POSTER PRESENTATION Open Access Good cop, bad cop: challenging patients to make hard decisions about aggressive treatment Katrina Richards From Australasian Podiatry Council Conference 2011 Melbourne, Australia. 26-29 April 2011 This is a case study that focuses on two acute presenta- tions of diabetic foot ulcerations. Both men had a his- tory of previous ulceration and presented to the Emergency Department at Box Hill Hospital with acutely infected weight-bearing foot ulceration caused by blistering. Both men worked in manual occupations and were subsequently weight-bearing for a large part of the day. In both cases a Total Contact Cast was decided to be the most effective means of treatment. Upon dis- charge from hospital, one of the men took a week’s sick leave from him occupation and his ulceration improved rapidly, so much so that he didn’ t require a second week of total contact casting. The wound quickly healed and he has had no further problems to date and has returned to work as usual. The second man was in a Total Contact Cast for one week. On review, the Podia- trist determined that he would benefit from a second week in a TCC. The patient refused this treatment as it was inconvenient to his workplace and he didn’t like the TCC. He was treated with a padded CAM walker. Unfortunately he presented with an acute infection one week later and subsequently required a transmetatarsal amputation. He also had to take several weeks sick leave from his workplace and had to be slowly rehabilitated into the workplace post-amputation. These cases have highlighted the benefits of aggressive treatment when dealing with weight-bearing diabetic foot ulcerations. Quite often as Podiatrists, we don’t want to cause incon- venience to the patient’ s working life, but this may in fact be to the patient’s detriment. Sometimes to provide the best patient centred care, we need to be the ‘ bad cop’ and make unpopular decisions that will offer the best results. Published: 20 May 2011 doi:10.1186/1757-1146-4-S1-P50 Cite this article as: Richards: Good cop, bad cop: challenging patients to make hard decisions about aggressive treatment. Journal of Foot and Ankle Research 2011 4(Suppl 1):P50. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit Correspondence: [email protected] Podiatry Department, Box Hill Hospital, Eastern Health, Australia Richards Journal of Foot and Ankle Research 2011, 4(Suppl 1):P50 http://www.jfootankleres.com/content/4/S1/P50 JOURNAL OF FOOT AND ANKLE RESEARCH © 2011 Richards; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Page 1: Good cop, bad cop: challenging patients to make hard decisions about aggressive treatment

POSTER PRESENTATION Open Access

Good cop, bad cop: challenging patients to makehard decisions about aggressive treatmentKatrina Richards

From Australasian Podiatry Council Conference 2011Melbourne, Australia. 26-29 April 2011

This is a case study that focuses on two acute presenta-tions of diabetic foot ulcerations. Both men had a his-tory of previous ulceration and presented to theEmergency Department at Box Hill Hospital withacutely infected weight-bearing foot ulceration causedby blistering. Both men worked in manual occupationsand were subsequently weight-bearing for a large part ofthe day. In both cases a Total Contact Cast was decidedto be the most effective means of treatment. Upon dis-charge from hospital, one of the men took a week’s sickleave from him occupation and his ulceration improvedrapidly, so much so that he didn’t require a secondweek of total contact casting. The wound quickly healedand he has had no further problems to date and hasreturned to work as usual. The second man was in aTotal Contact Cast for one week. On review, the Podia-trist determined that he would benefit from a secondweek in a TCC. The patient refused this treatment as itwas inconvenient to his workplace and he didn’t like theTCC. He was treated with a padded CAM walker.Unfortunately he presented with an acute infection oneweek later and subsequently required a transmetatarsalamputation. He also had to take several weeks sick leavefrom his workplace and had to be slowly rehabilitatedinto the workplace post-amputation. These cases havehighlighted the benefits of aggressive treatment whendealing with weight-bearing diabetic foot ulcerations.Quite often as Podiatrists, we don’t want to cause incon-venience to the patient’s working life, but this may infact be to the patient’s detriment. Sometimes to providethe best patient centred care, we need to be the ‘badcop’ and make unpopular decisions that will offer thebest results.

Published: 20 May 2011

doi:10.1186/1757-1146-4-S1-P50Cite this article as: Richards: Good cop, bad cop: challenging patientsto make hard decisions about aggressive treatment. Journal of Foot andAnkle Research 2011 4(Suppl 1):P50.

Submit your next manuscript to BioMed Centraland take full advantage of:

• Convenient online submission

• Thorough peer review

• No space constraints or color figure charges

• Immediate publication on acceptance

• Inclusion in PubMed, CAS, Scopus and Google Scholar

• Research which is freely available for redistribution

Submit your manuscript at www.biomedcentral.com/submit

Correspondence: [email protected] Department, Box Hill Hospital, Eastern Health, Australia

Richards Journal of Foot and Ankle Research 2011, 4(Suppl 1):P50http://www.jfootankleres.com/content/4/S1/P50

JOURNAL OF FOOTAND ANKLE RESEARCH

© 2011 Richards; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.

mailto:[email protected]

http://creativecommons.org/licenses/by/2.0