I retired early from the profession I loved because the devolution of the health care system had made it impossible for me to care for my patients in a manner that met my standards. It also left me with a wound of “moral injury” which makes me leery of re-engaging with our health care system.
My early career
My first post-training job (1989) as a physician was in a BCBS clinic. After …
In the latest issue of Clinical Endocrinology News, I found an interesting article reporting a proposal to change the name of a hormone. The rationale for the proposed change was “patient safety.”
In 2009, a patient with known panhypopituitarism was admitted to a U.K. hospital for elective surgery. Diagnosis included panhypopituitarism with diabetes insipidus. The patient developed hypernatremia and volume depletion, tragically leading to pronounced hypotension and death.
The author attributes this …
On January 2020, I got the dreaded call: You have Type 1 diabetes. The rest is a blur. I went into a global pandemic, one of the highest risk categories, a red lab value that stared at me “HgbA1c > 15.”
As a family physician, I was supposed to manage patients and ease their fears. I was supposed to know all about the disease management of a “bread and butter condition” …
Having spent over 30 years of my career in diabetes, first as a practicing diabetologist and later as a diabetes researcher, I’ve met many people with diabetes. And while diabetes care has evolved significantly over my career, I’m amazed to see that daily insulin management is just as complex and manual for many people, particularly those with type 2 diabetes (T2D) — daily insulin management is just as complex and …
For diabetics, insulin matters as much as H2O. Unfortunately, insulin’s a hell of a lot more expensive than bottled water. High insulin prices force approximately nine million Americans to balance their wallet and well-being.
The American Action Forum reported that a type-one diabetic’s average yearly expense for insulin was $~6000 (i.e., $500/month). It’s easy to lambast Big Pharma companies for the current state of insulin’s affairs, but history and market behavior …
An excerpt from Care: How People of Faith Can Respond to Our Broken Health System.
“Why do you have to be such an asshole?”
Roger was visibly angry with me and ready to get up to leave. Forty-five years old, he worked long hours repairing cars and had very poor control of …
The recent report from the National Center for Health Statistics on declining U.S. life expectancy painted a bleak picture, fueled in large part by the impact of Covid-19, but not exclusively. Many of the contributing factors are deeply systemic – poverty and health disparities among them — but other longstanding health issues, including high rates of obesity and Type 2 diabetes, are contributing factors.
More than 34 million people – one …
Admittedly, this comes to you from a place of concussion-inducing-head-banging-against-brick-walls-level frustration.
For the past year, I have made it a personal mission to get people suffering from obesity on GLP-1 agonists. These drugs are all in the same class, have identical mechanisms, and three are the same generics. (Ozempic, Wegovy, and Rybelsus are all semaglutide.)
They are advertised as Wegovy, Ozempic, Rybelsus, Saxenda, Trulicity, and Mounjaro.
To say these are life savers is …
In Australia recently, a woman successfully sued a hospital for $2.4 million for a series of misdiagnoses that left her quadriplegic. A London woman was recently misdiagnosed four times before doctors discovered she had cervical cancer.
A Canadian woman recently filed a $3.5 million lawsuit claiming she was misdiagnosed and ignored when relaying her symptoms to doctors; she could have died. A 26-year-old woman nearly died after a …
A patient, let’s call him Jay, came to me refusing a leg amputation. He had open sores that were necrotic, foul-smelling as if he had been neglected for a long time. At his consultation, he fought with every cell of his being, refusing to lose his leg as his uncle did. He wanted a second opinion on whether or not his foot could be saved.
Traditional insurance-based medicine has …
An excerpt from Pluck: Lessons We Learned for Improving Healthcare and the World, published by Silicon Valley Press.
We met Joseph S. Murtaugh, our new chief at the National Institutes of Health, for the first time on July 3, 1967. He sat behind his desk, looking every bit like …
“Diabetes uniquely requires patients be experts in their own care and demands 24/7/365 vigilance. Close communication with a health care team eases the burden and improves outcomes.
Glucose management revolves around numbers. Unfortunately, numbers are just noise unless translated into actions. Innovations, such as color for people with low numeracy, are essential …
This article is sponsored by the Academy for Continued Healthcare Learning. Visit the CME activity and Clinical Inertia Assessment Tool. This activity is supported by an educational grant from Lilly.
It’s been over …
“COVID-19 melted down the world at a very inopportune time in history. Just as medicine was getting a handle on previously intractable conditions, from sophisticated diabetes management to less invasive surgical procedures, a new threat that devastates our population with few good treatments overwhelms health care.
Medical workers come to the rescue, …
A patient undergoing chemotherapy for breast cancer was diagnosed on April 20th with profound secondary adrenal insufficiency (hypophysitis: ACTH undetectable, cortisol 0.2) caused by immunotherapy (pembrolizumab). She was started on corticosteroids and sent home from the hospital on April 24th with a prescription for only five days of prednisone. After completing the five days of prednisone, she predictably began to feel profoundly weak and nauseous. She continued losing weight …
This article is sponsored by the Academy for Continued Healthcare Learning, an independently owned and operated full-service medical education company that has been developing certified health care education for nearly twenty years.
Visit the CME activity and Clinical Inertia Assessment Tool. This activity is …
Over their lifetimes, adults in the United States have a 40% chance of developing type 2 diabetes. And the likelihood for Latino adults is 25% higher. Even worse, Latinos develop type 2 diabetes when younger, and experience more severe complications and higher hospitalizations.
The stark disparities of type 2 diabetes reveal how cultural and social factors affect disadvantaged populations. As a case in point, managing diabetes is more difficult for patients …
In the face of genetically engineered therapies for many cancers and the incredibly rapid development of effective vaccines for COVID-19, it’s easy to lose sight of the breadth and depth of unsolved puzzles in medical science. Many of these remaining mysteries may be at least partially resolved as we overcome the mind/body dichotomy. A fascinating example of this issue has emerged with recent evidence of the excessive prevalence of Type …
My patient is a brilliant, 30-something-year-old highly educated woman with type 1 diabetes. I’ve known her for many years, since she was a teenager. She is sweet and fun, even though she can be fierce and fiery at times. She has type 1 diabetes.
She has been living with this life-altering, life-threatening disease for many years. Even as a child, she always took charge of her life and consistently maintained her …
A few years ago, a close friend of mine met a guy who knocked her off her feet. It had been a while since she’d met anyone whom she really liked and she was deliriously happy, so much so that we didn’t see her for two months.
By the time we did, she’d become both a rabid soccer fan and French bulldog lover, neither of which she’d been eight weeks prior. …
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