Particularly impressive is the accuracy with which glycohemoglobin predicts cardiovascular outcomes such as heart attack and stroke in non-diabetics.

Glycohemoglobin is a well-known predictor of vascular events in people with diabetes – but the fact that it is such a powerful predictor of vascular disease and death in non-diabetics is big news.

Many of my patients have slightly high fasting blood sugars on their physical. It’s hard to know what to tell them. Does a blood sugar of 103 mean they are going to get diabetes? Do they need to be on medicine like metformin to lower their sugar?

It looks like glycohemoglobin (which gives an “average” for the blood sugar over a three month period) will be a much more accurate test. We can avoid frightening patients over meaningless random fluctuations in glucose; and we can better identify those in need of real risk factor modification or medicine to lower their blood sugar, before frank diabetes develops.

Mass Medical Society has released this year’s Physician Workforce Survey.  The number of primary care practices accepting new patients has dropped from 58 to 44 percent.  The practice climate for primary care is getting more difficult every year, with the flood of paperwork coming from the insurance companies, the advent of “tiering“, and primary care reimbursement dropping every year while specialty incomes rise.  Most physicians completing residency programs and looking for careers in general medicine are sensibly choosing hospital medicine, where salaries are higher and the hours better.

I am a Democrat.  I supported Barak Obama in his campaign.  I think he’s a good president.  From a citizen standpoint, I think his healthcare plan, if passed, will probably improve health care quality and access at least modestly.  But from a primary care standpoint, I’m disappointed.  None of the various drafts and proposals I’ve seen do a thing to address the crisis in primary care.

If we keep paying enormous sums for invasive procedures, and next to nothing for doctors to listen, think and communicate with patients, then we’ll continue to have an expensive, fragmented, procedure-based healthcare system rather than a humane and rational one focused on patient needs.