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October 2, 1999

Daily Care

Question from a nurse in Marietta, Georgia, USA:

My 40 year sister has had type 1 diabetes for 37 years. At the time she was diagnosed our local pediatrician worked closely with a nationally-known Clinic concerning management of her care. She has end-stage retinopathy in one eye, paresthesias [uncomfortable feelings] in all extremities, and has recently experienced serum creatinine levels of 2 mg/dl. As a nurse, I want to be sure she is availing herself of the most progressive complication management possible. Her care is coordinated by an internist nearby. She also sees a neurologist, endocrinologist, nephrologist and an ophthalmologist. I referred her to a nearby School of Medicine for a consult, but she was not satisfied with access to the physicians. Do large centers provide consultations to adults like my sister? She has two children, 14 and 6 and so complication management, coordination of care and quality of life are major concerns.

Answer:

Presumably, as in the UK, a patient has a right to a 2nd opinion, and could be referred to an alternative centre. With the patient having multiple problems, the care needs to be carefully coordinated by a competent diabetologist, and be able to involve the appropriate specialists experienced in dealing with diabetic complications. In the UK, if a patient was unhappy with their care, they would be referred for another opinion.

JS