Saying ‘No’ To Patients With Diabetes
The preceding lists the three most common situations in which we tell our patients with diabetes no but the list is certainly not representative of all situations. We also tell patients with diabetes no when our podiatric surgical interventions will not lead to an appreciable increase in functional outcome and/or when there is little potential for healing in cases of critical limb ischemia for examples. We wish that we could tell you we always stick to our guns but the fact of the matter is that we all will at least occasionally take unnecessary risks with our surgical recommendations.
In regard to diabetic foot surgery, although we may try to make the best recommendations for our patients and we may try to educate them as specifically as possible with respect to the potential risks and complications, there are certainly times when it is easier to “yes” and more difficult to say “no.” We need to be stronger in those situations instead of looking to assign responsibility to the patient.
It is a physician’s duty to provide patients with the best possible outcomes and there are many situations when this may involve knowing when to say “no.” Elective surgery is just that: elective. In contrast to certain trauma and infections, we can schedule elective surgery when the patient has been optimized for the best surgical outcome or even not at all. This is particularly true with patients with diabetes and it is all of our responsibility to continue to define and learn the risks inherent to this disease process.
Dr. Pirozzi is a fourth-year Chief Resident with the Temple University Hospital Podiatric Surgical Residency Program at Temple University Hospital in Philadelphia.
Dr. Meyr is an Associate Professor in the Department of Podiatric Surgery at the Temple University School of Podiatric Medicine in Philadelphia.