Everytime I see patients with long standing, non-healing foot ulcers due to their poor sugar control, I get furious.
Am I mean? Should I be emphatic?
Most of the time, these patients (and their family members) are either ignorant or stubborn, or both. I am not referring to those of below average socioeconomic class. These are fairly educated and financially doing-OK patient.
One of them was a known diabetic for over 10 years. Decided to default treatment and follow up and self-monitor his blood sugar level at home (wonder if he knows what's the normal range and what he does to deranged levels). Eventually, complications kicked in.
He started with an infected toe, progressed to a foot ulcer. Went doctor shopping at various private hospitals. Consulted many doctors yet none of the doctors advice was taken seriously. Refused for toe amputation. Ended up with sepsis due to a gangrenous lower limb and got admitted to where I work.
An emergency above-knee amputation had to be performed. Yet, the infection wasn't controlled. Wound healing was poor. He was counselled for hip disarticulation.
I can understand if patients are saddened over losing their limbs. He and his wife refused for the surgery.
What surprised an upset me was, the wife started telling us that they had been to private hospitals (while it was only an infected toe) and the doctors gave the option of trial of antibiotics if they don't want any surgeries. So she thinks the private doctors' opinion is more valid and we should follow. And she took out some herbal lotion and insist on us doing dressing for her husband's amputated stump with it.
Another gentleman. Also a diabetic with Multiple hospital admissions due to an extensive infected sole. Despite spiking fever and pus pouring out from the almost-eaten up sole, he and his wife do not want any amputation. They only want dressing to be done.
Not only that, the wife wants us to write a referral letter to a particular private hospital to get his dressing (only) done there but still wants patient to be admitted in this hospital where you get free food and don't even have to pay a cent. Hey! What's wrong with the dressing that we do for you? Do they think that we provide substandard treatment?
Why oh why are they so ignorant? Why don't they see the gravity of the problem?
So, who is to be blamed for the ignorance?
Lack of disease education?
Counselling and more counselling.
Reinforce again and again.
I still believe education is the key - education which targets the community based on their mental acceptance.
* Note: we are no butchers. We treat. We don't intend to chop of limbs.