September 10, 1997

Clinical Crossroads Update: A 65-Year-Old Man With Poorly Controlled Type 2 Diabetes Mellitus-Reply

Author Affiliations

Beth Israel Deaconess Medical Center Boston, Mass

JAMA. 1997;278(10):821. doi:10.1001/jama.1997.03550100047032

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In Reply.  —We asked Dr S, the patient's primary care physician, to reply:Dr S: Dr Saudek expresses important concerns, which I share. My follow-up notes on the patient were intended to be descriptive; they were not intended to imply any complacency on my part or on the patient's. He is at risk for serious complications, and he is fully aware of that risk, although I would respectfully suggest that Saudek's 27-story-fall metaphor is a bit hyperbolic since we cannot predict with any degree of certainty which, if any, complications he will develop.This patient is an educated man who has on his own explored the medical literature, has been evaluated by an ophthalmologist and a neurologist, has been treated by a respected vascular surgeon, and has willingly participated in an open discussion with our distinguished consultant, Dr Rubenstein. While he appreciates that all these members of his health care team are