Integrated attention
10/11/2010 2:25 p.m.
I present myself:
I am a Andalusian doctor.I would like to share with all the situation in the attention to the diabetic.Public services are in technical bankruptcy (the services are overwhelmed, for one cause or another the truth is that they are ... saturated consultations, training problems in professionals, burned professionals).Recently the tires are added.It is true that as in all aspects there may have been a certain abuse by a few and it is also true that administrations are without a hard one (let's not get into part that this is guilt for poor resource management).The thing is that they have passed from one extreme to another, and many diabetics see how they do not have enough strips to perform self -controlles.
As a professional who also feels little done in these adverse situations I thought about how to contribute better attention in private sphere for diabetics.We are creating an online registration for glycemia and a program that alerts about when the tests must be done (glying twice / year, eye funds, standing sensitivity exploration ...)
I would like to know that you would like to be in this service and that you would like it to be in a private one.The idea is to provide a free registration service.
I would be very helpful for opinions and criticisms to help me prosper while I help prosper and improve others (it is my philosophy of life).
Greetings and I wait for your answers.
10/11/2010 2:25 p.m.
I am a user of health services, with experience of more than 20 years using them ... from my earliest childhood that I handle for hospitals/health centers and the like.
For life situations, I have come to know the general policy of Valencian health and the particular policy of some hospitals/health centers.
In my opinion, what is bankrupt is the prehistoric management of human resources.
Environmental management, occupational risk prevention, professionals security, data protection, the latest wills have been modernized ...
But health is still installed in a model of care focused on acute patients when the highest percentage of patients are chronic (only with those belonging to metabolic syndrome we would already have enough task for an army).
See whole swarms from doctors and/or nurses not attend to a patient in the first person for years ... It makes me sick (more than I am).
Should we continue to endure health professionals dedicated to diabetes who do not know what the glycemic variability is and means?
Should we continue to endure health leaders who obviate all the bestiality of complications and statistics generated by diabetes?
How can it be that in an entire Valencian autonomous community there is not a single day hospital for diabetes (try to be attended in the afternoon ... Juas, Juas) or that there is a single specialized consultation on diabetes in centers ofhealth?
Do I have to explain the existence of a glucometer that measures ketones to an endocrine:-/?
Do I have to remind health leaders of the social and economic costs that entry into a hospital of a patient with diabetes and complications of their illness?
To specify, that I roll up.
2 GLICADAS YEAR?: Shock :: Shock: .... In the case of type 2, without right to strips in most autonomies, the treatment modifications are extended years (not for a glyd of 8 you are going to change their ado)
In my view:
100% mandatory screening from 45 years and scrusted opportunist from 18 (before if there are other conditions)
3-4 GLICADAS YEAR, FOR TYPE 1 AND TYPE 2, accompanied by lipids and blood pressure.Review in all the visits of the feet.
Annual reviews of: eyes, kidney, heart.
Annual thyroid problems in type 1
Compulsory Diabetological Education All patients with diabetes ... We leave the content for the next installment.
Team: Endocrine or diabetologist+Diabetes Educator+Specialists: eyes, kidney, heart, feet, psychologist, social worker
Possibility of telephone and internet consultations.
Obligatory that all studies and communications on experiences related to diabetes attention include a cost/benefit section for health.
Essential the management of cases in common: that the doctor and the educator say the same, with the same words and with the same objectives.
Right now this is one of the very serious deficiencies ... the educators go on one side and the endorses on the other ...
I don't know if I answered your question.
I have passed 3 villages: Oops:
10/12/2010 5:11 a.m.
I am with Owash.The truth is that, in the center I am going, the educator gives me a lot of freedom to choose quotes and is always available via e-mail, but there is still much to change.For example, what I believe is now vital (among what Owash has mentioned) is psychological care, education to patients (which leads to a good and prepared education in endocrine and educators, is clear), the specialized reviews and that the endocrine and the educator go in unison, because more than once we end up confused with so much different opinion.
All the best.
10/12/2010 7:06 a.m.
I am also with Owash, and I emphasize something he has said, and it is about patient care and diabetological education.
It is very sad that a nurse see your little book with figures that range from 50, until 200 and peak, and only tell you: "Well, but in general you are going very well."You always go very well, even if you have a hem of 8 ... if you tell them that you do not see it well, they jump you with that you are very demanding. You have to ask them to teach you to count rations, that they have never taught you, andThey simply give you a list and a standard: every 10g of hydrates, a ration.And Ale, look for life.
That you have to walk begging an insulin bomb, and instead of telling you the truth (that we are also people, we know how to understand) they tell you milongas, or scare you saying: Ufff, look that you need more fat you would have to put ....
Anyway, and a thousand things could put to write a whole post, but I think that a little understanding of the patient would not come bad, and above all, a good diabetological education by the nurses, so when you have any questions, know how to answer youThe best possible, and not with a: you are very good ... or well ... I don't know ... you keep doing everything to Boleo if you do well ...
10/12/2010 9:06 a.m.
Well, I also agree with Owash.
And that my daughter has the great luck of being Asturian.If there is a day hospital, and they have put the insulin bomb, and they do not put in, for the moment, in the supply of how many strips you need, including those of ketones.
But yesterday I was talking to a gypsy I know years ago, and I tell you above (although she is also Asturian): she started at 33, with a gestational diabetes that never left.
It has been taking Dianben for years.Rarely her figures fall from 200. She has asked insulin, because she was scared of her figures (which are fasting).His header has prescribed "an insulin" (he did not remember the name) that has to be put twice a day, and goes fatal, with very high figures.Well, this doctor's eminence does not occur that perhaps he does not know how to treat diabetes, and that there is a specialty called endocrinology to which diabetics must.
She has also asked to send her to a specialist, and he has told her that, if it continues, she will send her "to internal medicine"
Meanwhile, that woman has been over 200 years and her doctor stays so oreao.
Those things are the ones that enervate me.That woman will have complications that will bitter life and that will cost all a money to all, and the cause is none other than laziness.
That professional evil is wasting a valuable time with her, and is mortgaging the future.But it must be calm, because she is a woman, gypsy and uncultured, so there is few chances that they demand her.
That's how we are doing.The biggest problem is not the lack of money, but how bad it is used and how it is waste in gilipolle.In Llanes, in the health center, there is an X -ray installation that was in its day.It cost a money about 15 years ago and has not been released.Those of Llanes must go to the radiographs at 50 kms., Having everything here, but they did not foresee that, apart from the devices, they would have to provide the center with a person who knew how to handle them.
A shame.
Health
10/12/2010 12:50 p.m.
I totally agree with you except in one thing ... The security management of professionals is not adequate at all.And what you demand is very necessary of course, but it is difficult to get while the consultations are 3-4 minutes.You also have to be self -critical and recognize that in general there is a lack of professional training, but this is a very complex and difficult solution:
1st) It is difficult to form when there is care overload (usually TB likes to be with the family and that)
2nd) Second: Perhaps the English Mdoelo would be fine in which part of the salary is charged for formation and accreditation of merits (of course, for that they leave you part of the day)
3rd) In generates in this country (not only in health) mediocrity is encouraged, since people who contribute added value just see how double work.It is difficult for the thing to improve with good professionals who end up burned.You cannot pretend that everyone is perfect, there have been bad professionals, there are always them, as there have been, there are and there will be users who abuse more or less of the system.It totally agrees that it is a management situation.
Well, I thank you because your opinions come very well, since I am one of those who wants to leave the public sphere.While I can dedicate myself in the early hours of the guards to try to solve the doubts that are raised in this forum.
All the best
10/12/2010 5:23 p.m.
Because you are, I envy you where I live by Norma is paid 25 % of any health expenditure, be it medications, priests, urgencies, etc.
It also usually happens that certain medications are not low concert with our social security, so that you have to pay 100%, curiously it usually happens with the most expensive.
Until recently the strips had to pay 100% for the patient, recently they have had the goodness of including them in the concert.
In any case, the only thing that I wanted to add is dietary education from school to all children or not diabetics, if you have the possibility of being (by genetics or any other reason) they will do very well to know since before the disease is manifestedAnd if they have no chance of being also, since they will learn a healthy and healthy way of nourishing and the only thing that can be reported is benefits.
10/13/2010 11:45 a.m.
Hello everyone, I speak to you as a doctor and as a patient.I am type 1 diabetic for almost 27 years.I have a controlled preprolive diabetic retinopathy with Panfotocoagulation and with good evolution, with a vision of 0.9, that is, normal, with the inconvenience of the slow adaptation to darkness and things but very well.
I have recently joined a new health center when I take my place, I am also from Andalusia.Today in the afternoon, he had consultation, there was a major diabetic (type 2) for a long time that a self -control had never been made, he had never had a diabetological education and they had never given him a glucometer or prescribed strips.I have stayed a little chafada Péro more chafada I have stayed when I have referred it to the nurse to give it a glucomeno and tell him how to use it and how to make a profile and he has come again to the consultHow it was used, how one made a profile and so on.That is, the nurse had only given him the glucometer and period.It is no longer a matter of nurse or doctor but does not seem to take it seriously.It also depends on the center and the concern of each professional but of course, no matter how much you want, I agree that it does not give you time.I have a patient cited every five minutes, if it is a simple thing you can do it but a diabetic consultScheduled consultation and at least dedicate it about half an hour.But of course, the consultation ends at 7 in the afternoon, then you are urgently until 8 and then leave when you do all that?, And in the morning we are in them.Anyway, there should be more people to decongest consultations and be ableall...
10/13/2010 5:24 p.m.
Meginer, that's the line that I point out ...
It is a completely obsolete human resources management policy ...
It is inexplicable that there are no individualized consultations of diabetes, HT, COPD, lipid, overweight ... That at least.
In Valencia in the early 90s there were ... then modernity threw them from health centers.
Even if it was 1 afternoon a week for each of them.
Primary centers seem prejubilation vacation withdrawals of nurses, except glorious and release exceptions ...
The recent one (a couple of years?) Reform of Nurses Specialties has left out, once again and for a long time, to education in diabetes ... with the boring look and the silence of endocrine, internists, primary doctors andpatient associations.
For years, the years of fat cows, the annual training time that professionals have in mere procedures have beenState mediated by the future impact on professional rise (in diabetes more than 75% of those attending diabetes training courses, then it does not see a single patient .... simply because the course punctuates at most in thefollowing internal promotion), the pharmaceutical laboratories as a source of formative financing (leaving the existence or not of the professional ethics of each) have been squeezed and used to then cut their profit margin more and more (when nottaking them out of the market).
Spain is one of the few European countries (but I remember bad together with Italy) where psychology is not recognized as a medical profession.As the podologists are also still outside.
Of course, collaboration agreements with the neighbors friends of the ruling politician on duty are signed.
And yes, in the end you see what there are: diabetes do not care, some because solving it is to change from top to bottom an organization (and that costs negotiations, favors and conditioning the future) and others because until they see the complications do notThey realize the potentially dangerous of their illness (and that no one explained or helped them at the time, for the reasons that are).
10/13/2010 6:23 p.m.
Congratulations on the square to the doctor ... We are already two with a place ...
Anyway, it is clear that the interest that the person or professional puts great influences.The time I was in Primary and retinographies began to be made in my area about 60, I think that the a whopping 35 or 40 were mine (we are talking about a template of 31 doctors).Obviously I had to stop informing them in the guards.That is why I say that it also influences not feeling valued in general ... they end up burning you.Even so and luckily I remain very predisposed for those who need it and try to move from all the jets from managers to users (I think it is the best to get bored or get angry).
Come ... a health ...
10/14/2010 7:43 a.m.
Hello good:
Well, I wanted to break a spear in favor of the S.S in the Valencian Community.
I entered almost diabetic coma, because of my ignorance when ignoring the symptoms of diabetes, I endured until I could no longer (-10kg of weight, I did not see to drive, or the computer, extreme tiredness, etc)
From the moment I entered the hospital, they turned to me.They made me analytical every 2 hours, a test of vision where the ophthalmologists reassured me and told me that it was typical of diabetes, but that everything would return to normal after stabilizing the sugar, and so it was.
The talks with my educator, were very positive, both for education and psychologically speaking, since not everything is learning, and in those days you also need support and force that helps you and understands you.
Then, with my family doctor, without problems for insulin or strips, I have plenty.And every time I go for needles, they give me the boxes of 2 in 2 so that I do not have to go so often.
The Endocrine, Dr. Ampudia, was freaking out, the first day I went, an hour of consultation.He treated me like his son.I was amazed with the S.S.
Then I learned that he is a specialized doctor and very renowned in the field.I would like to be a candidate for insulin bomb, and I will let my endocrine know since in a few days I have an appointment.
I am very grateful to the S.S, if I lived in the US, for example, it would have it very, very small since private medicine is very expensive, unless you have an insurance hired before the diagnosis, because then any disease is cause to revoke anyPrivate insurance contract.And well, medications run on the patient 100%, in all.Unless you are, very, very bad.(If you break a leg, it's not so bad, it hurts, but you have a leg, I don't know if I explain)
Yes, many things must be improved in the S.S such as waiting times, more visits to other specialists, improve education to prevent more doctors, but I think we must also appreciate that the system works.I could not afford the expenses of my treatment, and both expenses, as well as patient medical treatment have been a high.
10/24/2010 4:34 p.m.
Hi, Imadis!You leave a little thoughtful with the issue of that of the United States ... that is, that if my daughter, which is diabetic since childhood, would like to go to work and live in the US, would have to pay all the treatments of her pocket, because she could notdo any private insurance ??And that will also happen in other countries in Europe?:-/:-/ To see if it turns out that diabetics will not be able to leave Spain ...., because already, if a transplant is needed, or think about it... Well, I hadn't raised it .. :?:?
10/24/2010 5:38 p.m.
Hija de 35 años , diabética desde los 5. Glico: normalmente de 6 , pero 6,7 la última ( 6,2 marcaba el Free)
Fiasp: 4- 4- 3 Toujeo: 20
You don't know how I am glad to know that in some places things are done well.Of course we have a healing that is the chicken of the golden eggs, but sometimes I see some criticisms with creative intention.Indeed, in other countries or you have pelas or you endure ... unfortunately, sometimes due to political interests, poor administration of resources or misuse/abuse by some users this chicken of gold eggs is endangered.In short, we must respect our social security, although there are many improveable things.
10/24/2010 7:05 p.m.
It is true that the SS is a barType of bombs will come here when they are there with the artificial pancreas.Although the SS finances us, it is undeniable that Spain is very late with respect to other countries (let's not talk about the attention of diabetic children in schools ...).
10/25/2010 8:51 a.m.
Imaadis, Dr. Ampudia is an oasis in the middle of the desert ... It is a recognized endocrine throughout Europe, specialized in gestational diabetes and new technologies ... saying that it is one of the best endocrine in Spain is obvious.
When you look at the rest of that hospital (I will obviate names), your soul falls to your feet ... is the opposite of Dr. Ampudia.
It is public and notorious the enormous difficulties that Dr. Ampudia has passed and will happen to develop his work.
If you have not abandoned the hospital, it has been exclusively for patients because you earn and offers have not been sure.
I imagine the educator was Pepa, a very good person.
Now if you want to make an eye review, they send you to primary care, even if you have retinopathy: shock:
10/25/2010 1:54 p.m.
Hello Regina.
As for your question, about medicine in the US, the issue on health is very complex and simple at the same time.President Obama with Hilary Clinton, are making a great effort to change the current health system, and to have a public health, where the high costs of an operation, a transplant, or a simple resonance, which can cost around some€ 3000 for those who do not have a private insurance hired, so that the patient does not have to pay for it.Hiring private insurance is really difficult for a healthy person, let's not say for a person with a chronic disease such as diabetes, practically impossible, unless you are an eminence, v.i.p, or have a lot of pasta.Then there are the packages, if they have to do an operation that is not covered, on the other hand, they are clear, or pay or leave, the point is that in the US it is a giant of private medicine, it is considered asOne of the best in the world, patient treatment, treatment, facilities, media, medical, technology, etc.Fighting against this type of medicine is interested in any giant, because they would stop hiring expensive millionaire contracts.Would it like fighting the oil system, for a water engine, would you be interested in refineries?No, they would pay the patent, or kill to continue selling oil.
From what I know, in Europe, in countries like England they have an enviable health system (NHS Natioanl Health Service) as with France.So you can be calm that if your daughter decides one day to work and live abroad, she will not have problems in some European countries.
Thanks Owash, it's a relief to know that I have the best endocrine.Many people from the world have told me wonders of the DC.Ampudia, and for me it is a privilege to be able to have it as "my" endocrine.I do not know how the rest of the endocrine of the S.S.As an educator I have Pepa, who has helped me when learning to count the portions, but I have had to be the one who gradually marks the insulin units that I must increase or decrease.
One of the things that struck me between Endocrine and Educator was that the endocrine told me to reuse the aguajas in the same day, that is, 3 punctures with the same needle, while the educator convinced me more, and told me not to reuseNeedles because Moratones can come out in my body, and it will be more difficult than insulin to take effect on my body.
10/25/2010 4:08 p.m.