Friday, September 30, 2011

If Your Diabetes Is Out of Control, Go See Your Family Doc Every 2wks!

I try to call a spade a spade.  I've pointed out colleagues who perform colonoscopies too frequently and place unnecessary coronary stents.  I've also pointed out areas for savings in our insurance system and in our government (stop paying benefits to the deceased! and reign in legislatures' ability to plump up their retirement benefits in ways that you & I can't do).  Earlier this month, two authors concluded that primary care physicians in the United States, including family physicians like myself, are paid too much relative to other countries and are thus driving up the cost of healthcare (conveniently, the reporters underplayed the point that primary care in the States is way underpaid relative to specialty care in comparison to those other countries - but that's another battle for another time).

So just how do I jack up the cost of healthcare?  By seeing more patients!  Really?  At $40-50 per visit? Even at $100/visit, I'd be seeing patients 24/7 in order to approximate the cost of just one (unnecessary) procedure running into the tens of thousands of dollars.  Can you tell I'm not very happy about how we've moved away from prevention and towards treatment after the fact?  Don't get me wrong.  I love being a family physician.  I've truly been blessed with this opportunity such that I wouldn't trade this profession for any other.  I just don't care for our dysfunctional sickcare system.

But I digress.  What I wanted to point out is a study published this week in Archives of Internal Medicine whereby patients with diabetes who are seen more frequently (every 1-2wks) have their cardiovascular risk factors brought under control much more quickly than those seen every 3-6mo.  The authors arrived at their conclusion after evaluating patient charts for over 26,000 patients w/poorly controlled diabetes, dyslipidemia & hypertension followed for 9 years.  The patients seen most frequently were able to reach goal blood pressure, cholesterol & hemoglobin A1c in weeks-to-months as opposed to months-to-years.

So, would you rather pay your family physician $40-50 per visit for a few weeks-to-months to get your health optimized or would you rather pay a specialist to emergently place a stent in your heart or bypass an artery for $50,000.  Which brings up that healthcare conundrum once more:  quick, great, inexpensive - which two adjectives do you want to describe your healthcare because you can't have all three at the same time (at least not w/our current system) unless you put in the effort like a Biggest Loser.

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