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Emphasizing Patient Education And Motivation In The Treatment Of Patients With Diabetes

In a quiet moment of reflection, I wondered how many patients visits I conducted in my 40-plus year podiatry career. With calculator in hand, I ran the numbers and figured it out. It’s a broad average and the total number could be a few more or a few less, but the number came out to 192,000. 

The formula I used to figure this out was: 20 patients/day x 5 days/week x 4 weeks x 12 months x 40 years. (For those who might want to calculate their professional activities just substitute your personal variables into the formula and see what you get. It may be surprising.) Yes, I do take vacations, attend continuing medical education meetings and have an occasional sick day. Some days, I do see more than 20 patients. So it all averages out. I was very surprised at the result and realized that the numbers will, of course, increase the longer I stay in practice. I am happy with that thought and am now shooting for 200,000!

Then I thought about my experiences in the course of serving my patients’ foot health needs and realized I had helped many of my patients with their sometimes personal or unique general health issues as well. After all, as a podiatrist, my focus is on the health of my patients’ feet and legs but I never forgot that I treat people, not just feet. 

Education is the cornerstone of prevention. Elliott Joslin, MD, the pioneer physician whose focus was in treating people with diabetes, realized his patients needed specialized education to deal appropriately with their condition and prevent complications like foot ulcers and amputations. He conceived and developed the profession of diabetes educators to fill that void. 

The issue of patient education remains as critical as ever due to the increasing numbers of people with diabetes, people with pre-diabetes and the increasing costs of health care. Not all of my patients with diabetes have had the benefit of formal education about their condition. That is often reflected in the pathology I see in their feet. For those who need the education, I take the time to discuss how diabetes affects their foot health. I explain why they suffer with burning or shooting pain in their feet, or why they developed a foot ulcer. We discuss controlling blood glucose levels, diet, exercise, medications and practicing preventive foot health behaviors. I have done this for so many years I now consider myself a PDE or a Podiatric Diabetes Educator.

Some of my patients needed motivation. In my first book, Keep the Legs You Stand On, I wrote a chapter titled “Denial and Resignation: Two Ends of a Grey Rainbow.”1 In this chapter, I reviewed the psychological issues of patients with diabetes and what motivates them toward properly managing their diabetes/foot health versus what keeps them from being successful at doing this. Regardless of which end of the rainbow they were on, many benefitted from some motivation, a jump-start if you will, toward taking better care of themselves. I took the time to share with them the “why,” the “what” and the “how” to properly motivate them to understand benefits of, for example, keeping blood sugars in the normal range, performing certain treatments for their feet and the consequences of not doing the treatment.

Some patients had difficulty managing their diabetes. It is a 24/7/365 experience that can at times overwhelm people. This situation was often reflected by the condition of their foot health. The experience plainly burned them out. They needed emotional support, to know that others care about them and to know there were solutions to their issues. I often took the time to offer insights to their issues and options to deal with them. That may have been a referral to another provider or sometimes simply a kind word of encouragement, a smile or a hug. For some patients, I just needed to be a good listener and that was enough.

Often, the needs of some patients were beyond what I could offer or could do for them. For those patients who I was not able to help, I always felt badly. It was not that I had failed but that I had not succeeded. 

Recently, a patient came to see me and when I entered the treatment room, he met me with a huge grin and said, "Doc, you probably don't remember me, but two years ago when I came to see you about my foot pain, I was very overweight and as part of your care, we discussed that problem. Thank you so much for what you told me about my foot health and my weight, and for your suggestions on how to deal with it. I took what you said to heart and made a commitment to get in better shape." I was delighted to hear of his success. He went on to tell me, "I walk two miles every day, I go the gym and lift weights three times week and do water aerobics twice a week. I changed my diet too. 

“Doc, you probably don't remember that when we last met, I weighed 458 pounds and today I weigh just under 250 pounds thanks to you." At that point, he gave me a hug and I could see a tear in his eye.

Every once in a while, something happens that makes me so glad that I take just a bit of time for my patients, that I go the extra mile for them. When I see that my care has changed someone's life for the better, it makes what I do all worthwhile.

Dr. Hinkes is President and Chief Medical Officer of ePrevenir, Inc. He is board certified by the American Board of Foot and Ankle Surgery and is a Fellow of the American College of Foot and Ankle Surgeons and the American Professional Wound Care Association. He is the author of “Healthy Feet for People With Diabetes” and “Keep the Legs You Stand On,” available at


  1. Hinkes M. Denial and resignation, two ends of a grey rainbow. In: Keep The Legs You Stand On. Mequon, Wis.:Nightengale Press; 2009.
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