Author Archives: drleethegp

Medical aids and the future?


In my opinion which some may argue is not humble. I argue it is.

Medical aids restrict care for patients as well as shoot themselves in the foot when it comes to downstream costs.

Particularly in an environment like south africa where we have this tsunami wave of a diabetes epidemic. Approaching things holistically (as CDE which originated in Joburg and is now all over RSA) is the only way to manage the finances we have. Yet the push back from some medical aids is interesting to use a word so as not to offend.

I am merely a GP – general practitioner. I have made it my mission to stay up to date (as well as the most qualified I can be) regarding diabetes at large. I am passionate about it. I am even more passionate about the best care for my patients. This largely could translate to the best money spent for medical aids but alas it does not turn out that way 9 times out of 10.

There are medical aids who are open minded and practice preventative care like Discovery and medications and appliances are provided with insight and good application.

I wish this were across the board. Alas not in our beautiful country.

Patients vote with where they pay their money.  The next few years are critical as to both the direction of medical aids and whether the money will be spent effectively saving downstream costs or whether the whole thing just implodes. Every day another massive wave of patients are added to this problem. It is soon to hit that critical mass where devastation occurs.

We have to become more preventative, we have to manage what we have to the best of our abilities with what we have.  That is best done with more brains. Team is key. Technology is key and unfortunately not everyone is on this boat.

Think before you drink before you drive, think before you eat that cake and you don’t survive.

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Death Oh who art thou?


Source: Death Oh who art thou?

Death Oh who art thou?


To lose a loved one is one of the hardest things for me. I am so unsettled by it, especially if it is someone my age or younger. Because I am young. And Death is so definite.

At someone’s memorial or funeral one expects to gain closure and to get some kind of “feeling” that the world is upright again. But alas it is not always so.

My “friendus” Mark Reynolds was a larger than life person who was always going to defeat death until he didn’t. I met Mark on the “kleuterskool” play ground in a small town called Tzaneen where english speakers were in the minority. There were 3 of us : Mark, Vivienne and myself.

We played on the “baantjie” and said ” get away, get away” a lot. We forged a friendship right there and then that lasted an eternity (I hope). Death confuses me and many of the things I hope for (faith) elude my desire for confirmation thereof.

Throughout junior and high school we played, we learned, we experimented. Mark was the first to offer me a cigarette -menthol nogal. I tried it, hated it and it convinced me lifelong that I would not smoke. We hiked in the gorgeous agatha forest, slid down the rocks. We laughed so much mostly our sides split.

We rode horses in Sabie – galloping into eternity together.

More recently Mark attended my sister and my wedding. I will never forget Mark giving my bemused husband-to-be a flower as was his custom.

Mark’s laugh was one of those that triggered others to laugh and not stop. His smile captivated. His heart was one the most beautiful I have ever seen. He sacrificed so much for others – his important others.

In love I believe he was let down so badly it still hurts me. He painted out of that and gave up on romantic love – which is so so desperately sad but I believe he was trying to self preserve. For me this is so tragic as he was a gorgeous soul and the love between 2 people – true romantic love as it were is something that can take one to heights that nothing else can- and it did – only it dropped him too (as it does many).

He had so much to give – in life and love.

Taken way way too soon, I just don’t understand and I guess never will.

What I know is that we must live here now, and make each minute count. We must cherish each other in the moment. Be present in the moment and live each as if the last.

 

To Mark – my “friendus” ignite heaven as I know you will with your soul. Devastate them with the joy that radiates out of it. The deeper the sorrow carves into your being the more joy it can contain. I love you and I always will.

Celebrate and live each minute


Our time on earth is limited by a number none of us know. The quality that we experience depends almost entirely on us – each one, in our own capacity.

Life is very short for some and interminably long for others. The enigma is that there is no way of knowing.

Where does that leave us each, individually?

Life is a strange bag of tricks and boils down to little more that about 40-60 years on average of a daily slog : waking, working, paying for things, sleeping. And yet it can be so much more. It can be.

It depends entirely on your own self. The quality of each minute. The minutes add up and create memories. But essentially if you are not present in the present and enjoying that very minute wholeheartedly it may be a wasted minute, hour, life.

I wish we knew in a way. The hours we each had and the moments that we should make count.

But we don’t.

Perhaps only when you lose a loved one do you re-evalute life on a minute to minute basis.

Today actually counts for more than you think and if you understand that in the realm of time and space we are each such a small inconsequent speck that may or may not live another day, surely it’s worth making this very minute worth it.

Sorrow and sadness fill my being for the loss of a life so huge at some moments and so full of the very essence of life. He lived indeed and took the time to make it special. I so hope that one day I will understand the reason we have a this life and a “death” or after life. I certainly don’t today.

Tidal wave required


Source: Tidal wave required

Tidal wave required


Ok so life is interesting in south africa. I would like the kind of money that Manyi  has, 450 million? was it. I would use it to “fund” my patients needs.

Diabetics, type 1’s in particular have many needs. Most of these are not taken care of by their medical aids and despite the fact that patients pay a LOT of money for the privilege of being on one.

Type 1’s require tight control of glucose above a certain range and below a certain range and everything including the weather impacts on blood sugar. Thus continuous monitoring is a tool that can make a very very big difference in a patient’s life – it can also make such a difference that the medical aid is spared costs of admissions for highs and lows, for amputation, renal dialysis, heart attacks as well as costs attached to being blind.

However medical aids at large do not seem the slightest bit interested in saving themselves money.

Far rather milk the patient for all they are worth and at the same time provide the minimum service and complain about any request made by the health care provider who has studied long and hard and has a passion to save the medical aid costs.

Yes I am angry, perhaps at this time of day I am even h”angry”.

I am tired of begging, pleading for minimum standards of care.

I am tired that overseas things get “accepted” years before they do in south africa. Are we really 3 rd world? Despite having the “Manyi’s” ???

We require a tidal wave of protest in the form of intelligent debate with the stakeholders that matter in the realm of diabetes. I am just so tired of fighting.

Please from far and wide across  this beautiful country we call home join me, join the debate, write to your medical aid. Email me : drleethegp@gmail.com.

Please.

Continous monitoring is available in 4 forms in south africa : dexcom G5 and G4, libre flash abbott, medtronic standalone CGM and most new to the scene : ever sense.

Coming in at the lower end is the abbott flash R990 once off and R990 every 2 weeks. Dexcom is a cost upfront more than about 25k and then monthly around 4 k, medtronic around 15 and 2k per month and ever sense brand new so not too sure but in the ball park for the last 2 mentioned.

What is boils down to is MARD and quite frankly this is the bottom line with CGM is accuracy. The lower the MARD the more accurate. There are really only 2 in the market that a great on MARD : dexcom G5 and ever sense, however for the cost the libre is actually a very good value for money.

The other thing that helps me as a practitioner is a trend and all of the devices are good for this.

What we need is for the medical aids to realise that CGM is a tool they their patients can NOT afford to be without! FOR THEIR own sakes – the medical aid’s sakes.

Please tsunami arrive and let’s flood the medical aids with the truth.

Alternatively could the guptas or the Manyi’s or maybe Grace Mugage give me 450 million to spend on my very deserving patients.

Thanks ;).

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