Remembering The Words Of Anne Frank

I have quoted Anne Frank (I still think of her as more like a relative) a few times in my life.  I especially remember once, in my residency training, when I believed an evil colleague had “fired a difficult patient maliciously,” my preceptor called me “Doctor Pollyanna.” I have helped people who could not afford drugs get “compassionate care” programs set up by drug companies for patients who could not get drugs they needed for a long time.  For as long a time, I have been known as a doctor who goes the extra mile and I have been proud of it.  I don’t see myself changing.

In an online professional medical blog I read the story of a doctor who kept a poor and sick woman in his practice when her husband lost his job and she had no health insurance. During this time, she couldn’t afford to get necessary blood tests regularly for several months and — predictably — the laboratory measures of her diabetes quality of treatment, the Hemoglobin A1C, went wildly out of control. The insurance company thought this reflected poorly on the physician, who was a Good Samaritan.  It wasn’t his fault the patient couldn’t get enough money to pay a lab.  Yet he was — at very least — scolded by the insurance company for poor quality of care.

I’m so old fashioned I still have trouble with an insurance company assessing the quality of a patient’s treatment by “numbers.”  They know nothing of medicine, only of the counting of beans.  They see numbers go up or down and don’t really know what it means.  Yet they weigh in as if their opinions are as valid as a trained medical doctor. Patients, God bless them, don’t always take medication as directed, or comply with what  doctors tell them to do.  Sometimes because of factors beyond their control, like a change in financial status. But the doctor was prescribing medication, so he was using the conventional paradigm of prescribing blood sugar lowering drugs, maybe including insulin.

There is a surfeit of medical literature proclaiming the deleterious problems of eating excess carbohydrates. I have rhapsodized about this elsewhere.  In this cheap and efficient treatment, diabetes can be and is, reversible. I know — I reversed mine and I am not alone. To paraphrase Anne Frank: “In spite of everything I really do believe that doctors are good at heart.” The system is destructive at every level. First, we need to make medicine honest and effective.  Scientific truth exists and should not be obscured by layers of bureaucracy from folks who treat patients. Scapegoating doctors accomplishes nothing. Layers of bureaucracy, concerns about access to care when quality is measured by unproven science —  well, that is quite wrong. I cannot stop saying it.