The disclaimer I include in the misc.health.diabetes FAQ is
Advice given in m.h.d is *never* medical advice. That includes this
FAQ. Never substitute advice from the net for a physician's care.
Diabetes is a critical health topic and you should always consult
your physician or personally understand the ramifications before
taking any therapeutic action based on advice found here or
elsewhere on the net.
It appears in each of the five parts under the heading READ THIS FIRST
and before even the table of contents. I intend this placement to make
it prominent to both those reading an entire posting or downloaded
file, and those using digest-conscious newsreaders or the WWW.
I've indeed thought about this a good bit, and find quite a dilemma.
You'll notice that I waffle distinctly in the disclaimer. I say
straight out that neither the FAQ nor anything else posted is medical
advice. This is pretty much a minimum requirement, and is even stated
in the group charter. Yet I go on to say "consult your physician or
personally understand ...". This is in recognition of two facts. First,
many diabetes patients are not receiving adequate information, advice
or guidance from their health care providers. Second, diabetes more
than any other widespread major disease is primarily managed and
monitored by the patients themselves -- indeed, the level of monitoring
and adjustment required precludes physician participation in every
daily management decision.
So there's the dilemma. In fact, much advice given on mhd *is* medical
advice. It's often much-needed medical advice, and I do expect readers
to act on that advice -- but I want them to do so with caution. The
exact nature of the caution depends on the circumstance. Often the
action will simply be to present the information to a physician. (It's
often unrecognized that the majority of physicians are simply too busy
to keep up, and that they appreciate an informed patient.) For some
treatment changes, the potential ramifications are not dangerous and
the reader/patient is safe trying the advice to see if it works. A
well-informed patient who is monitoring blood glucose carefully can and
does make more significant changes without consulting a physician.
More important, many readers aren't getting good advice from their
health care providers. Many have physicians who are actually
antagonistic to patents wanting to take an active role in caring for
themselves, wanting to set tighter goals for self-care, or just wanting
to do more for themselves. Too many physicians are fatalistic about the
consequences of diabetes and don't want to take the time to help
patients improve their self-care. In fairness to physicians, many have
poured large amounts of time into trying to get patients to make
difficult lifestyle changes with no results, and don't want to waste
time they could spend more productively helping other patients. But
this doesn't help the patient whose physician won't listen.
Example: a type 2 diabetes patient thinks he can improve his health by
engaging in an exercise program. This is standard practice, but his
physician says in effect "don't bother, you can't stop the
complications, you can't do anything about it". This verges on
malpractice, and the patient/reader gets good advice from the net which
he takes back to his physician. Much of that advice deals with how to
persuade the physician to spend the time discussing the topic. Yet for
a few patients exercise can be dangerous due to concurrent conditions,
so net advice to start an exercise program in defiance of a physician's
advice could be extremely dangerous, even while the physician is
probably giving the patient very dangerous advice. I address some of
this in the FAQ, though not nearly as much as I'd like to.
Example: a parent/reader's teenage daughter is faking blood glucose
tests to look "good" (a common problem). The parent gets advice from
the net on improving communication with his daughter. This topic comes
up periodically in the newsgroup, and I address it in the FAQ. There's
no direct medical issue here, and the net can give much better advice
than most health care providers not trained in psychology.
Example: a pregnant women has just been diagnosed with gestational
diabetes. Her physician's nurse prescribes a diet and tells her to come
back in two weeks for a blood glucose test -- despite the fact that
this condition needs immediate initiation of home blood glucose
monitoring, and adjustment of treatment daily by the physician to
normalize her blood glucose, since even minor elevation of blood
glucose during pregnancy can cause serious problems. She gets lots of
advice from the net on starting monitoring her blood glucose -- why and
how -- without waiting for her physician to recommend it or acquiesce
in it. This is completely safe advice, since monitoring only gathers
information, and the net tells her to gather this information for a
couple of days and then take it to her physician -- and to demand an
immediate appointment with an endocrinologist if her primary care
physician isn't prepared to handle the case, either for lack of
knowledge or lack of time. She also gets advice on how to deal with
insurance issues. I don't address this one in the FAQ yet, though it's
on my short list.
So back to the dilemma. On the one hand, proper medical advice and
supervision is critical. Yet to many readers, acting on advice from the
net, sometimes quickly, can vitally improve their lives. I'd like to
assure that readers -- with their wide disparity of pre-existing
assumptions -- don't either ignore their doctors or adhere slavishly to
their doctors' advice. That balance isn't easy to attain.
Edward Reid
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