Taking a Deep Breath...

I rarely comment on politics on my blog. But, after watching this, I am left with no options.

President Obama makes a good point when speaking about preventative treatment and early intervention in the treatment of diabetes. Diabetes is a growing problem in the U.S. and we have not begun to feel the long term effects of this disease. The President notes that primary medical doctors get little reimbursement for early treatment of the disease. While it is true that there is minimal payment for patient education, the President also needs to flesh this out a bit, or maybe he needs to deepen his own knowledge base before speaking.

It's important to note that people diagnosed with diabetes mellitus type 2 have typically had the disease for years. People can be insulin resistant or have elevated blood glucose levels for 6-10 years before the diagnosis is made. Why is this important? Because organ systems are being affected prior to diagnosis. Therefore, you can educate all you want, but the disease is already in process and there still ultimately may be end stage organ damage requiring surgical intervention.

Second, patient education involves the medical provider, the patient and one more elusive, but integral element: compliance. As a health care provider I have learned that you can teach, coach, encourage, chide, and provide information, but you can not force compliance. The patient has to want to make the lifestyle changes necessary to intervene in this disease. Yes, Mr. Obama, they have to CHOOSE to exercise, change their diet, give up fast food, check their blood glucose levels and show up for their next doctor's appointment. These things happen at an individual level with a personal choice. I would propose a close look at the current compliance levels of patients WITH insurance who have the diabetes. I would suggest that they are lower than we would all like to believe and somehow we all appear to have BMI's that are going higher. It is not likely this would change with a government system.

Third, primary care doctors are not the only health care providers that do diabetes education. There are on-line resources, nutritionists, books, certified diabetes educators, nurses, nurse practitioners, seminars, support groups and, dare I say, even the evil drug companies have excellent resources. Imagine what we could learn on our own with little direction.

Finally, I must comment on the suggestion that surgeons can amputate the foot and make $30,000-$50,000. That information is dead wrong and it infuriates me. No surgeon makes that amount of money on an amputation. While it does cost to do an amputation, the surgeon simply is not making that sum and to insinuate he or she is is a misrepresentation and manipulative. Surgical costs include the doctor, operating room set up, operating room instruments, nursing staff, the anesthesiologist, medications, sutures, dressings, and operating room overhead. Those costs do add up, but they do not translate to a $35,000 check to Dr. Hacksaw. If fact, the global surgical fee includes a 90 day period where the patient is seen in clinical follow up with no additional charges for the appointments.

I have seen the ravages of diabetes, I have seen legs amputated and put on the back table in the OR. I have seen compliant patients and I have seen patients who are so apathetic to their disease that its shocking. I have seen hospital bills, I have worked with a surgeon for years. President Obama, come spend a week with me, hold the retractor, mop up the blood, chat with me over a mocha and please speak with a little more knowledge than you displayed in this meeting.