Diabet Foot Treatment Skill #7: Continually Re-Evalaute After Surgery, In Order To Avoid Re-Ulceration, Re-Hospitalization, And Re-Amputation

In these discussions, we discuss each of the 7 essential skills that your diabetic foot treatment must possess. As a better educated person determined to thrive in spite of your diabetes, you’ll be able to evaluate the competency of your treatment team. A competent team will give you the best chance of avoiding a diabetes-related amputation.

Finally we’ll discuss essential skill number seven:

7. Continually re-evalaute after surgery, noting the risk of recurring problems in order to avoid re-ulceration, re-hospitalization, and re-amputation of the diabetic foot.

When you think about all of the things you know about how diabetic foot problems begin, this last skill at your diabetic foot treatment team should possess seems obvious.

But in fact, it is one of the frequently missing pieces. The unfortunate reality is that many doctors are trained to recognize a disease or condition and treat it successfully. Fortunately, many do exactly that. The problem is that modern Western medicine is based on disease cure or "management" and not disease prevention.

Because of this, doctors will often times "heal" a diabetic foot infection and then pat themselves on the back and send the patient on their way. They think they are done. While it is certainly worth applauding the foot doctor for healing a diabetic foot infection, and helping the patient to dodge a bullet so to speak, the patient is still actually in very dangerous territory.

Any patient with a prior history of the ulceration related to diabetes is at very high risk of developing another diabetic foot problem.

If the past episode actually led to an amputation, things are worse. Even if it was just one toe, the patient is at much higher risk of amputation in the future. Statistically, we know that one year after a patient undergoes a diabetic amputation, 26.7% will have another amputation. Three years after a diabetic foot or leg amputation, almost 50% will have another amputation. And five years after a diabetes related amputation, over 60% will have another amputation.

The fact is the odds are not in the favor of the diabetic patient. So diligence is required on the part of both the patient and the diabetic foot treatment team.

Whether it is an amputation of a toe or diabetic foot surgery to remove infected bone, bone spurs, or other deformities, the biomechanics of the foot are altered. The patient may then walk differently. The changes in the way someone walks can increase pressures tom part of the foot and put the patient at risk for developing another open sore.

This is why intensive monitoring after one of these episodes is so essentional.

The unfortunate reality of this however is that many doctors believe that following the patient closely is not within the guidelines of insurance coverage. In essence, they feel that this care will have to be free if they provid it. And in today’s turbulent healthcare environment, most doctors are struggling to see as many pain patients as they can.

The insurance companies have it set up in such a way that if you have diabetic foot surgery, all of your care is included in the surgical fee for 90 days. To the doctor this means that all the care that you need for the next three months is free. This only applies to doctors that Medicare or accept other insurance assignment. They are bound by the contracts that they signed.

For this reason, in most cases, the doctors will tell patients, “Just call my office if you have a problem.” But this usually is not enough. It is much more appropriate for doctors to see their patients at ever increasing intervals following surgery so that they can actually monitor the foot they operated on themselves. This type of intensive monitoring by the foot surgeon is just good medicine.

In my private practice, I would see every surgical patient within one week of the date of surgery. I would then see them one week later and one week after that. And depending on their progress might put them off for two weeks following that. But on average, most patients and had surgery would be seen six to 10 times during the postoperative period. In talking to my colleagues, I discovered that I see patients far more frequently than virtually every other podiatrist I know. But this is just good medicine.

When evaluating your diabetic foot treatment team in order to determine whether or not your doctors are providing the very best care for you, you must look closely at how often they want to see you. They should see you often.

If you have a concern and feel that you need to see your doctor, they should see right away. If you ever hear the phrase “I’m sorry, but your insurance company will not cover that.” You should become concerned.

All doctors take an oath to provide the best treatments and care for their patients. They do not take an oath to only take care of patients if they’re going to get paid well by the insurance companies that they agree to work for. Sometimes doctors just have to do what is right and not just what pays.

As long as your doctors have your best interests at heart, they will take very good care of you and you will get very intensive monitoring. This intensive continued evaluation after a diabetic foot emergency can help you prevent a diabetic foot amputation. As stated before, however it requires a great deal of diligence both from the patient and the diabetic foot doctor and team. But with this care, most diabetic patients will do well.

Diabetes amputations are preventable. Don't just survive...thrive with diabetes!



Dr. Christopher Segler is an award-winning diabetic foot doctor and foot surgeon. He firmly believes diabetic foot problems and related amputations are preventable. It is his mission to share his expertise ad teach strategies that can empower diabetic patients and stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Why don’t you accept insurance?

Before I went to medical school and I would go see a doctor, I always thought that the insurance company was on my side. I would receive an explanation of benefits that showed that my insurance company had gone to bat for me and dramatically decreased the fee that the doctor was “allowed” to charge me. It made me feel as though they were protecting me from the doctor who is out to “overcharge” me.

Having been a foot doctor and surgeon in private practice who did at one time accept insurance, I realized that the insurance company is only interested in protecting their profits. In fact, the CEO of United Insurance company once stated that the insurance company would never attempt to keep doctors on the insurance plans at the expense of their profits.

Some insurance companies contracted rates that they offer as pay to doctors are so low that it is simply impossible to provide good patient care.

I once received a package via FedEx in my office from an insurance company. The delivery person said that I needed to sign for the package in order to receive it. When I opened the package there was a contract modification that dramatically reduced the rate the insurance companies said they would pay me for taking care of their members. Unbelievably, at the end of his contract was a paragraph that stated that by signing for receipt of the package constituted agreement to all of the conditions contained within the contract inside the package. It is absolutely ludicrous to think I would have agreed to rates without ever even opening a package. But these are the games that the insurance companies play.

The insurance company industry representatives have stated that any doctor should be able to see a patient in five to seven minutes. If you’ve ever been to the doctor, this is ridiculous. Now having said that, I have worked in clinics where I saw 60 people a day. I also believe that the patients did not receive quality care.

What I believe is quality care is providing evidence-based medicine as well as thorough explanations and patient education. All of this is necessary in order for a patient to participate in their own care. Providing a prescription for an order for an MRI or just an recommending that someone return in a few months is not really providing care.

Anyone with diabetes or any complicated medical condition deserves to have explanations. They also deserve to have their questions answered. And they certainly deserve more than five to seven minutes.

I have had multiple other doctors contact me and ask me for surgical second opinion on the patient. I have had many cases where these patients clearly needed a procedure that the insurance companies said they would not pay for. Those doctors then asked me what the second-best procedure was. I would supply them with my opinion. In most cases these other doctors would say, will you please come scrub in with me on the procedure that is covered by the insurance company.

In this scenario, my answer was always the same… absolutely not! , I would tell them that if you want to allow an insurance company to tell you to do the wrong procedure just because it cost them less money than you can do it yourself, and I will not participate.

At the end of 2008, I decided that under no circumstances would I allow an insurance company to tell me how long I can spend with the patient. Under no circumstances can insurance company tell me that the cheaper procedure is necessarily better. At least not better for the patient. So I opted out of Medicare and decided to no longer accept any insurance whatsoever.

High quality medical care is expensive. It doesn’t have to be prohibitively expensive, but it does have to provide the best outcome for the patient. Making decisions based only on price is a mistake for the patient. It is also a mistake to the doctor in the long run. A string of bad outcomes (whether because the wrong procedure or wrong medication was chosen) would certainly not be good for any doctors reputation. But when doctors choose to follow the guidelines of the insurance companies rather than their own medical decision-making, this is exactly what happens.

But this is not a problem for me, because I don’t accept insurance. Patient care comes first and cost is second.




Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed plenty of diabetic foot amputations, he firmly believes that diabetic foot amputations result from a continually worsening health care system that the force patients to live with the lowest cost treatments and deprive them of patient education. He does not accept insurance assignments of that he has the time necessary in order to provide the education for his patients that can prevent diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.