Have this person attend diabetes support groups at the local hospital to obtain When you develop “Diabetes Education” forms for your practice, leave room on the …
Dealing With Diabetic Patients
By William N McCann, DPM
and Richard S Levin, DPM
10 Maple Street, Suite 301
Middleton, MA 01949
978-646-9091 978-646-9092 fax office@aappmorg
wwwaappmorg
Dealing With Diabetic Patients
Diabetic patients often present with the most challenging podiatric
conditions and can give us the greatest satisfaction when treated
successfully As podiatric physicians, we realize that diabetic patients
require an extra degree of care when being treated Too often we neglect to
realize that this extra degree of care should extend beyond the podiatrist
but must include every member of the office staff
Our office has adopted the policy that diabetic patients are VIPs very
important patients Every member of my staff understands the importance of
responding rapidly to requests, from diabetic patients, for information, to
speak to the doctor or to make an appointment All diabetic patient charts
are yellow in color This
differentiates them from non diabetic patients
without placing alert stickers on the outside of the chart denoting their
diabetic status Two appointments each day are left unfilled, one in the
morning and one in the afternoon, for the staff to be able to place a
diabetic patient, who calls the office that day, into the schedule,
without disrupting the normal flow of the schedule If those appointments
go unfilled, it allows the office time to catch up if we fall behind
Every diabetic patient is told that they have access to these VIP
appointments and they are directed to call the office immediately if they
have a problem or question This leaves little excuse for those at risk
patients to not be able to see me on a timely basis
Diabetic patient education is a hallmark to preventing future pedal related
complications of diabetes Appoint one of your podiatric medical assistant
to be your in office Podiatric Diabetes Educator This then affords the
rest of your staff one source of information regarding issues of care and
education of your diabetic patients Have this podiatric assistant read all
pertinent articles regarding diabetes and foot care Review these articles
with your
assistant on a frequent basis Have this person attend diabetes
support groups at the local hospital to obtain additional information that
can be incorporated into the office diabetes education form given to
diabetic patients When you develop Diabetes Education forms for your
practice, leave room on the bottom of the form for patients to sign,
acknowledging they received and understand the information, leave a space
for a witness your staff to counter sign Place a copy of this form in
the patients medical record and hand the original to the patient Its a
good idea to print these forms in a large font 12-14pt as many of these
patients have concurrent opthalmic problems associated with diabetes
Write letters to the physician who is caring for your diabetic patients
after their initial visit, citing your pertinent findings and plan of care,
whether they were referred to you by that physician or not First, this
keeps the lines of communication open for all care givers of the patient
Secondly, its good marketing for your practice Keep these letters short
and to the point Busy physicians do not want to sit and read a novel, they
just want to be informed as to the podiatric care of their
patient Do not
forget to write a follow up note to the physician at the successful course
of treatment of the patient This informs the primary physician that you
were able to identify a problem and treat it successfully If a diabetic
patient presents to your office, after being treated by another podiatrist
or other care giver, request the previous medical record of that patient
This is not meant to inflame the previously treating physician or
podiatrist, but it allows you to formulate a proper plan of care, without
duplicating previously unsuccessful treatment options It will also give
you a larger vignette of the patients overall condition then you could
possibly glean from your initial evaluation ie Has the patient been
compliant with past treatments? Has the patient continually failed to make
their follow up appointments? If the diabetic patient does not have a
primary care physician or other physician treating their diabetes, offer to
make them an appointment with a local physician of their choice, if they
have no choice offer them a local physician that you have worked with in
the past It is always medical legally prudent to offer the name of a Board
Certified physician, in
their field, to treat them Have your staff
actually make the appointment on behalf of the patient at the time of their
visit to your office If the patient refuses to make an appointment with a
physician to treat their diabetes you should consider releasing the patient
from your care
Also it is important, from a compliance standpoint, to have available in
your office, over the counter products that your diabetic patients can
benefit from Items such as shower bags, diabetic skin moisturizers,
diabetic socks and extra depth toe box shoes with accommodative insoles can
all be effective adjuncts to the care of the diabetic podiatric patient
Review the pages of the podiatric magazines for products that your diabetic
patients can utilize Diabetic socks, which are made from combinations of
natural and man made fibers, without toe seams, are available in many sizes
and colors These items are hard for the patients to find on their own and
are the foundation of good preventative diabetic foot care The Medicare
diabetic shoe program, administered through Durable Medical Equipment
Regional Carriers DMERC, allows each qualified Medicare diabetic patient,
a pair of extra depth toe box shoes with
three pairs of dual density
accommodative insoles each calendar year The diabetic shoe companies have
evolved their programs to be easily incorporated into your practice, with
minimal overhead and no need to carry any stock of shoes in your office
The benefit of the podiatric foot care specialist suggesting and ensuring
proper fit of foot wear to the diabetic patient is immeasurable Many
pharmaceutical companies have diabetic skin moisturizers available without
prescription, which can be offered in your office to your diabetic
patients These are important skin preparations to be used to help keep
skin well hydrated and less susceptible to shearing forces and callous
formation
Many wound care products, used in the treatment of diabetic ulcers are
reimbursable through DMERC as well Find two or three products to utilize
on these wounds and learn their properties and actions Over time, you will
become more and more familiar with the actions of these products and you
will be able to observe predictable events in the healing process If these
events are not occurring it would be important to reassess the wound and
any underlying factors, such as circulation, undiagnosed infection
and
increased weight bearing of the area can be addressed In our office we
utilize Polymem foam dressings for our diabetic ulcers Through continued
use of this product, I have become aware of what a typical healing response
to these bandages should be in clinical appearance of the wound and overall
healing time of the wound I have also found that I no longer need Home
Health agencies to provide at home wound care for these patients, as the
bandage is in a Band-aid form factor, easily applied by the patient, and
there is no need for any cleansing or soaking between PolyMem bandage
applications by the patient There are also Durable Medical Equipment
devices, that can be used as adjunct therapy to local wound care, to aid in
off loading plantar wound sites Off loading products form Bledsoe, Aircast
and DeRoyal are all reimbursable through DMERC with proper coding and
medical documentation I suggest you try each of the products and determine
which is the best clinical fit for your practice
Keep your diabetic patients informed regarding recent advancements in the
treatment of their condition or any new services or treatments you are
offering This can be done through the use of a
newsletter from your
office You can ask local experts in the treatment of diabetes to prepare
guest columns to appear in your newsletter This can include
endocrinologists, dermatologists, diabetes educators and
nutritionist/dieticians We have found that question and answer sections to
be most informative for the patients These questions can be solicited from
those that receive the newsletter or from recurring questions you answer in
the office Place a schedule of local hospital diabetes support group
meetings in the body of the newsletter and suggest that your patients
attend the most convenient time and location for them One item we always
place in the newsletter, to reinforce the importance of our interaction
with the patient, is a banner asking the patient to call our office with
any questions or suspected problems they may have immediately Many of our
patients state that they look forward to each and every issue we mail out
to them In the past we have run small contests, of varying types, with
prizes which include our over the counter foot care products that we offer
in the office Our most recent contest was for a recipe for the best
tasting sugar-free cheese cake We had over
twenty responses, and my wife,
a local nutritionist and I baked and judged each and every one, until a
winner was crowned We now offer that recipe in our waiting room and cant
keep enough copies available
In summary, the care of the podiatric diabetic patient extends beyond the
doctor patient relationship A coordinated team approach amongst
podiatrist, staff and the patient themselves must be employed to assure
satisfactory podiatric clinical results
William N McCann, DPM
President and Fellow of the American Academy of Podiatric Practice
Management and Editor of the AAPPM News He is a Fellow of the American
College of Foot and Ankle Surgeons and is Board Certified by the American
Board of Podiatric Surgery He practices in Concord, New Hampshire and can
be contacted at wmccann@aappmorg
Richard S Levin, DPM deceased
Board Certified in Foot Ankle Surgery by the American Board of Podiatric
Surgery He was a Board Certified Wound Specialist by the American Academy
of Wound Management, Fellow, American College of Foot Ankle Orthopedics
and Medicine, Residency Director, JFK Medical Center, Atlantis, Florida,
Treasurer, Florida Podiatric Medical Association, Member, Board
of
Trustees, American Academy of Podiatric Practice Management, noted expert
on DME, In-Office Dispensing and practice enhancement, Author and
International lecturer
