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Comment & Response
September 2018

Toenail Examination Reveals Unmet Care Needs

Author Affiliations
  • 1Adult Primary Care, Highland Hospital, Oakland, California
JAMA Intern Med. 2018;178(9):1283. doi:10.1001/jamainternmed.2018.4288

To the Editor One week after the publication of an article by Orkaby and Schwartz1 on toenails as the functional hemoglobin A1c, I saw a clinic patient who had been doing well at our previous visits. She was in her 80s but had only a few chronic conditions, including type 2 diabetes, that were well controlled with oral medications only. She continued to live in her own home in the community; her grandson had moved in with her several years ago after he lost his job and fell on hard times. The arrangement worked well for both of them. She was happy to keep an eye on him—previously he had been involved with a “rough crowd,” as she put it, and having him close meant that she felt he was avoiding his previous risky activities. He helped her around the house with chores, but she still remained largely functionally independent and managed her own medications.

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