LateNightFright

This should be emphasized. The costs to our society from untreated mental health, ranging from lost wages to chronic homelessness, are astronomical. This is a crisis no one wants to talk about.

Type II diabetes is one of the most costly, if not THE most costly, because the disease can be poorly managed for so long. Kidney failure. Amputations. Blindness. Heart failure. Strokes and heart attacks. Things that rarely kill outright but can cost millions over 20+ years of a person having them.

We KNOW how to prevent diabetes: less obesity, more exercise, less crap in the diet. We also know how to reduce the side effects of type II diabetes: glycemic control.

Guess how many patients comply?

Excellent.

I'm a medical student who has doctors on both sides of the equation. One of them, a radiologist, says when the life and health of the patient is on the line, costs shouldn't matter. This was in reference to ordering an MRI when an x-ray wasn't conclusive.

The other side says doctors need to be aware of the costs to our patients. Starting with a cheaper drug that is almost as effective, limiting blood tests, etc. are things we need to do for our patients so they don't go into debt. I've seen this come into play in Australia, where there are tests on whether a shorter course of chemotherapy (that costs less) is as effective as a longer, more expensive course.

Also, how do you suggest doctors push back against CEOs of hospitals who want to have low readmissions, excellent outcomes, and cut-rate care?

Edited to add: Is the solution to start using cheaper PAs and NPs to deliver things FPs and PCPs used to do? You'll hear screaming on either side of the aisle.

Education runs into human nature and social reality, more often than not.

I've worked in a clinic with a large population of poor Indo/Pak patients. They have a genetic predisposition towards type II diabetes, so even younger, normal weight patients can get it. You get to tell them to change from a cultural diet that leans heavily on rice and bread, butter more than oil, and milk products. We can often get the brown rice substituted in, but it's hard to fix the other parts.

Then there's the reality of getting exercise in a poor community. If you're working three jobs, there's rarely time for running or lifting weights. If you're in a dangerous area, a nice stroll around the block can get you killed. If you're in an area that's merely poor, there may not be places where it's safe to walk because there are literally no sidewalks or parks. A membership at the Y, if there is one, is a week's worth of food.

We can get the kids out and moving but the parents? It's harder.