spearheaded by the International Diabetes Federation and the World Health The campaign slogan is “Fight Obesity Prevent Diabetes” …
Caring for People With Diabetes
By Barbara Aung, DPM
10 Maple Street, Suite 301
Middleton, MA 01949
978-646-9091 978-646-9092 fax office@aappmorg
wwwaappmorg
Care-ing for People With Diabetes
17 million Americans have diabetes and as podiatric physicians we play a
significant role in maintaining the foot health of people with diabetes
Current statistics state that 125-150,000 amputations are performed per
year, on people with diabetes 30 day perioperative mortality rate on a
BKA is 58 and AKA is 8-12 with an overall 40-50 mortality rate at 18-24
months Amputations therefore are NOT benign Quality of life researchers
are finding that people with diabetes feel that having diabetes with the
risk of amputation is worse than cancer
When people with diabetes come into our offices for care, they may be at
their most vulnerable; especially when they enter the clinic with a wound
on their foot We as clinicians need to step back a little, before
making
judgments about non compliance, or a non caring attitude that some patients
first present to us
Patients are often scared of what may lie ahead for them People with
diabetes have been told how easy it is for them to loose their foot, or leg
if they were to get an ulcer or get an ingrown nail with infection This
is told to them in diabetes education classes, this is often reinforced by
stories they hear from neighbors or family members They also dont know
you, the new doctor they were sent to see The patient may have been
referred to you by their PCP who knows your reputation in limb salvage, but
the patient does not know this Your patient also may have been seeing
another podiatrist who doesnt practice limb salvage and thus far has not
been able to treat the wound to closure They need to be reassured of not
just your knowledge but your compassion and empathy toward their medical
condition and your acknowledgement of their concerns about the possibility
life changing outcomes This is your time to make an impact in the life
of a person who needs to trust someone with their limb and possibly their
life
A great teacher in podiatry, Dr Larry Harkless, reminds residents
and
students to sit at the bedside of the patient and listen to the patients
story This is sound advice for the practice of good medicine, as well as
practice management Perhaps this patient was labeled with the dreaded
NON COMPLIANT stamp by other practitioners, but experience and now
research is showing us that many patients dont comply with treatment plans
that they may not understand If you dont tell the patient that non
weight bearing means not putting weight on their feet at any time and why
this is important to healing, they wont be able to comply with your
instructions Taking the time to listen to the patients needs, and to
explain the gravity of the situation, not making any promises to outcome,
but promising to work the hardest youve ever worked in attempting to
salvage the limb, you gain patient loyalty and cooperation When patients
start telling you about their personal E-D problems, you have achieved
ultimate trust Educating patients about their medical conditions empowers
the patient Once patients are given the tools to help in the management
of their care, compliance increases, fear of the unknown is no longer a
barrier to improved outcome
Education cannot be
accomplished in one visit Set periodic visits for a
comprehensive foot exam Using evidence based medicine, implementing the
UTHSA classification system of overall risk for developing complications
can be a helpful tool Teaching the patient whether their risk level is 0
or 3 can be a useful tool in prevention Instruct patients to use this
risk level when reporting a problem and that youve trained your staff on
these risk levels to schedule urgent appointments, this empowers the
patient and impresses the patient that you take their disease seriously
and they will not be put off by staff as they will be seen the same day
they call Using this strategy is a marketing as well as a patient
management tool to ensure that our patients with diabetes and foot
complications are provided with the most appropriate and timely care The
pre scheduled visits are opportunities to discuss with patients about foot
related complications or to take preventive measures such as prescribing
extra depth shoes with the proper insoles
Podiatrists can take an active role as a member of the diabetes management
team by asking when patients with diabetes have had their dilated eye exam,
their dental exams,
and attendance of a diabetes education class If
patients have not had these essential services performed, help patients by
scheduling these exams for them or referring them to other specialists
This not only allows the patient to get the care they need, but allows you
to market your services to other clinicians
People with diabetes have lives A 45 year old man with a deep abscess who
may be facing an amputation, his concerns focus on how he will support his
2 sons if he can no longer work How will he pay his bills? These concerns
increase the anxiety, let alone the toll the disease process itself puts on
the person is sometimes too much to bear Depression rates are very high
among people with diabetes regardless of co morbidities present We can
play a more impactful role as podiatric physicians, when we take the time
to know our patients and yes even get involved in helping them with some of
lifes minor irritants such as dealing with insurance plans, or arranging
social services, and or referring our patient to a psychologist
Barbara J Aung, DPM
Private Practice in Tucson Arizona; Member of the American Academy of
Podiatric Practice Management; Diplomate, American Board of
Podiatric
Orthopedics and Primary Podiatric Medicine; CDC-NIH: Pharmacy, Podiatry,
Optometry, Dentistry- Workgroup Member; Chair of the Community Linkages
Committee- Arizona Diabetes Initiative; Immediate Past Chair of the Arizona
Diabetes Prevention and Control Program
Source:caymanchamber.ky
