Wednesday, September 11, 2019

Retrospective #207: Diabetes Self-Care Just Got a Little Harder

My readers 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, preservation and extension; 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 Healthy Living, for Type 2 diabetes in particular and 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 over the years that is the way I have come to view these matters.
So, I had my quarterly 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 (to monitor my Type 2 diabetes and hypertension) – to get tested and receive a copy of the lab report – so I, as well as my doctor, can monitor my blood markers, has now been made more convoluted, and time consuming, and expensive, for me. Did I mention that if the medical record I am requesting (my lab report of blood tests) was to be sent 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. (Snail mail. How quaint!) I guess there’s no “administrative cost” to scan and email or fax the records to my physician. 
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 (EMR) 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, 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 group in which he now participates.
So, my healthcare just got a little less affordable and less convenient, for ME. No doubt, it will be more affordable for my doctor, my doctor’s large group, and the large corporation that owns them. But the worse part for me is that I am now 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 sounded like he could care less, but, 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 or rather corrected, actually, my medical records in their computer. Apparently, on my previous visit he had “prescribed” a STATIN for me, without bothering to give me a script; NB: if had he given me a script, I would not have filled it.). He then 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 eating VERY LOW CARB. She had a vague sense that this had something to do with nutrition. It seemed to register, anyway.
I then 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 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 comment:

  1. NB: "My doctor up north" still sends me a copy of my marked up lab report after each office visit, with a short dictated letter commenting on the results. At no charge. That's really nice.