[polyfractal]

Agreeing here. My SO is a medical practitioner, and some of the stories I hear are just crazy. Folks who can't sleep and come in wanting meds, but after digging into their history you find they are drinking four liters of soda, two extra-large (and extra-sugary) lattes, and a pack of cigarettes every day. And on their phone until 11pm.

The more I hear about healthcare from the inside, the more I realize it's a game of "work on the worst problem, ignore the rest". There's limited time in patient visits, and patients have limited motivation, so you really have to prioritize what to fix. If you tell the patient to fix all the things, the will fix none of them.

Worse, patient education is hard work. Patients don't listen, ignore advice, stop lifestyle changes as soon as it gets hard. So you focus on one or two of the worst offenders; you convince them cigs are going to put them in an early grave and they should cut back to half a pack a day. Maybe drop the soda to two liters a day. The rest of their problems you have to ignore until later. That's often when meds come into play because they can help bridge the gap while you work on their lifestyle issues.

Oh, and all of that happens in 15 minute visits every other month.

There are certainly bad doctors out there over-prescribing all sorts of things, but from what I've seen, it's more a matter of prioritizing what to spend your precious 15 minutes on and going from there. Doctors and other medical professionals are in an impossible situation most of the time.

Edit: for clarity, this is an American healthcare perspective.

[jazoom]

Amazingly, despite the fact that good diet and exercise are by far the best things you can do to treat type 2 diabetes, it's actually in the guidelines in Australia to commence metformin from the beginning. The reason being that studies have shown that the number of patients who actually do make long-term changes to their diet and exercise routines is excruciatingly small. So small, that it's best just to assume they won't actually do it, so just commence metformin (while still giving the advice, of course). At least this way the 95% (I dunno what the actual number is) of patients who won't change will be getting some BSL reduction in the meantime.

[magicnubs]

Also because metformin (last I heard) is considered exceedingly safe and almost universally beneficial--so much so that some recommend prescribing it to everyone over a certain age.