Eight percent of the U.S. population has diabetes, but nearly six million people remain undiagnosed. According to the American Podiatric Medical Association (APMA), foot problems can help doctors discover diabetes. Diabetes can cause nerve damage in people’s feet, which can easily lead to amputation.

In the U.S., more than 60 percent of the patients who receive non-traumatic lower-limb amputations have diabetes. In 2004, almost 71,000 American diabetics needed amputations. Luckily, most diabetic amputations can be prevented through vigilant footcare.

”Diabetes can cause patients to lose sensation in their extremities, therefore a person with diabetes might not notice injuries to their feet until serious infection occurs,” said Ross Taubman, D.P.M., president of APMA. ”In most cases, patients can avoid amputation by working regularly with a podiatrist.”

Once diagnosed, patients with diabetes can prevent amputation by creating a footcare plan. Plans should include annual checkups with a podiatrist and daily foot inspections. Diagnosed diabetics need to be especially careful about footcare and should work with a podiatrist to determine the best preventative treatments.

Early diagnosis helps prevent severe nerve damage. For patients at risk for developing diabetes, foot conditions can be an early warning sign. According to the APMA, patients should see a podiatrist if they notice the following conditions:

• Calluses, blisters, or dry and cracked skin anywhere on the foot can imply poor circulation or foot health, especially if you don’t feel them or they take two or more weeks to heal.
• Look for thin, fragile, shiny or hairless skin, which can denote decreased circulation to the foot.
• Check shoes for torn linings or foreign objects. If they don’t irritate you when you walk, you might have nerve damage. Other warning signs include foot deformities like hammertoes, a past history of foot ulcers, or lower leg or thigh pain when walking.

For more information on preventing diabetes complications to the feet, visit the APMA’s website at www.apma.org.

The number of emergency rooms has been falling in recent years, as the number of people heading into the ER has been climbing.

Urgent care centers — doc-in-a-box outfits that handle urgent health problems that aren’t life-threatening — have been growing to take up some of the slack.

But, this morning’s WSJ notes, urgent care has remained largely unregulated. Urgent care doctors and nurses do have to be licensed the same as health care providers anywhere else, but there are no national standards for what urgent care centers should offer, or what quality measures they should meet.

That looks likely to change. The Urgent Care Association of America recently made a deal with the Joint Commission, the group that accredits the nation’s hospitals, to accredit urgent care centers and publish national quality standards by 2010.

While many insurers already pay for some urgent care services, accreditation could lead to better reimbursements. “We’d look far more favorably at an urgent-care clinic that was accredited than one that wasn’t,” Troy Brennan, chief medical officer at Aetna, tells the WSJ. “[I]t means an organization is taking a hard look at a variety of safety issues that should be involved in caring for someone who is acutely ill.”

Health-Care Costs Easing
Workplace wellness programs may be reining in rising costs, a survey finds.
From: Inc.com | August 13, 2008 By: Michael Gadd

Employer health-care costs are expected to rise at a slower pace in the year ahead, as more workplaces offer wellness programs and consumer-driven coverage options, according to Aon Consulting.

Based on a survey of more than 70 health-care insurers, the Chicago-based consulting firm estimates that that health-care costs will increase by 10.6 percent over the next 12 months, a 0.3 percent drop from last year and the lowest rate since the study was launched in 2001.

Rising prescription drug costs are also expected to ease, dropping by 0.3 percent for last year to 9.2 percent.

The study attributes the lower costs to an upturn in workplace wellness programs and consumer-driven coverage.

According to John Zern, the firm’s health and benefits director, employers could be doing more to combat rising health-care costs, in addition to wellness programs.

“This includes greater senior management support for these programs, better employee communications and more consistent cooperation from the medical community,” he said in a statement.

Talking Points: Making the Most Of Doctor Visits
October 31, 2007; Page D1

When her sister Kelly Rooney was battling breast cancer, Erin Dugery went along to doctors’ appointments to help make sense of the treatment options. But the medical jargon was often hard to understand, and she often felt she had forgotten important questions her sister needed answered. “On the drive to the appointment, you think of a million things you want to ask, but when you finally have the attention of the doctor it’s almost like getting stage fright,” says the Philadelphia mother of four.

Ms. Rooney died 15 months ago at age 43, but Ms. Dugery says she learned valuable lessons during her sister’s illness — such as writing down important questions beforehand and not being afraid to ask the doctor to explain things. Much of this advice came from an unusual source: “Doctor, Doctor, Lend Me Your Ear,” a one-woman skit the sisters saw performed in Florida by Ms. Rooney’s radiation oncologist, Marisa Weiss. Dr. Weiss, who strips off her white coat and clothes on stage to reveal a hospital gown, uses humorous examples from her own experience to convey lessons on how to talk to — and listen to — your doctor. (See video of Dr. Weiss’s speech)

Dr. Weiss, who has turned the lessons from the skit into a new book, is one of a growing number of medical professionals and health-care groups offering advice through books, Web sites, DVDs and even personal consultations to help patients navigate the modern doctor’s appointment.

Though medical information has never been more accessible to consumers, many patients still don’t have the skills to talk to their doctors and cram all the questions they have about their health into a brief visit. They often ignore what they don’t understand, or leave delicate but important issues to the end and then run out of time. So to help patients get answers, health-care officials are offering new discussion aids, providing sample questions patients can ask, and offering advice ranging from making a list of your drugs, to starting with the biggest questions first, to checking that a doctor has your lab results before going to an appointment.

Given the growing concern about patient safety and malpractice liability, doctors, too, are under pressure to help patients ask the right questions in the limited time they have. The Joint Commission, a nonprofit group that accredits health-care organizations, recently began requiring hospitals to show that they are encouraging patients to participate in care. For example, health-care providers should be encouraging patients to ask questions, and using educational materials to help them make decisions. A growing number of health-literacy programs urge physicians to speak more slowly, use plain language, and, when possible, show models or actual devices or even draw pictures.

A survey by the Boston-based nonprofit Foundation for Informed Medical Decision Making found that the majority of adults have big concerns about doctors not spending enough time to explain all treatment options. The foundation, whose work stems from research originally conducted at Dartmouth Medical School about unwarranted variations in health-care practice, is working with physician-practice groups around the country to test videos, books and pamphlets called Shared Decision-Making programs. Used at the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and provided through health plans with about 20 million members, the aim is to see how they work when provided directly to patients by primary-care offices.

“The doctors don’t have time to explain everything you ought to know, and they may not even be the best people to provide basic information and frame it for the patients,” says Floyd J. Fowler Jr., the foundation’s president.

The Shared Decision-Making materials, which are organized by illness, procedure and condition, present background information to help patients make medical decisions, including pros and cons of various treatment options, risks and long-term survival statistics. Patients can review the information in the doctor’s office before an appointment and take materials home to review with family members. Unlike a broad Internet search, Dr. Fowler notes, the decision aids synthesize the most important information for the specific decision a patient has to make, such as whether to get a colorectal cancer screening or go forward with back surgery, and how different treatment choices might affect their lifestyle or personal preferences.

Yvonne West, a 41-year-old nurse and mother of two teenage girls who was diagnosed with breast cancer, learned of the Shared Decision-Making aids because Pittsfield, Mass.-based Berkshire Health Systems, the hospital where she worked, is participating in a test of the programs. Shortly before her own diagnosis, her husband died of cancer after being treated with radiation, and she was concerned about undergoing such treatment herself. Using the decision aids, she reviewed the evidence for different options and the risks of recurrence before consulting with her doctor, ultimately choosing a unilateral mastectomy and reconstruction. The videos include real patients talking about their choices and why they made them.

“The videos got me thinking about the different options, and really helped me with the decision process,” says Ms. West.

Consumers without access to such decision aids can still find help in preparing for doctor visits on Web sites sponsored by disease advocacy groups, hospitals and the federal government. The American Heart Association (americanheart.org), for example, offers a list of questions that patients with high blood pressure and high cholesterol should ask, while the Boston-based Joslin Diabetes Center Web site (joslin.org) offers a list of questions that diabetics should ask doctors who are managing their disease, and explanations of why each question is important.

Researchers at the University of California, Los Angeles, say that as many as 40% of patients bring more than one concern to a doctor’s visit — and possibly as many as three or more. In a study published this month in the Journal of General Internal Medicine, they suggest that a slight change in bedside manner can make a difference in whether all of these issues get addressed: Patients who were asked at the end of a doctor’s visit whether there was “something else” that needed attention were much less likely to leave with unmet concerns than those who were asked whether there was “anything else” that needed attention.

According to the study, “any” tends to be used in a negative context, predisposing patients to respond negatively. With many doctor visits averaging 11 minutes, doctors clearly have to make every question count, lead study author John Heritage notes.

Delia Chiaramonte, a Baltimore-area physician, started a business called Insight Medical Consultants that helps patients find medical experts, make treatment decisions and communicate effectively with doctors. She notes that patients often save their most important or embarrassing question for last, then find the appointment is over with no time to address their most important concern. “There is often a tremendous miscommunication between doctors and patients on what the visit is really about,” says Dr. Chiaramonte. “If your No. 1 priority is talking about your erectile dysfunction, it’s best to start with that.”

It’s also critical when making doctor’s appointments to be clear on whether it is simply a check-up or you have a specific urgent complaint or problems with a chronic health issue. Doctors schedule their time differently for all three and should be prepared ahead of time. Dr. Chiaramonte suggests asking office staff what the best time is to schedule an appointment if you need more time to talk, such as whether later in the day or the first appointment is best.

Dr. Weiss — whose book is titled “Seven Minutes: How to Get the Most from Your Doctor Visit,” available for $10 through her nonprofit Web site, breastcancer.org — advises that patients prepare a full report of any symptoms or concerns prior to the doctor’s visit, as well as a complete list of current medications. If you are awaiting interpretation of test results from a lab, make sure before you arrive that the results have been sent and that the office staff have given them to the doctor.

She also advises bringing family members or a trusted friend, not only for moral support, but to act as another set of eyes and ears to listen to what the doctor is saying and to help organize questions. Since grasping the doctor’s words can be the hardest part of the visit, she also advises using a tape recorder, but first asking the doctor’s permission to do so.

Ms. Dugery, who started a Web site, Save2ndbase.com, to help raise money for a foundation in her sister’s name, says she now uses Dr. Weiss’s advice to advocate for herself and others in her extended family. “Even though your doctor may be the captain of the ship, you are the first mate,” says Ms. Dugery. “It’s really empowering to be able to find your own voice in your own care and in the care of your loved ones.”

• Allergy & Immunology - Allergic and immunologic diseases and their respiratory complications (such as pollen, chemical and food allergies, asthma and AIDS).
• Anesthesia - Anesthesia or relief of pain during surgery and childbirth, and control of paid due to various causes.
• Cardiovascular Disease - Cardiology diseases of the heart and blood vessels.
• Dermatology - Diseases of the skin.
• Emergency Medicine - Diseases that are acute medical or surgical conditions or injuries that require urgent or immediate care (usually in a hospital emergency room).
• Endocrinology and Metabolism - Diseases of the internal glands of the body, including diabetes mellitus.
• Family Practice - All diseases and related total health care of an individual and the family.
• Gastroenterology - Diseases of the digestive tract, including the stomach, bowel, liver and pancreas.
• General Practice - All diseases and related total health care of an individual and the family.
• Geriatric Medicine - Diseases of the elderly.
• Gynecology - See “Obstetrics and Gynecology”.
• Gynecologic Oncology - Cancer diseases of the female reproductive system.
• Hematology - Disorders of the blood and blood-forming organs (including cancerous disorders of the blood) such as anemia, leukemia and lymphoma (see Oncology, Medical).
• Infectious Diseases - Infections of all types.
• Internal Medicine - All diseases and total health care of adults, usually 18 years of age and older.
• Neonatology - Disease of the newborn child.
• Nephrology - Diseases of the kidney, including dialysis.
• Neurology - Diseases of the brain, spinal cord, nervous system and related structures.
• Neurological Surgery - Diseases of the brain, spinal cord, nervous system and related structures requiring surgery.
• Obstetrics and Gynecology - Normal and abnormal pregnancy, diseases of the female reproductive system and fertility disorders.
• Oncology, Medical - Cancer and disorders of the blood and blood-forming organs (see Hematology).
• Ophthalmology - Diseases of the eye.
• Orthopedic Surgery - Diseases of the bones, joints, muscles and tendons.
• Otorhinolaryngology - Ear, Nose & Throat - Diseases of the ears, nose, sinuses, throat and upper airway passages.
• Pathology - Tissues and specimens removed by biopsy and surgery to diagnose normal from diseased tissues and specimens; supervises and interprets laboratory tests on blood, urine and other body fluids.
• Pediatrics - All diseases and total health care of newborns, infants, children and adolescents.
• Physical Medicine and Rehabilitation - Diseases with major and minor disabilities requiring restoration of functional ability such as assistance, retraining and recondition of muscles, tendons and extremities for ambulation and other activities of daily living.
• Plastic Surgery - Diseases and conditions requiring surgical reconstruction for deformity or loss of a body part, or for cosmetic purposes to improve appearance or function.
• Podiatric Medicine - Podiatry - Disease of the foot and ankle as they affect the conditions of the feet.
• Preventative Medicine - Health care and other measures to avoid delay or prevent disease or illness from occurring.
• Psychiatry - Diseases affecting mental health including diseases of the brain, nervous system and substance abuse of drugs or chemicals.
• Pulmonary Disease - Diseases of the lung.
• Radiology, Diagnostic - X-ray, ultrasound and other imaging techniques such as Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI).
• Radiology, Nuclear - Diseases requiring use of radioactive isotopes or as an aid in diagnosis and/or therapy.
• Radiation Oncology - Cancer and other diseases with x-ray therapy, radioactive isotopes and linear accelerator particle radiation.
• Rheumatology - Diseases of the joints including arthritis and autoimmune diseases.
• Sports Medicine - Diseases and injuries acquired in sports.
• Surgery, General - Disease that require surgical operation for diagnosis or treatment.
• Surgery, Hand - Diseases and injuries of the nerves, tendons, muscles, bones or skin of the hand requiring surgery.
• Surgery, Thoracic - Diseases of the chest, including lungs, heart, blood vessels and chest wall, that require surgical operation for diagnosis and/or treatment.
• Surgery, Vascular - Diseases of the blood vessels that require surgical operation for diagnosis or treatment.
• Surgery, Colon and Rectal - Diseases of the large intestine (bowel), rectum and anus that require surgical operation for diagnosis or treatment.
• Surgery, Urology - Diseases of the kidneys, bladder and male reproductive tract that require surgical operation.