High-risk diabetic patients are those with a significantly increased likelihood of developing complications such as foot ulcers, infections, or amputations if not closely monitored and managed. These patients may present with:

• Neuropathy
• Peripheral artery disease
• Foot deformities
• History of ulcers or amputation
• Multiple co-morbidities that complicate podiatric treatment

Managing these patients is one of the most liability-sensitive areas of podiatry. It’s essential to provide comprehensive care to improve outcomes and reduce professional liability risk.

Early Identification Is Key
It is important to identify high-risk diabetic patients early. Screen diabetic patients at every visit for neuropathy, vascular insufficiency, foot deformities, and skin integrity. Promptly address any abnormal or worsening findings. Work closely with the patient’s other healthcare providers to provide coordinated, multidisciplinary care. Make sure your staff is trained to identify and report the signs of high-risk diabetic patients.

Educate and Empower Patients
Provide patients with clear education on:

• Self-inspection of feet
• Proper footwear
• When and what to report without delay

When treating ulcers, infections, or other conditions:

• Offer both verbal and written instructions
• Confirm patient understanding and agreement with the treatment plan
• Encourage a support person (family member or caregiver) to attend visits to reinforce instructions

Build a Strong Referral Network
Maintain relationships with vascular surgeons, endocrinologists, infectious disease specialists, wound care specialists, and orthotists so that you can easily refer a patient when needed. Do not hesitate to obtain a second opinion or to refer the patient for further evaluation and testing if the patient is not progressing as expected or if the patient presents with an urgent condition that needs to be addressed and treated to prevent complications. Not only can referrals improve patient outcomes, but it may also reduce your liability risk in the event of a lawsuit.

Document Thoroughly and Thoughtfully
A major risk reduction technique is maintaining appropriate documentation. The patient’s medical record should contain a clear picture of the patient’s journey through your care from start to finish. What was the patient’s condition on the first visit? What did you do for the patient? What was your rationale for treatment, testing, referral, etc.? Did the patient’s condition improve or worsen during follow-up visits? Was the patient and/or family involved with their treatment? What was the patient’s condition on the last visit?

It is also important to document the patient’s informed consent for treatment. A high-risk diabetic patient may have additional risks associated with treatment or procedures and they need to understand their treatment options and the risks and benefits of each option. Document all patient/family/caregiver education and instructions. Document instances of patient non-compliance with treatment and your attempts to collaborate with the patient to develop a plan of treatment the patient can adhere to.

Stay Current with Evidence-Based Guidelines
Ensure your screening and treatment practices align with the latest evidence-based guidelines for diabetic care. Staying informed helps you deliver the highest standard of care and further protects against liability.

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Disclaimer: The information contained on the PICA Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. In the event any of the information presented conflicts with the terms and conditions of any policy of insurance offered by ProAssurance Insurance Company of America, the terms and conditions of the actual policy will apply. All information contained on the blog is subject to change.