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

On 27 Apr 98 at 19:37, BBradRN wrote:

> << 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...most diabetes educators hate the word non-compliance.  In my
> opinion, it only means that someone has not taken the time and effort required
> to find out why someone is having difficulty with their treatment plan that
> should have been negotiated based on an individual's lifestyle, not a medical
> "protocol".  No one is a textbook picture of anything!

That's true - the educators don't like the word because they 
understand what is required.  But too many doctors, nurses and now 
insurance companies are using this type of language to defend poor 
quality care.  My wife is a home health nurse and has been fighting 
battles with doctors for years to the effect that you cannot label a 
person "non-compliant" if you never told them what they were supposed 
to do in the first place.  And since most insurance companies don't 
pay for education services the patient's options are limited.  Not 
many of us can affort the $80 to $250 per hour charge for education 
services.  When I went on the pump I paid $85 for a half hour 
consultation with a dietician - insurance just laughs when you submit 
claims for education services.  The patient without the cash cannot 
afford the services, and the medical assistance programs are 
generally worse than the private insurance companies.  And given the 
current environment the patient is often fortunate if the doctor 
remembers their name, much less actually sits down and develops a 
treatment plan.  The trend today is to scratch a code number on a 
form and pass it along to the next person in the chain, who may be 
some insurance company serf who has instructions to deny all claims 
the first time through.  There are many excellent diabetes educators 
in practice today - but when patients either aren't informed about 
them or cannot afford their services it's kind of useless.  The local 
diabetes nurse has told me several times about the difficulty of 
getting a few of the doctors to refer patients to her because they 
still like to hand the patient a photocopied sheet of instructions, 
bill the insurance for an extended visit and call the patient 

My original comment concerns the attitude that the health care 
industry seems to be developing as envisioned by the insurance 
hegemony - where patient issues are secondary to cash flow and profit 
margins, and the prime indicator of a successful medical procedure or 
treatment was the percentage profit made.  Remember the fights 
when proposals for universal health care coverage came up in 
Congress?  According to the insurance industry and some big players 
in the health care industry it would have meant and end to their 
practice of free billing of Medicare, Medicaid and overbilling the 
patient... and an end to triple-digit profit margins for some of 
them...  very little was actually said about provision of medical 
care except comments from insurance industry moguls to the effect of 
"just let em die once we've made our profit off of them."

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/
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