[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IP] Support of medical doctors, nurses, etc (long -- sorry)

On 25 Apr 98 at 23:34, Ruth Elowitz wrote:

> I'm convinced that the problem is underlying assumptions made at large in society
> and through the medical training process about diabetics.  As a teacher in the
> California Community College System I think I encounter some of the problems health
> care workers face with students.  And I've heard many teachers over the years moan
> about apparent "lack of motivation" and "lack of compliance" from a highly diverse
> group of students most of whom face real risks as students that four year
> university students (especially the higher level university students -- i.e.
> Berkeley, Stanford, etc.) just don't face.  I know that my students, especially
> early in the semester, often appear unmotivated, flaky, etc.  I also know that
> early in the semester a high portion of the work looks nearly illiterate to someone
> with a university background.  (My 7th graders when I taught in a fairly diverse
> public school were more fluent in their writing than my college students often
> start out).

BANG!  I think you hit the center of the target, Ruth.  

> I am impressed by the many very motivated people on this list who have really taken
> control of their lives.  My sneaking suspicion though is that most of us have some
> combination of the following characteristics:   well -educated, middle class or
> come from families who have chosen less well paying jobs in favor of vocations,
> have had some seminal experience or mentor which taught us how to accomplish this
> kind of control, have a thoughtful and well informed family support system of some
> kind readily available and comfortable to work with, have generous and reliable
> medical insurance coverage that spans our time with diabetes.   Most human beings
> in America today do not have these factors in their lives.  I'd be thrilled though
> if we all did or if we were all provided with the means to obtain them.

Our social system and medical care system are actually working 
against people "taking charge" of their lives.  Both medical 
professionals and patients are generally taught that the doctors are 
like mechanics - something breaks or goes wrong you go visit the 
shop, they fix it up, then you disappear until next time.  This 
system tends to disintegrate when you face a chronic condition of any 
kind.  Some doctors and nurses have a conditioned response to 
patients - something is wrong or they wouldn't be in in the office... 
so when a person is asking questions or trying to learn they are 
labelled as "non-compliant" and often written off.  Obviously if they 
"followed instructions" they wouldn't be there in the first place...
Some doctors have overcome their training, tradition and the 
influence of the insurance companies to actually become competent at 
treating chronic conditions, but many more still need to begin to 
move in that direction...

> Given the system of diabetic control I learned at age 11 and the medical care I
> have often received, I wonder how many people are actually able to stick to an ADA
> diet without some of the above help?  It's not an easy thing to do though it was
> doable.  Imagine, though, that you don't see or feel the value of it? 

The ADA diet seems to have been created for a different time and 
place, by people who either have a cook and a maid on staff at home 
or don't live in the same reality that many of us inhabit.   The same 
goes for many of the "treatment protocols" used for MDI - they assume 
that you can work according to their schedule, never work overtime, 
never have any unanticipated changes at the last minute and that 
nothing ever goes wrong...  Add to that the problem that the 
percieved cost of compliance is so much greater than the cost of 

> I think that a huge number of diabetics are written off by the health care system
> as "non compliant".  So much so in fact that sometimes when I am trying to comply
> and am having genuine medical difficulties, I have found that I am dismissed
> instead of helped.  Think about how few Americans can even manage a simple diet to
> loose weight?  Why do we expect that diagnosing someone as diabetic will change all
> those life behaviors?  At the same time, why do we assume that we can't help
> somebody who can't do it themselves through the long difficult process of becoming
> motivated and self reliant?  Yes, it requires super human patience.  Yes, it may
> require between an hour and 100 hours of help a week per patient.  Yes, it may
> require health care workers to learn how to speak across all the kinds of cultural
> divides (race, class and much more specific ones) in our culture.  But we are
> talking about people's lives here!

Given the current state of affairs the cost issue means that many 
people are quite literally "written off" the books for disposal.  
I've read some insurance company documents that calmly discuss the 
cost of denying care for conditions like cancer and diabetes and show 
that profits are higher when you let people die.  Those types of 
"calculations" are what make companies like Kaiser and Humana such 
financial powerhouses and such questionable medical providers.   If 
you label a person as "non-compliant" then you can argue that you've 
done everything and you don't have to expend any more effort with 
them...  so you don't have to spend the mony for that 1 to 100 hour 
effort and your bottom line looks better.  The management doesn't 
give a rip that the sucker (oops, client..)  may die.  All that 
matters is that you have an decrease in the time per patient ratio 
and an increase in the revenue per patient ratio.  And the doctors, 
nurses and hospitals are caught in the middle...

Our society doesn't value people's lives.  There is ample evidence 
for that in TV and film violence, legislative initiatives for 
"assisted suicide" (which can lead to "encouraged suicide") and other 
areas such as the abortion debate and the death penalty arguments.  
We seem to be headed towards being a society where only the 
convenient survive, and everybody else can be "written off" because 
they have no "worth to society"...   This is a "hot button" for many 
people, but before you go ballistic just think about it for a moment 
- how many people have we heard from who have tried to convince their 
HMO to help with a pump and the horror stories they have shared.  How 
many times does it boil down to "we don't think you're worth that 
kind of expenditure..." or some similar economic argument?   And just 
think about what some of the people on public assistance are being 
told - "you aren't worth the effort to send to an endo for your 
diabetes because you are non-compliant..." - especially when the 
person needs some intensive training to even understand what 
non-compliant means.  

Randall Winchester

* The views expressed here are mine and do not necessarily *
* reflect the official position of my employer.            *
* There's no guarantee on anything said here...
* If I say I understand something completely the only thing
* we can both be assured of is that I must have completely
* misunderstood something. 
Insulin-Pumpers website http://www.bizsystems.com/Diabetes/
For subscribe / unsubscribe information,
send the next two lines in a message
to the e-mail address: email @ redacted