Risky feet, risk litigation
, . Litigation and the diabetic foot. Pages 19–23
Maureen Bates Podiatrist*, * Diabetic Foot Clinic, Kings College Hospital, London
Patients with diabetes and foot problems are cared for by podiatrists both in primary care and hospital foot clinics. This group of patients, more than any other under the care of podiatrists, is the most at risk of major and minor amputation, and podiatrists who treat diabetic foot patients may be at risk of litigation.
In the UK, foot care for diabetic patients is often regarded by patients and other health care professionals as a trivial part of overall patient care, and very little emphasis is placed on the importance of good foot care. Standards vary considerably throughout the UK. In some areas there is immediate access to a multidisciplinary team for all diabetic foot patients in trouble, either by self-referral or via a health care professional. However, in other areas there is no such easy access. Immediate access for the ulcerated foot to a multidisciplinary foot team is essential for timely and preventive treatment, followed up by long-term shared care from both community and acute trusts.
National Service Framework and National Institute for Clinical Excellence guidelines have been set up to help prevent amputations, but how many primary and acute trusts are using these guidelines? Are the resources required for good foot services available? Or is it still to be a postcode lottery? Implementation of foot care guidelines by trusts is essential, and it is tragic if it is necessary for podiatrists and trusts to be sued before proper guidelines are enforced.
The paper by Bending and Foster also brings into question the problem of patient empowerment. In both the cases described, patients were advised to visit their GP but chose not to do so. In Case 2 the patient also thought the foot problem was too trivial for a long wait in casualty. If the patient in Case 1 had been given a definite podiatry follow-up appointment his amputation may have been less likely, as his attitude towards his foot problem could have been altered by further advice and education. When patients have profound neuropathy and ischaemia they often do not see the need for podiatry or admission to hospital. To combat this all patients and health care professionals should be persuaded to take foot care seriously, and podiatrists should aim to develop more trusting and collaborative relationships with their patients.
