We are all aware of the alarming rate at which Diabetes is increasing in our country. Everyday, as we encounter new patients and continue to care for existing ones, we are faced with the realities of this powerful disease. As medical professionals, we diagnose problems and use our Podiatric knowledge to resolve them. However, what we overlook is the need to focus on the factors contributing to complications and what measures could have been taken to prevent them initially.
For example, if a patient presents with an ulceration just under the first metatarsal head, why not look at the patient’s shoes to make sure they are properly fitted to support that individual foot type. While performing the debridement, discuss with the patient, who may or may not be wearing therapeutic shoes, the importance of offloading pressure from areas of the foot which may easily break down. Make fitting the patient into proper shoegear a preventative goal once the ulceration is well healed.
In our office we make sure that every Diabetic patient with “at risk feet” is properly sized and fitted to approved therapeutic shoes and accommodative inserts. We take the time to explain the necessity of wearing shoegear that fits comfortably and supports well. Our patients are made aware of the benefits offered (but not advertised) by most insurance companies on an annual basis. Some are shocked to find out that with each new calendar year they are eligible to receive one pair of Diabetic shoes and three pair of heat molded or custom inserts. If patients ask why they would be entitled to such a benefit, we explain the cost effectiveness of keeping Diabetic feet in good health rather than treating complications after they arise. Subsequently, it costs Medicare less to pay for Diabetic shoes and inserts for every qualifying patient in your practice once a year than it does for the combined cost of just one amputation.
The same holds true for all conditions related to Diabetes. From regular dental checkups to annual eye exams, Diabetic patients need to recognize the importance of preventative care. It is always a good idea to encourage your staff members to ask routine questions as part of their Diabetic evaluations. “When was the last time you tested your blood sugar and what was the reading?”, or “When was your last eye exam?” These are great ways to assure your patients are taking an active role in their preventative care. Physicians should stress to their patients that ALL health care professionals involved in their care and management are equally important in keeping them on the right track.
In order for this idea of prevention rather than treatment to be realized, constant contact must keep with the specialists, primary care physicians, and Diabetic educators in your area. By informing other doctors of the services you are able to provide for their patients and them in turn for yours , you are doing your part to make this effort a success. So get communicating! Attend breakfast meetings at local hospitals for on staff physicians. Send letters informing the local medical community about new technologies you are utilizing in your office to diagnose Diabetes related problems early. Talk to your own dentist or ophthalmologist to find out how far their Diabetic population reaches. Make sure that primary care and vascular physicians are not referring Diabetic patients elsewhere to be fitted for their therapeutic shoes and/or offloading devices. Educate those highly trained professionals around you, who may not be so well educated when it comes to recognizing complications that first present themselves in the feet.
Always take time to listen to your patients and make sure they are listening to you. In caring for their feet, you are examining all of the ways in which Diabetes can affect their overall health. Make sure they understand the importance of choosing a group of doctors who will work together to make prevention of Diabetic related problems their number one goal. Care for your patients feet and care for their well being. Keep them happy and well educated and they will be patients for life; a long healthy one!
by Cindy Pezza