know many other diabetes vets who do still see their CDE’s even knowing it’s not really showing them anything they don’t already know. My endo wants me to send BG results to him weekly also, and I’ve never done that…It just seems silly to me. I know what adjustments need to be made if I’m having issues, so why waste his time?

    I also don’t think it’s necessary to see an endo every 3 months just to have my A1C tested, when it’s always under 6 and nothing in my treatment has changed…But I do it anyway, for the stupid reason that I don’t want my endo to wag his finger at me. :P We definitely waste a lot of money that could be better spent elsewhere.

    Somewhat off-topic, but the biggest problem I see with diabetes care is the times I hear about diabetics being diagnosed by a GP, and then just sent away with a bottle of pills (or an insulin regimen from the 80′s, probably from when the gp was in med school and learning the basics about diabetes.) They get almost no direction of what to do, and no referral to an endocrinologist. I’ve seen several patients misdiagnosed as type 2, and lord knows what damage is done to their bodies before anyone realizes the metformin isn’t doing much good. This happens over and over again, and it’s absolutely unforgivable, but I have no idea what the solution is.

  3. Lee Ann Thill
    Lee Ann Thill March 12, 2009 at 1:39 pm | | Reply

    Regarding T1′s “behavior-intensive” nature, and the idea of systemic integration, I’d be interested to know if there’s any discussion about better integrating behavioral health treatment options into D-care as a stepping stone towards reform.

    It’s a good thing I’m OK with being a broken record since I sure sound like one :D

  4. im1dc
    im1dc March 12, 2009 at 3:16 pm | | Reply

    Re “The Best-Ever Book on Health Care” fixing the Healthcare System in the USA consider reading this source:

    “Options for Controlling the Cost and Increasing the Efficiency of Health Care ”

    by The Congressional Budget Office March 10, 2009 where you will read such gems as:

    From “Payment Methods and Providers’ Incentives”

    “…One study randomly assigned enrollees to different health plans and found that those in an integrated plan (which owns the hospitals used by enrollees and pays providers a salary) used 30 percent fewer services than enrollees in a fee-for-service plan…”


    From “Comparing the Effectiveness of Medical Treatments”

    “…less than half of all medical care is based on adequate evidence about its effectiveness”

    You read right, 30% fewer serviced due simply to the HEALTH PLAN and only about half of what is done in medical care has a scintilla of scientific evidence to support its effectiveness.

    I don’t know about you or your readers but I seriously doubt either book you mentioned in your post today deals with what is wrong with our healthcare system except at the fringes.

    Real change must be made and soon.

  5. dan 2
    dan 2 March 12, 2009 at 4:47 pm | | Reply

    Hi Amy,
    I have a suggestion for you to see an intregrated system in action. James Hirsch in the book Cheating Destiny identified the location and it was cost driven. It is the VA. The VA has developed a comprehensive data management medical records system. In a prior article you commented on the lack of a medical team and their inability to share patient records. It is my understanding that the VA it includes the foot doctor, the eye doctor, dentist and any para or allied medical services. If they are part of military operations than it is in the system. The US bases, oversea bases, Europe, it really does not matter. If the records were loaded they are there.
    Hope this helps.

  6. Bill Halper
    Bill Halper March 12, 2009 at 4:57 pm | | Reply

    - Explaining the critical role of standardized personal electronic health records (why do we REALLY need these?)

    Without centralized record keeping, there’s no way to control costs on a global basis. It provides the ability for a government employee (aka Universal Healthcare System employee) to decide what treatment you’re allowed to receive. Simply put, it’s the core of the system and a computer hacker’s dream.

  7. nonegiven
    nonegiven March 14, 2009 at 12:41 pm | | Reply

    Any system that doesn’t take into account the long term health outcomes of the patients, but only money and services used is worthless and dangerous.

  8. Melissa Multitasking Mama
    Melissa Multitasking Mama March 14, 2009 at 5:55 pm | | Reply

    I certainly can’t wait for reform and this looks like a book I want to go check out.

  9. Laura
    Laura March 15, 2009 at 11:52 am | | Reply

    I agree that any system that only looks at money and services is worthless and dangerous. I see my CDE frequently because it is helpful to me. The DCCT proved that contact with diabetes educators is very useful in keeping this long term disease under control. Everyone’s A1c went up in the tight control category after they discontinued the study ….no more visits equaled less quality control.

  10. Manny Hernandez
    Manny Hernandez March 17, 2009 at 10:02 pm | | Reply

    I just ordered it. Christensen is a genius…

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