12/21/2023    Rod Tomczak, DPM, MD, EdD

Are We Failing our Diabetic Patients? (Allen Jacobs, DPM

For most of the 1970s, I was either a podiatry
student in Ohio or a resident in Philadelphia.
There was a television advertisement for a
financial company called E.F. Hutton where a broker
spoke to a client who was sitting next to him in a
filled Yankee Stadium. As the broker talked
investments to his client, the stadium suddenly
went silent and the narrator simply said, “When E.
F. Hutton talks, people listen.” The information
the broker was giving his client was so important
it could silence Yankee Stadium. The concept was an
admitted hyperbole, but clever, nonetheless.

I was lucky enough to have had both Allen Jacobs,
one of my trainers and Jim Ganley speak to me, and
I listened. Both educators spoke to the “why” of
facts being transferred from teacher to students in
such a way that the “why” could be answered at
least three times. Parents know the frustration of
trying to answer a child’s fourth “why.”

So, 1. “Why is it important to aggressively care
for diabetics?” “If not done, they will go on to
amputation.” 2. “Why does that happen?” “Decreased
circulation and infection.” 3. “Why is their
circulation decreased and they get infected?” “It’s
a complicated multi-system disease that is allowed
to get out of hand?” 4. “Why does it get out of
hand?” “Well, that is a tough question to answer,
and I really don’t know the answer.”

Dr. Jacobs adeptly answers that meta-analysis with
examples of, “The deep pockets don’t care.”
Unfortunately, the supplies needed to care for
diabetics and prevent amputations aren’t free even
though we don’t deny diabetics our time, knowledge,
and skill. That can be easy. Convincing the
insurance companies and the government to pay for
the supplies is more difficult. Trying to get
these providers to understand the fourth “why “is
often met with a short-sighted dismissive response
that ultimately results in the costlier serial
amputations, prosthetics, hospitalizations and even
death.

I remember patients telling me and a room of
podiatry students, “My mother had diabetes and she
ended up with both legs amputated before she died,
and I know it’s going to happen to me.” “Why do you
think that?” we ask the patient. Patients will
never understand the answer to the “why” is because
we don’t have the materials necessary to prevent
the amputations and we just acquiesce to deep
pockets obfuscating as to why there is not money.
At some point we as podiatrists must realize that
ethically we ought to be beneficent and fight for
the diabetic rather than merely non-maleficent “Do
no harm.” care givers. “Why?” Because we are
physicians. And when we talk about diabetics,
people should listen.

Rod Tomczak, DPM, MD, EdD, Columbus, OH

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