The aftermath of amputation advice to healthcare professionals

When catastrophes happen and patients lose a leg because of diabetic foot complications, then a storm of strong emotions, including fear and anger, is often aroused in the patient and his relatives. They may seek a scapegoat— someone to blame for the amputation—as if apportioning guilt makes them feel safer because they can then deny that a similar disaster could happen to the remaining leg. Unfortunately, it is often the last person who saw or treated the foot who is blamed for the catastrophe, and the sins they are accused of may be sins of commission or sins of omission.

When patients die after an amputation, their grieving relatives may similarly look for someone to blame. If patients and practitioners do not know each other well and treatments are not explained, problems of communication are more likely to develop.

Because diabetic feet can go wrong with alarming rapidity and the triggering factors may not always be clear, practitioners are very vulnerable to criticism. We recommend the following precautions:

• Wherever possible, practitioners should not attempt to treat high-risk diabetic foot patients in isolation

• Full and careful record keeping is mandatory

• When things are going badly, patients and their families should be forewarned.

Podiatrists are particularly vulnerable to false accusations because they often work alone and patients may not understand their scope of practice. Reasons for callus removal, cutting back nails and ulcer debridement should be explained clearly. Unproven therapies should be approached with caution.

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