Wednesday, May 7, 2014

The Nutrition Debate #207: Diabetes Self-Care Just Got a Little Harder

Readers here know that I am an advocate for self-management of type 2 diabetes. Among the reasons: 1) It’s my health and my life, and I want to be responsible for its maintenance and preservation; 2) I am much better educated and informed about nutrition, and I daresay, even about type 2 diabetes, than any physician with whom I have consulted; and 3) I do not believe that the Standards of Care for type 2 diabetes in particular, but for blood lipids and systemic inflammation as well, are designed with the best interests of patients like me in mind. Call it hubris if you like, but that is the way I view these things.

So, I had my triennial doctor’s visit this morning, and the first thing I noticed was a new notice in the office that in future a copy of the patient’s medical records of the office visit would be available only by completing an “Authorization for Release” form, leaving it with the office where I had the visit (and where they do their own lab work), and then waiting for them to “forward my authorization form through a secure electronic method” to their contractor in another city, “a leader in medical record request fulfillment,” who would then calculate the cost to me to get a copy of the lab report from them. Then, “once payment is received, (the vendor) will release your records and mail them to your home.”

Thus, the reason I go to the doctor for my type 2 diabetes and hypertension – to get tested and receive a copy of the lab report – so I, not my doctor, can monitor my blood markers, has now been made more convoluted, and time consuming, and expensive. Did I mention that if the medical record I am requesting (my lab report of blood tests) was to be mailed to another doctor, there would be no charge; but, if it is for my personal use, there is “an administrative cost” of $1.00 per page for the first 25 pages, plus postage fees. I guess there’s no “administrative cost” to fax the records to my physician.  (Snail mail. How quaint.)

I do not know if this new policy at the large medical group I have visited twice now in Florida is yet, or will soon be, universal. I do not know if it is related to the new electronic medical records laws, or even if the new medical records legislation is a state-by-state thing, or if it is part of the Affordable Care Act (“Obamacare”). I only know that when I complained to my doctor about it, he said that he was unable to do anything about it. He told me to take the matter up with the American Hospital Corporation, the entity that bought the large group in which he participates in 2007.

So, my healthcare just got a little less affordable and a little less convenient for me. No doubt, it will be more affordable for my doctor, my doctor’s large group, and for the large corporation that owns them. But the worse part for me is that I am now a little more detached from my own self-care. My doctor told me that someone on his office’s staff would be calling me in a few days with the results of my labs, and that, if I wanted a copy of the labs, I should take it up with her. He really sounded like he could care less. It reminded me, as I said in #206, “medicine…is first and foremost a business.”

As an aside, there was a 2nd new notice posted near the reception desk on this office visit. It said that my doctor has been selected to mentor and help train a medical student and that that meant he was top rate (since he was “selected”). During the consultation, a nice young woman in a white coat watched as my doctor went over my medical records, confirmed (corrected, actually, my medical records in their computer: he had me taking a STATIN!!!!!). He commented favorably (to her) on my most recent HDL (90mg/dL); I then mentioned my most recent triglycerides (34mg/dL), which he acknowledged was “remarkable.” That gave me an opening to tell the medical student it was all about Very Low Carbing. She had a vague sense that this had something to do with nutrition. It seemed to register, anyway.

At that point, I suggested she read Deep Nutrition, by Catherine Shanahan, MD and Luke Shanahan (see #205). I asked my doctor if he had had a chance to read my blog. I had given him my “business” card on our first visit in January. He instantly (and pointedly) scoffed, saying “No!” He doesn’t do very well “head-to-head.” Some doctors, I think, get used to being in the “jaybird seat” and find it difficult to deal “mano-a-mano” – but they probably make very good mentors….
Anyway, I left a urine sample and went to the desk where I was told they make “your next appointment.” She said, “The doctor would like to see you in 6 months.” I said, “I think not. I’ll schedule my next appointment in 4 months (in August), up north, then again in December, up north, and then again next April (up north).” I like my doctor up north. Let’s hope getting a copy of my lab report from him will not be so Obamafied. I know. That’s not fair. But I’m all in a huff over this.


  1. Dan, I'm so sorry to hear about the woes you are going through. I don't think I would be as calm as you seem to be. My doctor retired 15 years ago and I only now found one that doesn't think he's God. He printed out my lab results in seconds and gave me a copy for free. He doesn't send me for tests I don't believe in and he listens to me. So I am truly blessed. Hope you can work around this somehow.

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