Know your rights!
- Thread starter fergus
- Start Date
I have worked with quite a few doctors,Ally and without exception they all read the supplemental notes on things if they are not too sure of the subject.
oh yes i agree with that but the pont is that the phrase carb restriction is wooly and open to interpretation. Most gps use the local drugs list - well certainly where i work we have a local formulary devised i think to cut drugs costs!
I know what you mean,we have one of those as well.The point is no one uses the term restrict carbs.They go on about eating portions(what's a portion??) of complex carbs so that gives the go ahead to some folk to eat plates of chips,rice pasta etc "because the doc/nurse/dietician" said it is OK.If the restriction was spelled out in spoonfuls it would be much more beneficial.
Well, here is what the BNF website itself says:
The BNF reflects current best practice as well as legal and professional guidelines relating to the use of medicines. It is intended for use by prescribers, pharmacists and other healthcare professionals.
Designed for rapid reference
Authoritative, impartial and, where available, evidence-based advice on prescribing, dispensing and administering medicines
Updated twice a year to reflect promptly changes in product availability as well as emerging safety concerns and shifts in clinical practice.
So tell me, if a health professional doesn't advise a diabetic patient how to lower carbohydrate consumption in order to control the condition BEFORE prescribing oral medications, which of these guidelines would they be breaking? Best pactice, legal or professional? All 3 perhaps?
Of course 'carb restriction' is an imprecise term, just as the level of restriction required will vary between individuals. 'Wooly' doesn't mean 'let's not bother', it means you must use your professional skill in order to apply the clear guidelines to best effect.
Now, something tells me that's not hapening.
All the best,
fergus
The BNF reflects current best practice as well as legal and professional guidelines relating to the use of medicines. It is intended for use by prescribers, pharmacists and other healthcare professionals.
Designed for rapid reference
Authoritative, impartial and, where available, evidence-based advice on prescribing, dispensing and administering medicines
Updated twice a year to reflect promptly changes in product availability as well as emerging safety concerns and shifts in clinical practice.
So tell me, if a health professional doesn't advise a diabetic patient how to lower carbohydrate consumption in order to control the condition BEFORE prescribing oral medications, which of these guidelines would they be breaking? Best pactice, legal or professional? All 3 perhaps?
Of course 'carb restriction' is an imprecise term, just as the level of restriction required will vary between individuals. 'Wooly' doesn't mean 'let's not bother', it means you must use your professional skill in order to apply the clear guidelines to best effect.
Now, something tells me that's not hapening.
All the best,
fergus
Ally, remember when I started a thread called "Fergus will like this one...Interesting!" on the food forum and you said it was a pointless posting? I typed out the full list of what I was recommended to eat and it actually used the word "high" when suggesting the amount of fibre(carbs list followed) to be eaten. You cannot keep dismissing what we, as patients, are being advised. The advice we get is wrong. Regardless of how much we each decide to cut down on carbs. most of us on here agree that it does benefit us and we are just not being advised to do that. It has to change.
A portion of rice, according to the dieticians in my local hospital is a mound the size of a large soup ladle. there are places where portions are explained. However, look on a cereal packet and see the panel. It usually says something likr calories per normal 38 g portion. 38 g rice drispies is about a tablewspoonful The information on my dried dogfood is better. It gives ranges in grams per day for particular weights of dog. the one they're getting currently works out at about 20g per kilo of dog I did weigh it once, but now use an American cup measure and each dog gets a 3/4 cup twice daily. Why is it so easy for dogs o work out portions?
of course u need to restrict carbs but excess of any food is not healthy either.
I never take statements like it was produced by a dietitian unless i see it for myself because I know that often the rubbish nurses and doctors give out may have been cobbled together by them - seen enough over the years lol! I just think you also need to respect the people on here who are not very low carbing.
Fergus the bnf is a drug tarrif really and may not be in tune with practice.
I never take statements like it was produced by a dietitian unless i see it for myself because I know that often the rubbish nurses and doctors give out may have been cobbled together by them - seen enough over the years lol! I just think you also need to respect the people on here who are not very low carbing.
Fergus the bnf is a drug tarrif really and may not be in tune with practice.
wiflib
Well-Known Member
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- Type of diabetes
- Treatment type
- Tablets (oral)
I use the BNF frequently to challenge current practice, inform my practice and check that a client is not been given drugs that are contraindicated or just simply written up incorrectly.
We have often discussed, as a team, findings in the BNF to enhance the treatment and care of our clients and this frequently leads to someone pulling something very interesting from the web.
I can also recall on a few occasions, the reviewing of our trusts guidelines and policies in view of the information in the BNF.
Wiflib
We have often discussed, as a team, findings in the BNF to enhance the treatment and care of our clients and this frequently leads to someone pulling something very interesting from the web.
I can also recall on a few occasions, the reviewing of our trusts guidelines and policies in view of the information in the BNF.
Wiflib
tbh - if you look at general practice I havent any evidence that gps use it very much. Maybe in the hospital setting you do. Still think the term carb restriction is wooly tho! I will have a look on wed whne i ma in the surgery!
Guidelines!!
Will someone please define.
Surely to goodness there needs to be some degree of respect for medical professionals charged with applying or not applying guidelines.
If I need a plumber or a bank manager, or a mechanic, I don't tell him/her how to go about their professional business.
Will someone please define.
Surely to goodness there needs to be some degree of respect for medical professionals charged with applying or not applying guidelines.
If I need a plumber or a bank manager, or a mechanic, I don't tell him/her how to go about their professional business.
The trouble is,Jenny that the guidelines do not exactly fit type2 diabetics.they were originally for type 1's who can adjust their insulin to suit their intake.Type 2's can't do this ,we must adjust our carb intake to bring down our BS.
wiflib
Well-Known Member
- Messages
- 1,966
- Type of diabetes
- Treatment type
- Tablets (oral)
I'll do me best!
A guideline is a recommended practice that allows some discretion or leeway in its interpretation, implementation, or use. In the NHS, it is designed for HCP use and based on current research and usually considered best practice. Someone has done the legwork for me. This doesn't absolve me from ensuring I also keep up to date, or knowing my limitations in order to give the best care I can.
An example for my working day would be the list of conditions that would warrant referral of a client to an obstetrician. The guideline is for me, not the client. I can discuss with her why the trust wants me to refer her and all her options, but the final choice lies with the client.
My plumber wants me to use different tiles for my bathroom. I acknowledge his experience ans expertise but I'm willing to take the chance on the final result.
wiflib
A guideline is a recommended practice that allows some discretion or leeway in its interpretation, implementation, or use. In the NHS, it is designed for HCP use and based on current research and usually considered best practice. Someone has done the legwork for me. This doesn't absolve me from ensuring I also keep up to date, or knowing my limitations in order to give the best care I can.
An example for my working day would be the list of conditions that would warrant referral of a client to an obstetrician. The guideline is for me, not the client. I can discuss with her why the trust wants me to refer her and all her options, but the final choice lies with the client.
My plumber wants me to use different tiles for my bathroom. I acknowledge his experience ans expertise but I'm willing to take the chance on the final result.
wiflib
"discretion or leeway in its interpretation, implementation, or use"
The health professional has, therefore, choices and may or may not wish in light of particular circumstances, evidence/facts available to him/her decide to follow any particular 'guideline'. In doing so I would assume that they would be able, if challenged, to to robustly defend any particular course of action determined by them. (For example, having considered case x within the context of the guidelines on the basis of (whatever) I conclude that a more appropriate course of action would be..... ) On the other hand, a patient might assume, and I think many do, that guidelines are some form of mandatory direction/regulation to take a particular course of action - which they are clearly not.
Would be simple if the policy was set out in terms of 'in the case of x the following course of action should/must be taken. But then, if rigid rules applied would we need health professionals to make the decisions. I doubt it. Another task for delegation to the seemingly growing band of Stalinist practice receptionists perhaps.
The health professional has, therefore, choices and may or may not wish in light of particular circumstances, evidence/facts available to him/her decide to follow any particular 'guideline'. In doing so I would assume that they would be able, if challenged, to to robustly defend any particular course of action determined by them. (For example, having considered case x within the context of the guidelines on the basis of (whatever) I conclude that a more appropriate course of action would be..... ) On the other hand, a patient might assume, and I think many do, that guidelines are some form of mandatory direction/regulation to take a particular course of action - which they are clearly not.
Would be simple if the policy was set out in terms of 'in the case of x the following course of action should/must be taken. But then, if rigid rules applied would we need health professionals to make the decisions. I doubt it. Another task for delegation to the seemingly growing band of Stalinist practice receptionists perhaps.
I think the best use for the information is to use it in the usual tennis match type of exchange at the diabetic clinic.
Doctor: Your blood sugars are doing okay. Your not still on that low carb diet are you? It's much healthier for your heart to eat lots of starch and wholegrains and eat less red meat and butter and stuff you know. We can up your meds if your blood sugars get too high.
Patient: Have you seen what the BNF has to say about upping the meds? I would be very interested in what you think about it.
Doctor: (Looks at BNF) Duh?
Doctor: Your blood sugars are doing okay. Your not still on that low carb diet are you? It's much healthier for your heart to eat lots of starch and wholegrains and eat less red meat and butter and stuff you know. We can up your meds if your blood sugars get too high.
Patient: Have you seen what the BNF has to say about upping the meds? I would be very interested in what you think about it.
Doctor: (Looks at BNF) Duh?
There are probably more diabetics alive and well having followed the advice of the medical profession than there are dead through complications or whatever or from ignoring the advice given by, ehm, health professionals.
Consider, how many diabetics regularly use this site? Of that number, how many regularly pontificate. Count the relevant, meaningful contributions which are evidentially supported. What percentage of the diabetic community does the diabetic visitors to this site reflect.
I would hazard a guess that this 'community' is tiny proportion of diabetics living with and managing their condition. And no doubt having a very happy existence.
Perhaps the non-professional 'experts' need to stop navel gazing and get on with real life. How far would you stick your neck out with anecdotal evidence if you had to face the consequences?
Consider, how many diabetics regularly use this site? Of that number, how many regularly pontificate. Count the relevant, meaningful contributions which are evidentially supported. What percentage of the diabetic community does the diabetic visitors to this site reflect.
I would hazard a guess that this 'community' is tiny proportion of diabetics living with and managing their condition. And no doubt having a very happy existence.
Perhaps the non-professional 'experts' need to stop navel gazing and get on with real life. How far would you stick your neck out with anecdotal evidence if you had to face the consequences?
Can I ask you ,Jenny ,which diet do you follow? Are your BS levels down to round about 5-6?Please enlighten us as to how you manage your diabetes.
Jenny, with respect, I see you have had type 2 for a year.
You might bear in mind that the great majority of members on here have had T2 or, in my case, T1 for a great deal longer.
Age may be no guarantee of wisdom, but it does at least allow the time to compare and contrast different approaches to controlling the condition. The benefit of this time has lead a great majority of those on the forum to conclude that the medical profession's approach to diabetes care, particularly with regard to diet, is seriously flawed.
I have yet to read a post on this forum from a diabetic who has tried a low carb diet and not found enormous benefits in blood sugar levels, body weight, control of appetite, blood pressure, blood lipids and sheer bloody liberation from the complications surrounding diabetes.
Perhaps you have yet to try it yourself. In this case, in the interests of scientific objectivity, I'd suggest you see quite what a difference it can make before you jump to the defence of the medical profession.
We are united in our gratitude for the medical advances available to us. They make lives worth living and in my case have given me 27 years of life that I would otherwise have been denied. However, the litany of death, disease and disfigurement attributable to excessive blood sugar is enormous in scale. It is in no small part down to misguided dietary advice and we have a duty to expose it to all who are prepared to listen.
All the best,
fergus
You might bear in mind that the great majority of members on here have had T2 or, in my case, T1 for a great deal longer.
Age may be no guarantee of wisdom, but it does at least allow the time to compare and contrast different approaches to controlling the condition. The benefit of this time has lead a great majority of those on the forum to conclude that the medical profession's approach to diabetes care, particularly with regard to diet, is seriously flawed.
I have yet to read a post on this forum from a diabetic who has tried a low carb diet and not found enormous benefits in blood sugar levels, body weight, control of appetite, blood pressure, blood lipids and sheer bloody liberation from the complications surrounding diabetes.
Perhaps you have yet to try it yourself. In this case, in the interests of scientific objectivity, I'd suggest you see quite what a difference it can make before you jump to the defence of the medical profession.
We are united in our gratitude for the medical advances available to us. They make lives worth living and in my case have given me 27 years of life that I would otherwise have been denied. However, the litany of death, disease and disfigurement attributable to excessive blood sugar is enormous in scale. It is in no small part down to misguided dietary advice and we have a duty to expose it to all who are prepared to listen.
All the best,
fergus
Jenny,
Well, if you had the plumber we employed last year you might think differently. He installed a shower unit for us and I questioned his positioning of it on the shower base as incorrect. He told me I was wrong and it then leaked through the ceiling into our kitchen below. When he was unable to stop the leak, we employed a new plumber who promptly told me the shower base was incorrectly installed and it had to be repositioned... as I'd suggested in the first place.
The point is none of us are infallible. Some, in fact many, health professionals are advising us incorrectly and if we don't stand up and make our voices known, who else will do it for us?
Regards, Chocoholic.
