Sunday, September 19, 2010

Patient Repairman

My new job has commenced.  While I learn the lay of the land, I started seeing consults and visiting the primary care settings from which my patient originate.  Thus far, the consults have challenged me, which energizes me more than I have been in some time.  Not that I want anyone to be unnecessarily ill or ignore prevention but working as a repairman brings a type of thrill that had been dormant.  Most of the people that I've seen had little medical thought given to them by those who had been treating them.  A few easily correctable insulin revisions make all the difference the first 24 hours, though I ask each of these folks to bear with me for about six months to reconstruct their diabetes from insulin to end organs.  Some of the people seem a little surprised to learn that with some alterations of treatment, they could be doing better.  People had been experiencing marginal diabetic care for more than a decade, yet I was the first endocrinologist they had seen.

Can Obamacare really improve the medical outcome of these individuals?  Unlikely, as absence of insurance does not seem at first glance to be the barrier to lower glucoses or protection of body parts in the diabetics that have come my way the first week.  I think there needs to be somebody accountable for optimal medical decisions.  As I visit the primary offices in a three mile radius, I do not perceive a lot of attentive goal focused medical care, with a few exceptions that bring me a measure of optimism.

For now, I like getting up early to go to work.

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