It’s Dr. Naito, NOT Dr. Stacey

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Some of you are in the habit of referring to physicians by their first names, tacking on “doctor” before the name. In all honesty, those of you who do this are quite honestly showing disrespect in doing so, even if it isn’t your intention.

Please bear in mind that we physicians must endure four years of medical school, anywhere from 3 to 7 years of residency training, and for some physicians, additional years spent in fellowships. In addition, we must keep up with continuing medical education (my yearly requirement is at least 50 hours), maintain licensure, and recertify every few years for our board certification credentials.

So when doctors bristle at you calling them, “Doctor Bob”, “Doctor Stacey”, or “Doctor Karen”, don’t be surprised. It’s not cute, it’s far too casual, and again, it’s downright disrespectful.

I do NOT like being referred to as Dr. Stacey at all. I worked very hard to become a physician, and I deserve to be referred to properly. In addition, I refer to other physicians as Dr. (last name) at all times, unless a colleague gives me permission to refer to him or her on a first name basis.

If you have an issue pronouncing a doctor’s last name, ask the doctor for assistance in pronunciation. Sometimes, the physician may suggest that you use the first letter of the last name as an abbreviated version. For example, I could be referred to as “Doctor N”, which I am fine with. I will not respond well to “Doctor Stacey” or “Stacey” by a patient.

In case you were wondering, Naito is pronounced like “night”, with a long “o” at the end.

Are there any medical doctors out there who would like to chime in on this one?

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Doctors Are Detectives

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There is tremendous responsibility in being a physician, and I take it very seriously. Any time I walk into a medical facility and see patients, I know that the patients and staff are all counting on me to assess patients fully, make proper diagnoses, and provide appropriate treatments. Basically, I know that I MUST make the right decisions at all times and be at the top of my game. Talk about pressure! Nevertheless, the thrill of solving a problem is so rewarding that it quickly eradicates any feelings of anxiety.

I just read Atul Gawande’s excellent book, Being Mortal, and I love this passage in which he very aptly describes the satisfaction which can come from being a physician:

“You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. It is a deep satisfaction very much like the one that a carpenter experiences in restoring a fragile antique chest or that a science teacher experiences in bringing a fifth grader to that sudden, mind-shifting recognition of what atoms are. It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with problem you cannot solve.”

The truth is that pretty much every physician has come across a case which he or she could not solve, one which necessitated a discussion with a specialist, or a lengthy literature review to aid in diagnosing the zebra who walked into the office that day. Physicians are human, fallible, and though they usually have the answers to the puzzles which are constantly presented to them, they may find themselves stumped every now and then, and that is a dreadful feeling.

It is an honor to serve humankind as a problem-solver, and I will always strive to keep my clinical acumen as sharp as possible in order to provide the best medical care.

Understanding The Costs Of Diabetes Treatment And Planning For The Future

Original post can be found at:
https://www.thesimpledollar.com/understanding-the-costs-of-diabetes-treatment-and-planning-for-the-future/


by DeVonne Goode
Updated on 06.05.18

Diabetes is a prevalent disease. However, it can still take many by surprise, and leave them struggling to pay medical bills.
With the complexities of the condition and the wide range of costs involved with treatment, having a financing plan is necessary. Health insurance is obviously one of the primary methods of assistance. But not everyone has the adequate coverage to cover
the costs – let alone the out-of-pocket cash to put on the counter every time out.

Opening a savings account, particularly one with high interest, could be a worthwhile investment toward consistently managing the disease today and into the future.

Diabetes at a glance
Type 1 Diabetes

A condition that keeps the body from producing enough insulin. Insulin shots are used to control blood glucose levels. Most diagnosis occur among children and young adults, which is why it is also referred to as juvenile diabetes.

Type 2 Diabetes

The most common form of the condition where the body doesn’t properly use insulin to convert sugar, starches and other food into energy.

Gestational Diabetes

Occurs when women experience high blood glucose levels during pregnancy. It’s usually easily managed and goes away after pregnancy.
Prediabetes

When blood glucose levels are higher than normal, but not high enough to be diagnosed as Type 2 diabetes. A large number of Americans are living with prediabetes (1 out of 3 adults). But taking early action to manage glucose levels can prevent diabetes from forming.

People who have diabetes are at higher risk of developing the following health conditions:
Blindness
Heart disease
Stroke
Kidney failure
Blindness
Loss of lower appendages (toes, feet, or legs)

Keep in mind – these conditions occur in the case of severe complications with the disease. With consistent attention to diet and other medical treatments (like most living with type 1 or type 2 diabetes undergo), these conditions are avoidable.
Diabetes by the numbers

According to a recent report from the Centers for Disease Control and Prevention (CDC), more than 100 million U.S. adults are now living with diabetes or prediabetes. Of that, only 12% were aware that they had it. And with approximately 1.5 million new cases being diagnosed every year, the need for education and financial support is clear.

Prevalence
Infogram

Rates of diagnosis for the following ethnic groups
7.4% of non-Hispanic whites
8.0% of Asian Americans
12.1% of Hispanics
12.7% of non-Hispanic blacks
15.1% of American Indians/Alaskan Natives
Breakdown among Asian Americans:
4.3% diagnosed were Chinese
8.9% diagnosed were Filipinos
11.2% diagnosed were Asian Indians
8.5% diagnosed were identified as other Asian Americans
Breakdown among Hispanic adults:
8.5% diagnosed were Central and South Americans
9.0% diagnosed were Cubans
13.8% diagnosed were Mexican Americans
12.0% diagnosed were Puerto Ricans

Underreported deaths due to diabetes

Diabetes is one of the leading causes of death in the United States (seventh as of 2015). However, studies have found that it is also among the most underreported. According to the American Diabetes Association®, only 35% of people who died with diabetes had the disease listed on their death certificate. And of that number, only 10% had diabetes identified as the cause of death.

Underreported Deaths
Infogram

There are a number of possible reasons for the underreported rate. But a lot points to the lack of ability to pay for adequate diagnosis and proper medical treatment.

What specific costs will someone with diabetes have to address?

If you or your child are diagnosed with diabetes, or you’re told that you have prediabetes, management and prevention take center stage. While a lot involves diet and exercise, medication will inevitably have an effect on your finances as well.

According to the American Diabetes Association® (ADA), medical costs for a person with diabetes averages out to $16,750 per year (a total of $327 billion nationwide in 2017). Of that amount, $9,601 is attributed to treatment specifically for diabetes. That’s more than twice the medical cost for people without diabetes.

Of the $327 billion nationally, $237 billion was attributed to direct diabetes medical costs and $90 billion was attributed to indirect costs – absenteeism and reduced productivity at work. Understanding the different forms of diabetes treatment, as well as the direct and indirect costs, is important for wrapping your head around plans for financing.


Type
Treatments

Type 1 Diabetes
Diet
Exercise
Insulin therapy
Regular blood glucose tests/monitoring

Type 2 Diabetes
Diet
Exercise
Insulin therapy
Other medication
Gestational Diabetes
Diet
Exercise
Monitoring sugar intake
Monitoring the baby
Direct Medical Costs ($9,601/year)
Indirect Medical Costs ($90 billion nationally)
Prescription medication (30% of total cost)
Loss of productivity due to mortality ($20 billion nationally)
Hospital care (30% of total cost)
Inability to work as a result of diabetes ($40 billion nationally)
Routine doctor’s office visits (15% of total cost)
Reduced productivity while at work ($30 billion)
Other medications and supplies (25% of total cost)
Reduced productivity due to increased absences and loss of employment from diabetes ($6 billion)

Insulin

Insulin injections are one of the primary forms of medical treatment used to manage diabetes. Especially for those living with type 1 diabetes, who can’t produce insulin of their own, these types of injections are vital for survival. However, the cost for insulin has skyrocketed in recent years, leaving many in the position of having to choose between going into debt or cutting back on medication.

Average cost for insulin as of 2015: $100-$200 per month
Average cost for insulin as of 2018: $400-$500 per month

WIDELY USED INSULIN BRANDS AND INSULIN INJECTION TOOLS
Insulin
Apidra, Humulin, Lantuo, Lente, Levemin, Novolog, Novolin, NPH Insulin, Regular Iletin, Regular Insulin, Velosulin
Insulin Syringes
BD Ultrafine, Levemir®, Monoject, NovoFine®, Ulticare, UniFine, UltiGaurd
Insulin Pumps
Animas, Deltec, Medtronic

Diabetes screenings and other medications

Along with your normal doctor’s visits, diabetes screenings are an important part of the process for identifying the disease. Specifically, if you have been diagnosed, testing your blood glucose levels will become a regular part of your life. Much of the costs for medications involved should be covered by your health insurance. And there are a number of home testing devices you can invest in to help make things more convenient and cost-effective.


WIDELY USED DIABETES TESTING BRANDS AND OTHER MEDICATIONS

Blood Glucose Test Meters and Test Strips
Abbott Freestyle®, Abbott Flash, Accu-Chek Compact®, Ascensia Elite, Ascencia Breeze, Ascensia Contour, Lifescan One-Touch©, Prestige
Injectable Medications
Byetta (Exenatide) injection and Symlin (Pramlintide Acetate) injection, Victoza (lLiraglutide- rDNA origin) injection
Oral Medications
Acarbose, Avandia, Chlorpropamide, Diabinese, Glipizide, Glucophage, Glucotrol, Gylset, Meglitol, Metformin, Prandin, Precose, Repaglinide, Rosiglitazone (These drugs act in different ways to lower blood glucose levels and may be prescribed in combination with other medication.)


Diabetes health expenditures according to group

Depending on whether you or your child has type 1 or type 2 diabetes, total expenditures can vary. Those who manage their condition at home, through diet, exercise, and home testing will have different averages than those needing regular appointments with specialists. According to the American Diabetes Association®, average total healthcare expenditures for diabetes treatment differ according to gender, race, and states with the highest populations of people diagnosed.

Gender
Men: $10,060
Women: $9,110

Race
Hispanics: $8,050
Non-hispanic Blacks: $10,470
Non-hispanic Whites: $9,800
States with highest population of people with diabetes
New York: $21 billion in healthcare expenditures
Florida: $24 billion in healthcare expenditures
Texas $25 billion in healthcare expenditures
California: $39 billion in healthcare expenditures

Options for diabetes treatment financing

In a recent online survey of 500 adults with diabetes, more than half of the participants acknowledged the medical costs involved has had a negative impact on their finances. Many also admitted to going to “extreme lengths” to cover the costs. These lengths include accruing credit card debt, borrowing money from family or friends, and tapping into a savings or retirement account. Many may feel the need to take some extra financial risks because they don’t feel as supported as they’d like. Understanding your options will help you make the most informed choices.

Insurance

Government insurance, such as Medicare and Medicaid provides most of the financial assistance for diabetes care. The military also takes care of a good amount of costs for veterans. The remainder of the cost is covered by private insurance or out-of-pocket cash. According to the National Conference of State Legislatures, 46 states mandate that diabetes be covered under state insurance.

Diabetes Health Insurance Coverage
Infogram

These states require coverage for diabetes treatment as well as equipment and supplies for home use (insulin, pumps, syringes, test meters). Four states do not have that same insurance mandate, however – Ohio, Alabama, North Dakota, and Idaho. Anyone with diabetes who live in any of those four states will most likely need to deal with a private insurer or explore other methods of financing.

Coverage from private insurers usually come through employer-sponsored group plans or individual health plans. Advisors would suggest going with employer-sponsored plans, because they offer higher protections due to being subsidized. On the other hand, if you are unemployed and venturing into the individual market, it may be difficult to find affordable coverage. The reason is that diabetes is considered a “high risk” disease. Insurance companies anticipate a high amount of claims, especially from those with pre-existing conditions. So it will be reflected in the pricing.

HSA

People who have diabetes but don’t have coverage that’s comprehensible enough for their needs may utilize a health savings account (HSA). An HSA is primarily useful for people with high deductibles (at least $1,350 individually, or $2,700 for family). Also, those who are a part of low-income families or don’t live in a “mandate state” may see this as a helpful tool. One big benefit of an HSA is that you take the money with you. There’s no “use it or lose it” policy like some other savings plans. Being able to set aside pre-taxed dollars to help pay for medical expenses can go along way when trying to manage diabetes.

FSA

Another way to set aside dollars for medical expenses is through a flexible spending account (FSA). An FSA is provided through your employer with a $2,650 limit. You can also use it to cover medical expenses for your spouse and dependents. One thing to keep in mind with FSA’s is that they do have an expiration period. You’re generally required to use the funds within your plan year. But your employer may offer extensions at their choosing. The benefit is, it can be used with any type of health plan. And diabetic supplies are eligible to be paid through FSA’s.

High interest savings account

If you’re not interested in dealing with your employer for coverage or a flexible spending account, a high interest savings account could be a good option to explore. It’s just like any other savings account, only with fewer restrictions. Not only are you saving for your medical needs, but your money is also making money. High interest savings accounts are opened through online banks – which means they don’t have to worry about maintaining branches all over the country. They can offer you higher interest rates, with the benefit of accessing your money whenever you want.

Unlike an HSA, a high interest savings account isn’t tied to a high deductible health plan with a dollar limit. And unlike an FSA, there’s no expiration date on when you can use your money. It removes any additional stress so you can concentrate on managing your condition properly. And as you earn interest, you can still take advantage of a number of outreach resources available for people with diabetes.

This condition can be a tough one to get a handle on, but it’s not insurmountable. Let your understanding of diabetes, your knowledge of its treatments, and your strategy for tackling costs work in your favor.

Stacking The Deck

“So…what do you DO?”

This question is incredibly annoying to me, and I cringe every time I hear it. I resent the fact that many people are so quick to assess someone on the basis of what they “do” for a living, as if there are no other dimensions which should be taken into account.

I completely resent the demand to pick one career that defines me. To add insult to injury, when people find out that I am a medical doctor, they struggle with the stereotype of what they expect doctors to be like, in other words, very conservative in dress and demeanor, and without any flavor or personality. Well, I’ve got news for you. I will NEVER be a typical doctor. And please don’t doubt my credentials or schooling. I am NOT a nurse (not that there is anything wrong with this highly respected profession). I am a fully licensed and board certified physician.

However, I do not consider myself to be ONLY one thing, “only” a physician. Yes, I am a board certified physician. But I am also a degreed (Bachelor’s) fitness professional, professional athlete (IFBB Pro), certified nutrition coach, writer, model, brand ambassador and contest prep coach. If that’s too much for one to process, too bad. Because I am ALL of those things, and then some. I am just as much about fitness, bodybuilding and wellness as I am about medicine, and I shouldn’t have to choose one over the others. I am damned proud of what I have accomplished in bodybuilding, especially because I was in my forties when I took things to the next level, not when I was a young whipper-snapper, and I was already established in my medical career. I will not apologize to people who are confused by the sampler plate philosophy by which I live and who don’t believe that it’s possible to be more than one thing. Truth is, I live as what Marci Alboher describes in her book One Person Multiple Careers as a Slash, and I am proud of it. I know it’s unusual, but why is that so hard for people to grasp? I mean, here I am, doing all that I do, switching gears constantly, and sending a message to the world that no one should have to be one-dimensional and boring.

I am honest. I have sass, and I speak my mind. I will NOT hide parts of myself which some overly judgmental people may have a problem with. I am NOT going to apologize for having a sense of humor, for using cuss words here and there (though I don’t use them while seeing patients). I am not going to paint a false picture of who I am. If you don’t like what I am doing, no worries. Move on.

Here’s a message to you if you find that you are someone who is compromising your own vision, dreams, or goals, because you perceive a need to choose one thing to define you. Perhaps you need to re-examine why you are allowing that to occur. If you subscribe to a no limits philosophy, then you would never even consider pulling the reins back. I will always encourage driven people to go for whatever they want, and if it doesn’t fit in with the conventions of one of their chosen careers or hobbies, even better. Break stereotypes and show people what you are made of! Don’t hide all the facets which make you who you are!