Welcome back to another edition of Mounjaro updates, industry news, alliteration, and my patently impertinent opinions. Each week, I reveal my experiences with GLP-1 receptor agonist therapy for Type 2 diabetes. At age 78, I’ve been at it for almost a year now, with significantly tangible results, namely lowering my HbA1c from 7.4% to 5.3%, de-prescribing metformin, reducing losartan, my blood pressure medication, from 100 mg per day to 25 mg per day, and shedding 65 pounds of body weight. But I digress.
My personal objectives have evolved from weight loss and glucose reduction to maintenance in both those areas. Muscle loss always accompanies rapid weight loss, so I have amped up my resistance training program while increasing the protein and carbs in my dietary intake. Sarcopenia conspires with the weight loss to cause even more muscle atrophy in older adults, inspiring me to redouble my efforts.
My secondary objective is to discontinue Mounjaro before year-end. The fewer drugs I take, the better. Furthermore, Mounjaro ain’t cheap! Despite being covered by insurance, it costs me about $250 per month. I can think of a wide range of better things to buy with that money. However, quitting is a two-edged sword. The peril is a rebound in glucose and body weight, and the key to avoiding both is to continue the stringent lifestyle changes that got me this far.
Oversharing
I try not to bore you completely with my medical details. You’ve got problems of your own, so you don’t need to spend great gobs of time pondering mine. However, my hope remains that you will gather a modicum of useful information from what I write here. Please remember that I’m not a doctor, so I’m not offering medical advice—just recounting personal experiences and delivering irreverent opinions about the sad state of healthcare in the 21st Century. Surely, you will relate to some of it.
Later, on the mundane personal health front, I’ll share my happily boring weekly numbers and my latest lab results, which include a new low in HbA1c. I’ll recap my one-month honey experiment, which might have impacted those labs. But first, it is time to go off on those healthcare software abominations known as patient portals.
(RD, this one’s for you!)
This Week’s Non-Mounjaro Rant—Patient Portal Purgatory
In this week’s issue, we take a cynical look at the ubiquitous medical software backwater called “patient portals.” You’ve encountered them and you share my frustration with them, no doubt. They’re poorly written, they’re clunky, and they have seen little improvement through the decades. Could it be that the industry doesn’t care about effective communication with patients? Ya think?
I’ve been wasting lots of time on multiple patient portals compiling information for my forthcoming doctor change. When I brought up the subject with my wife, she commiserated with me by sharing her own patient portal tales of woe. She hates getting emails telling her she has a message in her patient portal, which is a pain in the ass to navigate. “The word ‘portal’ suggests a connection to The Twilight Zone,” said Jenny. “I can’t get it out of my head.” I’d say she was onto something—an apt characterization of an other-worldly software usability experience.
Who Wrote That Crap?
A friend who has been involved in engineering projects most of his life recently commiserated on the sad state of patient portal software. He is currently dealing with serious health issues requiring coordination of information among multiple providers. However, the poorly designed, antiquated, user unfriendly interfaces of patient portals make them more of an impediment than a useful tool. “You and I have led projects where such garbage interfaces and shoddy work would have been summarily rejected and would have gotten us fired. Are patient portals designed by committees of kids on skateboards, or what? Who is leading them?” My lamely dismissive response was, “The God of Apathy.”
I sure as hell wish the healthcare industry would actually care, but their aim has long been offering token compliance appeasements instead of useful tools. As long as the insurance companies and the federal government are their funding sources, patients will be relegated to their perceived role as necessary evils who happen to carry the key to the insurance reimbursement castle.
Understandably, patients are dissatisfied with the status quo, which suuuuuuuuuuuuuuuucks. Will patient portals ever fulfill their promise or will they top out disappointingly at “not too bad”? Read on and learn how they arrived at their current nadir of usability, then read our proposed solution. As always, your thoughts and comments are welcome!
The Patient Portal Problem: Healthcare’s Missed Digital Revolution
Introduction
Imagine, if you will, a world born from the luminous haze of the dot-com dawn—a world where the phrase “patient portal” was uttered in a health IT conference room with the hopeful naiveté of a new millennium. The name endured, calcifying into bureaucratic scripture, while time marched on. Now, thirty years later, what was once hailed as digital progress stands ossified—a relic of static screens and unmet promises, preserved in the amber glow of compliance. In this other world, you’re a card-carrying patient with no name and no face, just a date of birth and a password. You have now entered the Patient Portal Zone… [fade to black]
How the Portal Got Its Groove (and Lost It Immediately)
The ostensible original vision? Empower patients! Improve outcomes! Communicate with ease! Those goals would be attainable in a normal, customer-driven industry, but that ain’t healthcare! What we got instead was a clunky login screen, two-factor authentication that works 50% of the time, and a messaging system that might as well be a wax-sealed letter delivered on horseback.
In the early 2000s, the idea of a centralized digital interface for patients was radical. So naturally, healthcare vendors borrowed the word “portal” from the corporate world, where it meant a homepage stuffed with useless links. The branding stuck—because “screwed-up nightmare” was already taken.
Once Meaningful Use regulations, crafted during the Obama administration, began incentivizing the mere existence of patient portals, vendors rushed to ship half-baked, checkbox-satisfying garbage. The result? Software designed by committee, deployed by fiat, and maintained by people who hadn’t logged in since Bush v. Gore.
Glossary of Patient Portal Bullshit
- Patient Portal: A secure digital environment designed to prevent patients from easily accessing their data while feigning transparency.
- Secure Message: An email-like function where your doctor’s assistant might reply in 7–10 business days with, “Please call the office.”
- Visit Summary: A PDF download of your last appointment, formatted like it was generated by a dot matrix printer in 1987.
- Lab Results: Clinical test values released at 3:27 a.m. with no context, leading you to either WebMD-induced terror or apathy.
- Appointment Scheduling: A tool that lets you see all the available appointments you can’t actually book without calling.
Why We’re Still Stuck in 1999
- Healthcare’s Lack of Competition: Patients can’t shop around easily, so providers don’t have to care. Welcome to health don’t-care. If our patient portal is as crappy as the practice’s down the street, it’s “good enough.” A decade ago Healthcare IT News published a report stating that providers often regard portals merely as compliance tools rather than opportunities for meaningful patient engagement. Little has changed since then. The patient experience is worse than ever.
- Vendor Lock-In: Major portal vendors Epic and Cerner have contracts so long they require parchment scrolls written in cuneiform along with sworn blood oaths. These companies have no incentive for improvement with clients locked into ten-year deals and firmly entrenched Stockholm Syndrome.
- HIPAA as a Scapegoat: Let’s be clear, mateys—HIPAA isn’t stopping innovation. Banks, brokers, and dating apps all involve web sites that work under strict privacy laws and still manage not to suck. Nevertheless, HIPAA has become a convenient scapegoat for lack of progress on portable electronic records and conveyance of useful patient information in the medical industry.
- Insurer-First Revenue Models: As long as the claims go through and the pre-auths get denied on time, patient satisfaction can be safely ignored. This relegates patients to their true function: witless, soulless transporters of the all-important insurance card.
The Portal Experience: A Dramatic Reenactment
You receive a cryptic email: “You have a new message from your provider.”
You log in, reset your password, get a 2FA text, fail, try again, and finally enter a digital anteroom with no clear navigation. Poking around through several hits and misses, you strike paydirt: the proudly announced, promised message.
It reads: “Your labs are back.”
You click an obscure button labeled “Labs,” and find a PDF titled “Document-20240507-73612-Final-Final.pdf.”
ALT: 87. AST: 98. BUN: LOL. No context, no interpretation, no joy.
The Fix: If Anyone Actually Cared
- Design for Users: Start by not treating patients like adversaries with low digital literacy. Try usability testing that includes actual humans.
- Open APIs and Integration: Let wearables, apps, and smart devices integrate seamlessly. Your CPAP knows more about you than your portal does.
- Provide Real Messaging Tools: Look, if you can’t respond faster than the Pony Express, maybe don’t call it “messaging.” Send us real, informative emails and text messages through secure channels we regularly use, not perfunctorily vacuous announcements promising more vacuous messages, but only after the right sequence of incantations.
- Stop Hiding Behind HIPAA: Build secure systems like every other serious digital industry. Patients want access—not a 1982 game of Adventure with no connection to the world beyond. Plugh!
Conclusion: This XYZZY Portal Needs a Bulldozer
Patient portals were supposed to be the digital front doors to modern healthcare. Instead, they’re those rotating glass traps that make you miss the elevator. Token gestures toward engagement aren’t enough. It’s time to raze the cobwebbed ruins and build something functional, frictionless, and maybe—just maybe—actually patient-friendly.
Until then, the portal is probably useful for renewing your prescriptions, given enough lead time. Otherwise, enjoy your secure message. And don’t forget to call the office. Until your next disastrous visit, you are now leaving The Patient Portal Zone.
AI: The Quick Ticket Out
While we’re dealing with old TV shows, how about a quick trip to Fantasy Island, where all dreams are possible and I can share my vision of a useful patient portal of the future. The price of the ticket to the magical island involves a paradigm shift: the healthcare industry must fully embrace artificial intelligence (AI) to enhance the patient experience while reorienting itself toward serving real human patients instead of its sacred bottom line. Clearly, this can only happen on Fantasy Island, but please share my pipe dream of a useful patient portal of the future.
My Dear Friends… Welcome to Fantasy Island
Using currently available AI technology, the industry could easily accomplish the transformation by effecting the following improvements:
- Enhanced Patient Communication: Current portals typically rely on basic messaging features that leave patients waiting days for responses. Integrating AI-driven chatbots and virtual assistants would offer immediate, 24/7 interaction, dramatically improving response times and patient satisfaction while freeing the human medical staff from the encumbrance of answering routine questions. No more, “Our office is closed for lunch from 12 to 2 and we’re off on Friday. If this is a medical emergency, dial 911. Otherwise, leave a message and we’ll call you back as soon as possible.”
- Improved Lab Results Interpretation: AI could provide instant, personalized explanations of lab results, contextualizing information based on patient history and current health conditions, making complex medical data understandable and actionable. No more uninterpreted, cryptic PDFs.
- Dynamic Visit Notes: Rather than static, often jargon-filled notes, AI-powered tools could translate provider notes into clear summaries, highlighting important follow-up actions, medication instructions, and key insights tailored specifically for each patient. No more inscrutable dot matrix printouts.
- Efficient Appointment Scheduling: AI can revolutionize appointment systems by optimizing scheduling through predictive analytics. AI-driven portals could anticipate patient needs, proactively suggesting timely follow-ups and eliminating wait times caused by traditional back-and-forth communication. No more, “These appointment times are available. Please call us during office hours to book your appointment.”
- Personalized Health Recommendations: AI integration could continuously analyze patient health data from multiple sources, including wearable devices and prior records, providing personalized health recommendations and preventive care advice directly through the patient portal. This could reveal medical issues long before symptoms would impel you to make an appointment three weeks out.
- Administrative Streamlining: By automating routine administrative tasks such as filling forms, updating medical histories, and managing prescription renewals, AI could significantly reduce both patient frustration and provider workload, freeing up more resources for actual patient care. (I’ve watched my doctor increase staff while patient service declines—they’re all asses and elbows, and he doesn’t even take insurance! What the hell are all those people doing?)
Beyond Tokenism
Forward-thinking innovators have an enormous opportunity to redefine healthcare communication. However, achieving this vision requires industry leaders to embrace innovation, invest in user-centric technology, and prioritize meaningful patient engagement.
To realize their potential, patient portals must advance beyond mere tokenism. The healthcare industry must adopt a competitive, consumer-focused mindset, recognizing patients as engaged participants rather than passive insurance carriers.
I remain cynical about our possibilities of ever getting on de plane to Fantasy Island.
The Great Honey Experiment
In my Week 45 Update, I revealed my intent to act as a human guinea pig to test an assertion made by one of those diet/nutritional pseudo-experts on YouTube. Supposedly, slurping down a daily tablespoon of raw, unfiltered honey would not create a blood glucose nightmare, even for a diabetic. At the same time, it was going to lower my blood lipids—particularly triglycerides—by altering my gut microbiota. Wouldn’t it be wonderful if it were true? Eat more honey, fix your triglycerides, normalize your blood sugar, and be sweeter than ever! Yep, I was a doubter.
My obviously non-scientific tablespoon-a-day experiment can neither confirm nor deny the claims, but what I can say is that my HbA1c, which represents about three months of glucose impact, did not reflect the increased carbs and sugar intake. It dropped from 5.4% in February to 5.3%. I can also say that my serum triglyceride number was 108 mg/dL, which is the lowest in recent history. On the other hand, despite my frequent, strenuous workouts, “good” cholesterol (HDL), was down to 46 mg/dL. It was 53 mg/dL in February.
So, what gives? I don’t know. My only conclusion is that an occasional tablespoon of honey won’t kill me—but at this point I’m so sick of that sweet stuff that it won’t ever get the chance!
Other Blood Test Revelations
Aside from the honey angle, my blood test revealed an increasing potassium component, which at 5.7 mmol/L is too high. This mild hyperkalemia could represent muscle breakdown from my strenuous workouts with the added issue of my compromised kidneys. My calculated eGFR was 55, putting me squarely in chronic kidney disease stage 3A. This will bear watching, and I promise not to eat any more bananas.
The good news is that my functional iron deficiency first discovered back in October is a bit less concerning now. After not responding very well to elemental iron (Original Feosol), I switched to carbonyl iron supplementation (Feosol Complete). Since I switched, iron binding capacity and saturation levels have slowly rebounded. None of the numbers were out of range, despite donating a pint of my vintage B-negative on March 30. However, they remain at the low end of their respective scales, which means we’ll need to keep an eye on them.
Now, on to my week.
My Week on Mounjaro
It was another sideways week, which is fine with me. Thurday’s lunch involved a Hawaiian steak and a few bites of Jenny’s key lime pie at Hillstone. Nevertheless, on Friday my weight dipped below 180 pounds. This prompted Jenny to ask me when was the last time I saw numbers in the 170s on the scale. “High school,” I replied. “But I had a lot more muscle back then.” I’m not trying to lose any more weight anytime soon, instead concentrating on getting some of that muscle tissue back. Toward that end, my workouts are doing their job—I set a couple of new one-rep maxes this past week.
The Mounjaro Numbers, Already!
Body Weight: 180.4 lbs (82.5 kg) — down a pound
Fasting glucose: 95 mg/dl (5.3 mmol/L) — down slightly
Average glucose (Stelo biosensor): 106 (5.9 mmol/L) — not bad, not bad.
Concluding Thoughts — Still on Mounjaro (for now)
So here we are at the 50-week mark—three protein-shake-fueled seasons of body recomposition, glucose micromanagement, and screaming into the digital void of patient portals. If there’s a theme this week, it’s this: nothing gets better on its own. Not your muscle mass, not your metabolic health, not your iron deficiency, and sure as hell not the software trying to impersonate your healthcare system. As I close in on one year of Mounjaro, my trajectory remains forward—maybe slower and more nuanced, but still forward. The portal may be broken, but my resolve isn’t.
Over the next two weeks I’ll be busy with doctors while hoping to steer clear of their damn patient portals. First, on Tuesday, I’ll have what will likely be my final follow-up with Dr. DeLorean before shifting to the new primary care doc, Dr. Macallan. I will discuss the hyperkalemia and what I believe to be a developing inguinal hernia, which will need repairs. Next week, I have an appointment with a sports med doctor regarding my knee pain, and later, an appointment with the eye doctor for YAG laser zapping to fix cloudiness in my right eye. Three-and-a-half years after cataract surgery, this is a common sequel. Yea, verily, the remainder of May will require my Tesla’s full attention, so it can seamlessly teleport me from doctor to doctor.
A Good Use for the Patient Portal
Toward the end of the month, I will also need to write a nice letter giving notice to Dr. DeLorean of my intent to discontinue his services. The ten-year relationship impels me to magnanimously avoid summarily dismissing his ass with a characteristically snarky letter. However, I am seriously contemplating sending my even-tempered, professionally acceptable letter to him through his bloody annoying, user unfriendly patient portal. Guaranteed non-response!
See you next week, when maybe, just maybe, we’ll hear back from that secure message we sent in February. [Cue Twilight Zone theme music.]
For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.
