I recommend you show this to a doctor who treats patients with type I diabetes and see if it passes the intellectual Turing test. I don’t believe the doctor is being represented accurately here.
Alternative view: Your friend has a deadly disease that requires regular doctor visits and prescriptions. It sucks. It’s not fair, but it requires him to take some level of responsibility for his own care. He seems to have failed to do so by not keeping his appointments and letting his prescriptions run out. His doctor needs to see him and check his levels (presumably his A1c) to manage his diabetes. Your friend has unnecessarily escalated the situation by threatening to use the social media mob against the doctor.
Your friend is not evil. He’s just young. And like all young patients with a deadly chronic disease, is having a hard time dealing with his mortality. Your friend should keep his appointment with his doctor, but at the same time find a doctor who will be better suited to his schedule and needs.
The doctor is not evil. He just needs to have a clear view of the patient before he goes around prescribing deadly medicine (insulin can kill) to a patient who has shown an inability to manage his disease (keeping appointments, not running out of life-saving medicine).
Regarding the price of medicine in Canada: I believe the fixed low prices in Canada are being subsidized by your friend and all Americans.
“Hemoglobin A1c reflects average glycemia over approximately 3 months and has strong predictive value for diabetes complications (14, 15). Measurement every 3 months in patients with type 1 diabetes determines whether glycemic targets have been reached and maintained. It may also confirm the accuracy of the patient’s meter (or their reported CGM or SMBG results) and adequacy of the testing schedule.”
Alternative view: Your friend has a deadly disease that requires regular doctor visits and prescriptions. It sucks. It’s not fair, but it requires him to take some level of responsibility for his own care. He seems to have failed to do so by not keeping his appointments and letting his prescriptions run out.
Type 1 diabetic here. Regular doctor visits are actually pretty useless to us, other than refilling the prescriptions. Every six months is customary, but excessive. Every three months is scamming money out of insurers.
Regarding the price of medicine in Canada: I believe the fixed low prices in Canada are being subsidized by your friend and all Americans.
It’s cheap literally everywhere except the United States. It’s not a matter of subsidized capital costs, because those were all paid off more than a decade ago, and prices were cheaper then.
Measurement every 3 months in patients with type 1 diabetes determines whether glycemic targets have been reached and maintained.
Measuring HbA1c can be done cheaply with an over-the-counter test kit. It does not require a doctor visit. Also, testing HbA1c that frequently isn’t important and isn’t done by most diabetics.
I think your first remark is exactly the point. If the visits are useless then this is a crappy doctor scamming money and time out of patients and insurance companies, if the visits are important then asking OP’s friend to come in (for being over 4 months late on a 3-month checkup) sounds very reasonable to me. I think Zyryab’s suggestion of asking a doctor to Turing Test this makes a lot of sense—maybe the checkups are more valuable in certain life stages/demographics/early after diagnosis? Maybe the checkup is something more complicated than recording the HbA1c levels? I’m surprised to hear that without outside medical information the doctor is guilty until proven innocent.
Your friend has a deadly disease that requires regular doctor visits and prescriptions.
I think that this is a sketchy way to phrase this. Presumably, what a disease requires is a cure (or one of several cures). ‘Doctor visits’ and ‘prescriptions’ are one system society can have to assign cures to people, but there could also be other systems, like ‘you get to walk to a store and buy insulin if you want some without needing anybody’s seal of approval, and you can also see somebody to advise you on how much insulin to take’. Saying that the disease requires regular doctor visits and prescriptions seems to me to rhetorically imply that the costs associated with those are due to the disease, not due to the health care system, without doing the work of checking how well the system works (after all, if the system were about as well as we could manage, the costs really would be due to the disease).
I am confused why anyone would believe that this post is attempting to pass an ITT. It isn’t.
It’s also giving the doctor the benefit of the doubt in important ways that jimrandomh seems confident are unlikely to be accurate—in particular, that the doctor’s justification for such frequent and copious appointments is concern for the patient, and has no profit/fraud motive of any kind.
I’m really surprised this is being downvoted so much.
As far as I can tell (and frankly I don’t care enough to put serious effort towards finding more information, but I do note nobody in the comments started with “I am a doctor” or “After talking about this with my own doctor, …”) OP’s friend was in a life-threatening situation, the solution to which is a renewed insulin prescription. On top of that, the doctor/medical establishment enforces the rule that people (only young people? only people who recently developed diabetes? There could be a good medical reason here, I don’t know) with Type I Diabetes have regular checkups.
Now I imagine there are all sorts of reasons for wanting to skip this checkup. Maybe the checkup isn’t needed, and is just a money scam (small aside: if my doctor tells me I need a regular checkup, this is not my first thought. But individual situations can vary). Maybe the doctor’s schedule is so unreasonable that it’s impossible to make an appointment. There could be thousands of valid reasons. The problem as I see it is that, from the point of view of both the doctor and the nurse, they are only negotiating over the checkup. You mention right at the start that the nurse offered a solution (“drop everything and come see your doctor tomorrow”) - from that point on the situation was no longer life-threatening! There was no realistic scenario in which this would cost your friend more than the plans they made for the next day! You were just haggling over what is more important, your friend’s schedule or the rules set by the medical establishment that you need an active prescription to get insulin and you need a checkup to renew your prescription. Guess which one the nurse is going to find more important.
I understand if it feels like your friend is being blackmailed by the doctor (and in fact it seems like they are), but by refusing to visit the next day you are the ones who escalated the situation. And then escalated even further by threatening with media exposure. I think from the point of view of the nurse your friend is showing rather hostile behaviour. I’ll take the liberty of going through the phone call as you posted it, filling in how I expect nurses to act:
The nurse tells my friend he needs to go see his doctor, because it has been seven months, and the doctor feels he should see his doctor every three.
Probably standard procedure. At any rate this decision it out of the nurse’s hands, so they are just providing information here.
My friend replies that he agrees he should see his doctor, and he has made an appointment in a few weeks when he has the time to do that.
The nurse says that he can’t get his prescription refilled until he sees the doctor.
Still standard. Nurses don’t get to overrule conditions doctors set for medication, if the doctor says a checkup is needed then the nurse has no way of handing over insulin.
My friend explains that he does not have the time to drop what he is doing and see the doctor the next day. That he is happy to see the doctor in a few weeks. But that until then, he requires insulin to live.
The nurse says that he can’t get his prescription refilled until he sees the doctor. That if he wants it earlier he can find another doctor.
Still the same issue. The nurse doesn’t have the authority to overrule the conditions set by the doctor. Also I’m missing a sentence here, who introduced talking to the doctor the very next day?
My friend explains again that he does not have the time to see any doctor the next day, nor can one find a doctor on one day’s notice in reasonable fashion. And that he has already made an appointment, and needs insulin to live. And would like to speak with the doctor.
The nurse refuses to get the prescription filled. The nurse does not offer to let him speak to the doctor, and says that he can either wait, make an appointment for the next day, or find a new doctor.
So apparently making an appointment one a one-day notice is very doable on the doctor’s side. By this point you are solidly haggling about time, not medicine. I also think the nurse could have let you speak with the doctor here. But I think it’s also plausible that they get/did in the past get phone calls from all kinds of entitled weirdos who refuse to show up to appointments, and at this moment it’s really not clear your friend is not one of them. Why would their day plans be more important?
My friend points out that without insulin, he will die. He asks if the nurse wants him to die. Or what the nurse suggests he do instead, rather than die.
This seems not to get through to the nurse, because my friend asks these questions several times. The nurse does not offer to refill the prescription, or let my friend talk to the doctor.
My friend says that if the doctor does not give him access to life saving medicine and instead leaves him to die, he will post about it on social media.
The nurse now decides, for the first time in the conversation, that my friend should perhaps talk to his doctor.
Really? Your friend escalates from “I don’t want to visit you tomorrow” to “that means you must want me to die”, which of course the sensible nurse ignores, and your strategy was to repeat it a few more times? Yeah, you really showed them there. I bet the nurse immediately realised they were wrong the first time, and connected you through with the doctor before you got to the third repetition. From their point of view you’ve refused a good solution to the problem and are now just bugging them to make your life easier (who likes going to checkups? Nobody. So who haggles about not wanting to show up? Well, not everybody, but more than just your friend I bet). And at that point your strategy is to escalate even more by threatening media exposure, and put even more pressure on that poor nurse? I’m not surprised the doctor claimed you are blackmailing them after this.
What was your goal of the conversation with the nurse in the first place? You need a doctor’s prescription for the insulin, so shouldn’t you have aimed for talking with the doctor? And if that was your goal, what purpose did it serve to tighten the screws on the nurse? You should have acted like a model patient and calmly requested you speak with the doctor, who can (and did) overrule the normal medical process just to give you life-saving medicine.
I guess that became a far longer monologue than I planned, I’m not going to go through the phone call with the doctor because it’s just more of the same. I think OP is in the wrong here, at the very least in their interaction with the nurse. And I do agree that this is a bad medical system, but you really can’t throw the co-pay costs, the lack of automatic prescription extensions/sufficiently large prescriptions to last you a long time and your interaction with the nurse and doctor on one heap and pretend this is the fault of “the American medical system”. The overall structure sucks, but some of these people are just local actors who cannot make a change and your friend threatened them to not have to change their schedule.
There was no realistic scenario in which this would cost your friend more than the plans they made for the next day!
Do note that, although they probably weren’t in this case, the consequences of dropping your plans for the next day can be almost arbitrarily bad.
For example, it might cause you to lose your job, which in turn causes you to lose your health insurance and your flat.
(In another situation, you might be told “either you work tomorrow or you’re fired”, and someone could tell you that you’re not in danger of losing more than your plans for tomorrow. But in that situation, maybe your plans for tomorrow include “visiting the doctor to get the insulin you need to remain alive”.)
What was your goal of the conversation with the nurse in the first place? You need a doctor’s prescription for the insulin, so shouldn’t you have aimed for talking with the doctor? And if that was your goal, what purpose did it serve to tighten the screws on the nurse? You should have acted like a model patient and calmly requested you speak with the doctor
The part you are looking for is here:
My friend explains again that he does not have the time to see any doctor the next day, nor can one find a doctor on one day’s notice in reasonable fashion. And that he has already made an appointment, and needs insulin to live. And would like to speak with the doctor.
Then after being ignored several times, social media is brought up:
My friend says that if the doctor does not give him access to life saving medicine and instead leaves him to die, he will post about it on social media.
The nurse now decides, for the first time in the conversation, that my friend should perhaps talk to his doctor.
The nurse is not in any sense the victim, until the doctor threw them under the bus. They refused a refill of a prescription, and also refused access to the person with the authority to do so.
My friend explains again that he does not have the time to see any doctor the next day
He had the time to see a doctor. He didn’t have the time to see a doctor without disrupting his life, which isn’t the same thing as actually not having the time to see the doctor. And the fact that seeing a doctor disrupts his life is his own fault for delaying the appointment.
The doctor shouldn’t be required to alter his procedure just because doing so would alleviate the consequences of the patient’s own decisions.
I recommend you show this to a doctor who treats patients with type I diabetes and see if it passes the intellectual Turing test. I don’t believe the doctor is being represented accurately here.
Alternative view: Your friend has a deadly disease that requires regular doctor visits and prescriptions. It sucks. It’s not fair, but it requires him to take some level of responsibility for his own care. He seems to have failed to do so by not keeping his appointments and letting his prescriptions run out. His doctor needs to see him and check his levels (presumably his A1c) to manage his diabetes. Your friend has unnecessarily escalated the situation by threatening to use the social media mob against the doctor.
Your friend is not evil. He’s just young. And like all young patients with a deadly chronic disease, is having a hard time dealing with his mortality. Your friend should keep his appointment with his doctor, but at the same time find a doctor who will be better suited to his schedule and needs.
The doctor is not evil. He just needs to have a clear view of the patient before he goes around prescribing deadly medicine (insulin can kill) to a patient who has shown an inability to manage his disease (keeping appointments, not running out of life-saving medicine).
Regarding the price of medicine in Canada: I believe the fixed low prices in Canada are being subsidized by your friend and all Americans.
Regarding the 3-month figure from the story, from https://annals.org/aim/fullarticle/2653838/treatment-type-1-diabetes-synopsis-2017-american-diabetes-association-standards
“Hemoglobin A1c reflects average glycemia over approximately 3 months and has strong predictive value for diabetes complications (14, 15). Measurement every 3 months in patients with type 1 diabetes determines whether glycemic targets have been reached and maintained. It may also confirm the accuracy of the patient’s meter (or their reported CGM or SMBG results) and adequacy of the testing schedule.”
Type 1 diabetic here. Regular doctor visits are actually pretty useless to us, other than refilling the prescriptions. Every six months is customary, but excessive. Every three months is scamming money out of insurers.
It’s cheap literally everywhere except the United States. It’s not a matter of subsidized capital costs, because those were all paid off more than a decade ago, and prices were cheaper then.
Measuring HbA1c can be done cheaply with an over-the-counter test kit. It does not require a doctor visit. Also, testing HbA1c that frequently isn’t important and isn’t done by most diabetics.
I think your first remark is exactly the point. If the visits are useless then this is a crappy doctor scamming money and time out of patients and insurance companies, if the visits are important then asking OP’s friend to come in (for being over 4 months late on a 3-month checkup) sounds very reasonable to me. I think Zyryab’s suggestion of asking a doctor to Turing Test this makes a lot of sense—maybe the checkups are more valuable in certain life stages/demographics/early after diagnosis? Maybe the checkup is something more complicated than recording the HbA1c levels? I’m surprised to hear that without outside medical information the doctor is guilty until proven innocent.
I think that this is a sketchy way to phrase this. Presumably, what a disease requires is a cure (or one of several cures). ‘Doctor visits’ and ‘prescriptions’ are one system society can have to assign cures to people, but there could also be other systems, like ‘you get to walk to a store and buy insulin if you want some without needing anybody’s seal of approval, and you can also see somebody to advise you on how much insulin to take’. Saying that the disease requires regular doctor visits and prescriptions seems to me to rhetorically imply that the costs associated with those are due to the disease, not due to the health care system, without doing the work of checking how well the system works (after all, if the system were about as well as we could manage, the costs really would be due to the disease).
I am confused why anyone would believe that this post is attempting to pass an ITT. It isn’t.
It’s also giving the doctor the benefit of the doubt in important ways that jimrandomh seems confident are unlikely to be accurate—in particular, that the doctor’s justification for such frequent and copious appointments is concern for the patient, and has no profit/fraud motive of any kind.
I’m really surprised this is being downvoted so much.
As far as I can tell (and frankly I don’t care enough to put serious effort towards finding more information, but I do note nobody in the comments started with “I am a doctor” or “After talking about this with my own doctor, …”) OP’s friend was in a life-threatening situation, the solution to which is a renewed insulin prescription. On top of that, the doctor/medical establishment enforces the rule that people (only young people? only people who recently developed diabetes? There could be a good medical reason here, I don’t know) with Type I Diabetes have regular checkups.
Now I imagine there are all sorts of reasons for wanting to skip this checkup. Maybe the checkup isn’t needed, and is just a money scam (small aside: if my doctor tells me I need a regular checkup, this is not my first thought. But individual situations can vary). Maybe the doctor’s schedule is so unreasonable that it’s impossible to make an appointment. There could be thousands of valid reasons. The problem as I see it is that, from the point of view of both the doctor and the nurse, they are only negotiating over the checkup. You mention right at the start that the nurse offered a solution (“drop everything and come see your doctor tomorrow”) - from that point on the situation was no longer life-threatening! There was no realistic scenario in which this would cost your friend more than the plans they made for the next day! You were just haggling over what is more important, your friend’s schedule or the rules set by the medical establishment that you need an active prescription to get insulin and you need a checkup to renew your prescription. Guess which one the nurse is going to find more important.
I understand if it feels like your friend is being blackmailed by the doctor (and in fact it seems like they are), but by refusing to visit the next day you are the ones who escalated the situation. And then escalated even further by threatening with media exposure. I think from the point of view of the nurse your friend is showing rather hostile behaviour. I’ll take the liberty of going through the phone call as you posted it, filling in how I expect nurses to act:
Probably standard procedure. At any rate this decision it out of the nurse’s hands, so they are just providing information here.
Still standard. Nurses don’t get to overrule conditions doctors set for medication, if the doctor says a checkup is needed then the nurse has no way of handing over insulin.
Still the same issue. The nurse doesn’t have the authority to overrule the conditions set by the doctor. Also I’m missing a sentence here, who introduced talking to the doctor the very next day?
So apparently making an appointment one a one-day notice is very doable on the doctor’s side. By this point you are solidly haggling about time, not medicine. I also think the nurse could have let you speak with the doctor here. But I think it’s also plausible that they get/did in the past get phone calls from all kinds of entitled weirdos who refuse to show up to appointments, and at this moment it’s really not clear your friend is not one of them. Why would their day plans be more important?
Really? Your friend escalates from “I don’t want to visit you tomorrow” to “that means you must want me to die”, which of course the sensible nurse ignores, and your strategy was to repeat it a few more times? Yeah, you really showed them there. I bet the nurse immediately realised they were wrong the first time, and connected you through with the doctor before you got to the third repetition. From their point of view you’ve refused a good solution to the problem and are now just bugging them to make your life easier (who likes going to checkups? Nobody. So who haggles about not wanting to show up? Well, not everybody, but more than just your friend I bet). And at that point your strategy is to escalate even more by threatening media exposure, and put even more pressure on that poor nurse? I’m not surprised the doctor claimed you are blackmailing them after this.
What was your goal of the conversation with the nurse in the first place? You need a doctor’s prescription for the insulin, so shouldn’t you have aimed for talking with the doctor? And if that was your goal, what purpose did it serve to tighten the screws on the nurse? You should have acted like a model patient and calmly requested you speak with the doctor, who can (and did) overrule the normal medical process just to give you life-saving medicine.
I guess that became a far longer monologue than I planned, I’m not going to go through the phone call with the doctor because it’s just more of the same. I think OP is in the wrong here, at the very least in their interaction with the nurse. And I do agree that this is a bad medical system, but you really can’t throw the co-pay costs, the lack of automatic prescription extensions/sufficiently large prescriptions to last you a long time and your interaction with the nurse and doctor on one heap and pretend this is the fault of “the American medical system”. The overall structure sucks, but some of these people are just local actors who cannot make a change and your friend threatened them to not have to change their schedule.
Do note that, although they probably weren’t in this case, the consequences of dropping your plans for the next day can be almost arbitrarily bad.
For example, it might cause you to lose your job, which in turn causes you to lose your health insurance and your flat.
(In another situation, you might be told “either you work tomorrow or you’re fired”, and someone could tell you that you’re not in danger of losing more than your plans for tomorrow. But in that situation, maybe your plans for tomorrow include “visiting the doctor to get the insulin you need to remain alive”.)
The part you are looking for is here:
Then after being ignored several times, social media is brought up:
The nurse is not in any sense the victim, until the doctor threw them under the bus. They refused a refill of a prescription, and also refused access to the person with the authority to do so.
He had the time to see a doctor. He didn’t have the time to see a doctor without disrupting his life, which isn’t the same thing as actually not having the time to see the doctor. And the fact that seeing a doctor disrupts his life is his own fault for delaying the appointment.
The doctor shouldn’t be required to alter his procedure just because doing so would alleviate the consequences of the patient’s own decisions.