PIG Meeting: 18th March 2021

55 year old male for ACDF for neck and arm pain.

Background

• Hypertension
• Type 2 Diabetes Mellitus – recent HbA1c 10.7%. Patient variably compliant with insulin therapy

Issues

• HbA1c discussed with surgeons. Agreed to defer OT for 3 months to allow optimization. Noted that patient did not have myopathy with urgent indication for surgery.
• Patient abusive on phone when told. Hung up phone multiple times on nursing and medical staff in clinic.
• Patient also threatening GP clinic for sharing HbA1c data with Perioperative staff.

Discussion

• Difficult situation.
• Patient in denial about significance of chronic disease.
• Emphasised the importance of decision made in consultation with surgical team. There may be surgical indications to perform surgery in patients not ideally optimized from the diabetic control.
• The use of a guideline written in consultation with Endocrinologists provides support for clinical decision making.

Plan

• Discussion with patient liaison officer. Requested their assistance with management of patients complaints and concerns.