[jazoom]

> What is wrong with doctors these days :(

Disclaimer: I'm a doctor.

It may be different where you are from, but patients are usually the ones who want a script for something and not to be told to put away their devices, stay away from coffee and alcohol, etc.

Also, there's a difference between addiction and becoming dependent on taking a substance, which seems to be a common misunderstanding in this thread.

[polyfractal]

Agreeing here. My SO is a medical practitioner, and some of the stories I hear are just crazy. Folks who can't sleep and come in wanting meds, but after digging into their history you find they are drinking four liters of soda, two extra-large (and extra-sugary) lattes, and a pack of cigarettes every day. And on their phone until 11pm.

The more I hear about healthcare from the inside, the more I realize it's a game of "work on the worst problem, ignore the rest". There's limited time in patient visits, and patients have limited motivation, so you really have to prioritize what to fix. If you tell the patient to fix all the things, the will fix none of them.

Worse, patient education is hard work. Patients don't listen, ignore advice, stop lifestyle changes as soon as it gets hard. So you focus on one or two of the worst offenders; you convince them cigs are going to put them in an early grave and they should cut back to half a pack a day. Maybe drop the soda to two liters a day. The rest of their problems you have to ignore until later. That's often when meds come into play because they can help bridge the gap while you work on their lifestyle issues.

Oh, and all of that happens in 15 minute visits every other month.

There are certainly bad doctors out there over-prescribing all sorts of things, but from what I've seen, it's more a matter of prioritizing what to spend your precious 15 minutes on and going from there. Doctors and other medical professionals are in an impossible situation most of the time.

Edit: for clarity, this is an American healthcare perspective.

[jazoom]

Amazingly, despite the fact that good diet and exercise are by far the best things you can do to treat type 2 diabetes, it's actually in the guidelines in Australia to commence metformin from the beginning. The reason being that studies have shown that the number of patients who actually do make long-term changes to their diet and exercise routines is excruciatingly small. So small, that it's best just to assume they won't actually do it, so just commence metformin (while still giving the advice, of course). At least this way the 95% (I dunno what the actual number is) of patients who won't change will be getting some BSL reduction in the meantime.

[magicnubs]

Also because metformin (last I heard) is considered exceedingly safe and almost universally beneficial--so much so that some recommend prescribing it to everyone over a certain age.

[sibeliuss]

I don't thing the crisis we're in right now should be blamed on patients; they might want a script, but that doesn't mean its in their interest.

[jazoom]

> I don't thing the crisis we're in right now should be blamed on patients; they might want a script, but that doesn't mean its in their interest.

I'm guessing you're American since you're assuming everywhere has the same crisis you do. From what I've read here (on Hacker News), you have plenty of systemic problems. I doubt blaming doctors is going to be the most useful course of action. But then, I don't really know. Perhaps all doctors in your country deliberately do things that are against patients' best-interests, and would continue to do so if patients actually wanted the best thing for them. Do your doctors really not suggest good diet and exercise as treatments for type 2 diabetes? I'd be very surprised if they don't.

Edit for clarification.

[bkanber]

Not OP, but one thing I've always found absurd about our medical practice is doctors recommending things like whole wheat pasta for type 2 diabetes. Really? Plate of carbs? Many health systems here still have this kind of stuff in their official guidelines.

[jazoom]

I've never seen that in a guideline or heard a doctor recommend that, but I agree it's strange. But it makes sense to me if it's a case of "replace your endosperm-only pasta with whole-wheat pasta". It's not practical to tell someone with T2DM they can never eat pasta ever again.

It's far more important to look at the diet overall than to agonise over the occasional pasta meal.