Providers with longer experience are said to have implemented more components of TTT. I suspect they used the ‘evil physician gestalt”. This article has lots of holes. My problem with TTT is we have lousy measurement tools. The DAM are helpful but have a lot of variability with wide coefficients of variation in the non-laboratory components. We do not have a hemoglobin A-1-C for RA. Our measurement are not that good. We have Biomarkers like MBDA (or VECTRDA) which is a chemical thermometer and is helpful also but even MBDA is not as pinpoint as Hgb A-1- C, but I like it and use it. All of these DAM make me think about the whole patient but they alone are not enough and thus TTT is tunnel vision. We need more data, synovitis, osteitis, cardiovascular, other comorbidities etc. to make our decision tree. We need physician gestalt. Remember even when TTT indicates a change in therapy is needed how do we choose the therapy? – WE USE PHYSICIAN GESTALT! None of these measurements include one of the most important impediments to patient care the “Insurance, Pharmacy Benefit Manager Complex”. This like the military Industrial complex rules the my response was cut off:
Providers with longer experience are said to have implemented more components of TTT. I suspect they used the ‘evil physician gestalt”. This article has lots of holes. My problem with TTT is we have lousy measurement tools. The DAM are helpful but have a lot of variability with wide coefficients of variation in the non-laboratory components. We do not have a hemoglobin A-1-C for RA. Our measurement are not that good. We have Biomarkers like MBDA (or VECTRDA) which is a chemical thermometer and is helpful also but even MBDA is not as pinpoint as Hgb A-1- C, but I like it and use it. All of these DAM make me think about the whole patient but they alone are not enough and thus TTT is tunnel vision. We need more data, synovitis, osteitis, cardiovascular, other comorbidities etc. to make our decision tree. We need physician gestalt. Remember even when TTT indicates a change in therapy is needed how do we choose the therapy? – WE USE PHYSICIAN GESTALT! None of these measurements include one of the most important impediments to patient care the “Insurance, Pharmacy Benefit Manager Complex”. This like the military Industrial complex rules the my response was cut off: