Many people have developed type 2 Diabetes Mellitus (the kind that does not usually need insulin). The best treatment for it is weight loss through diet and exercise. The mainstays of drug treatment over the past decade or so have been Metformin to improve insulin efficiency in the body, and one form or another of sulfonylurea medications that increase insulin output by the pancreas. These treatments are variable in their success, though the variability is largely due to dietary indiscretion and inadequate exercise.
A few new types of medications have come along, and all successfully reduce blood sugars. Two of the new classes seem to prevent cardiac events that are so common in diabetes, although the true extent of the benefit to risk rations has not been fully elucidated.
I cannot emphasize enough how significant this risk is. Although not common, the severity is so high that no one should take the medication unless they absolutely need to, and all the alternatives have been considered.
This new warning about a very heavily promoted medication that seems great but has only marginal benefit over older medications while carrying significant risks and unknowns serves as another reminder that it is critical to take charge of your own care by collaborating with your doctor on important medical decisions.
We can help you collaborate better. Contact us for a free consultation.
The behavior of many of the caregivers described is clearly not compassionate, or even professional. Additionally, the underlying culture of blindly following guideline-driven care using important but incomplete and controversial medical science is a devastating indictment of the vocation that I entered. Doctors are healers and life-givers first, and healing or life-giving involves practices much deeper than simply using technology only partially tested in small groups regardless of its effects on the individual encountered in an exam room.
If your physician or their assistants are not listening to you or your specific needs, as in this story of being rushed through an exam and having symptoms that appear after complex medical therapy ignored, take charge of your care by asserting your concerns until they are addressed.
And insist on learning the benefits, risks, alternatives and unknowns of any treatment plan your doctor has. Asserting your right to hear them and having your doctor explain them aloud may help your doctor to realize that the plan that simply follows the guidelines may not be the best plan for you or your family member.
The evidence from the SPRINT trial that was used to create the blood pressure guidelines in this story is flawed and controversial because the study did not contain enough subjects to be scientifically certain (even though it was considered statistically certain, a vastly different and deficient kind of certainty). And as some of the doctors in the article discuss, even reasonable guidelines are meant to be applied individually, not uniformly.
If your doctor can’t or won’t explain the full details of how the guidelines they’re applying to you were created, they may not be making the best decision for you, and they’re definitely not engaging your collaboration by allowing you to apply your own needs and values to share in the decision.
We can help you understand guidelines, and collaborate better with your doctors. Call for a free consultation to learn more.
This Story from NPR about a risky and not fully tested medical procedure approved by the FDA but marketed using the “sexy” title of “vaginal rejuvenation procedure” provides a great example of why it is important to take charge of your own health decisions.
It’s important to make medical decisions together with a doctor who fully explains the benefits, risks, alternatives and unknowns of any treatment.
If a doctor does not spend the time to do that with you then you cannot fully share in the decision.
It is deceptive marketing to “presuade” a patient using anticipatory guidance by calling a medical procedure “rejuvenation”, a concept that creates a strong cognitive bias that changes the way a person thinks about a decision.
The term “vaginal rejuvenation” is such a marketing technique. Even the most honest and unbiased doctor cannot undo the cognitive bias created by the name of the procedure. A wise decision becomes more difficult to make.
Add a doctor who profits from the decision and does not listen carefully to thoroughly investigate the underlying problem, as happened with the patient who actually had ovarian cancer, and it’s a formula for bad medicine.
Be aware of how good medical science is rigorously applied, and how cognitive bias can subvert it’s application.
We can coach you to help you make good medical decisions with your doctors.
The decision to screen for cancer is not as easy as just wanting to find cancer early. The screening test must be followed by more definitive tests, which have some risks.
As with all medical decisions, you should discuss the benefits, risks, alternatives and unknowns with your doctor before embarking on the journey to cancer screening.
If you need guidance on how to make such a decision, we can help you sort out the details or what questions to ask your doctor. Call for a consultation.
A recent study published in the British medical journal reveals why strong collaboration is so critical to good healthcare.
The authors tried to compare aerobic exercise and Tai Chi for treating fibromyalgia. Both are known to be effective for some patients; so the authors tried to discern which might be better.
Due to limitations in study design and execution, the results of their trial could not achieve their goal.
However, they did confirm that exercise helps fibromyalgia, and also that an individualized treatment plan is critical to getting the best outcome possible:
Beware of a doctor, however well intentioned, who does not collaborate with you to find the best treatment for you as an individual. Suggesting one type of exercise or another must always be accompanied by a robust discussion of the benefits, risks, alternatives and unknowns, and a shared decision on which plan to try.
Simply offering a prescription for exercise, or for any other treatment, is not collaborative care, and runs a strong risk of failing to help you achieve your goals.
A recent news article on NPR describes a patient experience with doctors who prescribed an effective but very expensive medicine to treat a minor toenail fungus they noticed but that the patient did not even go to them for.
This story illustrates why the best care is also always the least expensive, and Why collaborative care is the best care.
There were many safe, effective and inexpensive alternatives available to treat the problem.
A good shared medical decision would have included a discussion of the mild nature of the problem, and the benefits, risks (including financial risks), alternatives and unknowns of the treatment.
The best care is collaborative care because it is individualized, and it strongly engages the patient to optimize the healing process.
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