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My Healthcare Wishlist (I can dream, right?)

The current healthcare system feels like a ginormous heap of missed opportunity, so it's not hard to imagine ways to improve it, for example:

The Doctor-Patient Relationship

This is how it works at my endocrinologist's office: I get 15 mins a year with the endocrinologist. The other three visits per year I see the Certified Diabetes Educator. That seems to be the protocol at a lot of endocrinology offices.

In my improved reality, I'd get to see my endocrinologist quarterly. We'd have at least 30 minutes together, so we'd have real discussions. My doctor would come to know me as a person. She would understand my health goals and help develop strategies to maintain and improve my health. Also, any appointments or labs would be based the needs of the patients and doctors, rather those of pharmaceutical and insurance industries.

The Wellness Center (formerly the “Medical Center”)

Illness plays far too big a role in today's healthcare system! Most of us interact with it only when we're already sick or hoping to prevent sickness.

How about framing our system differently?  So that instead of "Medical Centers" (emphasis on medical intervention) we have “Wellness Centers” (like this one), reflecting an emphasis on health rather than on medicine. The Wellness Center could house not only a primary care doctor, nutritionist, and Certified Diabetes Educator, but also a massage therapist, gym, and cafe serving healthful food. As a bonus, the Wellness Center could be near my home so I could walk or bike to it.

Integrated Technology

Right now I rely on data from a meter, a pump, a fitness tracker, and a handful of iPhone apps and none of them talk to each other.

If I must have all these devices, could they at least communicate seamlessly with each other? And let's have all their data consolidated in a single, easy-to-use Electronic Health Record (EHR) that includes real-time data from doctors and labs. Let's make the data accessible via a smart phone, website, or wearable device. And I'd like to own it and be in charge of it, please.

Insurance Companies

Yeah, just kidding. Insurance companies don't exist in this dream.

7th Annual Diabetes Blog Week

This post is part of Diabetes Blog Week.
Today's Prompt:
How would you improve or change your healthcare experience? 

For more perspectives on this topic, click here.

Six months ago my long-time and most trusted endocrinologist suddenly stopped practicing. The prospect of having to replace her was unsettling – after years of working together, she knew my disposition, motivation and relevant goals and shortcomings. All that knowledge translated into effective care. Transitioning to a new endocrinologist meant starting over from scratch.

Last month I met my new team and was struck by how different their model is from that of my previous team. I’ll still have an appointment every three months, but at those visits I’ll alternate between seeing the endocrinologist (every six months) and either the Nurse Practitioner or the Certified Diabetes Expert/Nutritionist.

While I appreciate the emphasis on specialized care, I wonder how easy it will be to build relationships within this structure. I believe patient/medical team relationships are closely related to both the quality of care I receive and my own motivation. So I have some concerns. With these in mind:

I Hope My New Health Care Team Will Understand:
Diabetes is demanding. Managing blood sugars is a never-ending exercise in planning, calculating, adjusting, and refining. And the resulting numbers don’t  necessarily reflect that effort, which can be enormously frustrating. Diabetes is also pretty solitary.

Because of that, I hope the new team won’t say things like:
Your blood sugars look awesome. Keep doing what you’re doing!”
A comment like that, from my medical team, will make me feel like diabetes is mine alone to understand and manage. I suppose for a few hours a year, I’d like it to feel less that way.

I hope instead they'll say:

“Your blood sugars look awesome. You’re doing a great job and we know it’s not easy. Stick with it – because all the that work is paying off. Here are some ideas that may make things easier and help you get even better results.”


What I Hope My New Health Care Team Doesn’t See (just yet)

  • I replace my blood glucose meter about every 5 years (not the recommended 1-2 years).
  • I change the lancet maybe once a year (not with every test, as recommended).
  • I do not store ketone strips properly (nor do I replace them when they expire, as they did in 2010).
  • And while on the subject of expirations, my glucagon pen expired in 2007.

It’s not that I wouldn’t disclose this information; it just feels a little early in our relationship.

4th Annual Diabetes Blg Week 2013

This post was written for Diabetes Blog Week 

The Prompt (suggested by Melissa Lee at Sweetly Voiced):
Often our health care team sees us for just 15 mins several times a year. What do you wish they knew about your and/or your loved one's daily life with
diabetes? What do you hope they wouldn't? 

At a recent annual physical, I was discouraged to see that despite a healthy diet and more frequent trips to the gym, I was gaining weight (the unwanted, non-muscular kind). “How could this be?” I asked my doctor.

Dr:   [glancing at medical record] Let’s see… oh, you’re turning 40 next week.
          Happy Birthday! And welcome to your 40-year-old metabolism.
Me:  For real? Doesn’t reaching my target A1c count for anything metabolically?
Dr:   Nope.
Me:  Here’s the thing: I don’t want to gain weight.
Dr:   Great! Do you count calories?
Me:  (Pause) No. I don’t count calories.
Dr:   Have you ever counted calories?”
MeNo. I count carbohydrates.

(She’s my endocrinologist. She knows I count carbohydrates. And fiber. She knows I consider exercise. And stress. And how much sleep I got last night. And what time of the day it is. And what day of the month it is. Every. Single. Time. I. Eat. Calories? Hell, no!)

DrOkay, so from now on you’ll count carbohydrates and calories.
(I’m sorry, did you not hear everything I just thought?)
Dr:  You get 1,500 calories per day. 50% carbs / 30% protein / 20% fat. Got it?

(Damn you, slowing metabolism, how dare you take more fun out of eating?
But… I don’t want to gain a pound a year either.)

Me:  Okay. I’ll do it. I’ll get an app.

That night I downloaded LIVESTRONG’s Calorie Tracker app and played with it for way longer than I should have. It's pretty cool. It incorporates a large database with nutrition info for most of the foods I eat. There’s a place to track exercise. At a glance I can see progress toward my daily calorie threshold. I like this app! It’s going to help me reach my goals. It’s even going to remind me to drink water. Awesome.

         

The following week, my schedule was dreamily predictable. I exercised, ate, worked, and slept at consistent times. I had complete control over the carbohydrates in my meals. There are were no unexpected twists, no curve balls. It was the perfect week to be a carb-and-calorie-counting diabetic.

But, really, who has weeks like that? Life is full of schedule-wreckers. Within three weeks I had fallen off the calorie-tracking wagon. And yet, I like Calorie Tracker and continue to reference it for counting carbs (and the odd calorie).

But as far as a strategy to prevent weight gain, it’s more time in the gym for me.
And maybe I'll consider drinking my coffee black.

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