My diabetic patient refuses to regulate his blood sugar and.......

[Sho-4]

My diabetic patient came with an abscess.
he's refusing to regulate his blood sugar with insulin but he's suffering a severe pain because of that abscess

I tried to refer him to someone else but he refused that.

What should I do? how do I manage his case? how do I drain his abscess without causing any damage to his health?

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[FanOfCostco]

Sometimes you gotta be firm and not treat. Gotta protect yourself. The money you make from an InD is not worth the complications if anything happens

 

[suarez 7]

Test his blood sugar chairside.
Manage the abscess either with I/D or extraction, and RX antibiotics
IMO, leaving the abscess is going to harm his health more than treating with a weakened immune system and delayed healing.

 

[vellnueve]

Sometimes you gotta be firm and not treat. Gotta protect yourself. The money you make from an InD is not worth the complications if anything happens

Refusing emergency treatment is a great way to build a practice.

Not.

Stab incision, blunt dissect with hemostat, drain, send to OMFS for extraction on Clinda or Augmentin. In doing so you will address the emergency and the medicolegal concerns, while referring appropriately to someone more equipped to handle the definitive treatment.

 

[Munks]

Refusing emergency treatment is a great way to build a practice.

Not.

Stab incision, blunt dissect with hemostat, drain, send to OMFS for extraction on Clinda or Augmentin. In doing so you will address the emergency and the medicolegal concerns, while referring appropriately to someone more equipped to handle the definitive treatment.

Not much of a practice builder to have a patient fall into a diabetic coma or bleed out in your chair either, just puttin it out there.

That being said, if a patient presents with an actual abscess (as opposed to a diffuse cellulitis), that is a dental emergency that you can do at least palliative treatment. I would check bp, chairside test for sugars, I&D, and send to OS for ext.

Above all though, you really do have to be firm if you are uncomfortable with the actual extraction - doctors doing treatment beyond their comfort level for patients they didn't want to treat in the first place is how undesirable outcomes and/or lawsuits happen. Get comfortable rejecting patients - "I just don't feel comfortable treating your needs in my office, let me set you up with a specialist who can". The patient may try to badger you into tx with questions or logic, but there isn't much to say if you just have a bad feeling about it. Another - "your needs are beyond the scope of my ability", again, can't say much about it if you just don't feel comfortable treating beyond your abilities.

 

[vellnueve]

The standard of care in that situation is still to drain and give abx, or immediate referral. That's something that GPs need to be comfortable with.

 

[Munks]

The standard of care in that situation is still to drain and give abx, or immediate referral. That's something that GPs need to be comfortable with.

Oh I definitely agree with you. A dental abscess does constitute a dental emergency and does require tx, whether that's an I&D/abx in the GP office or like you said immediate referral.

My reply was moreso to OP that at minimal some sort of palliative care does need to be done, but that if he does not feel comfortable with a non-cooperative pt to be confident and comfortable referring out and standing his/her ground.

 

[setdoc7]

Did someone really say diabetic coma? Come on. Refusing to regulate blood glucose with insulin? Type 1 must have insulin to live, and Type 2, although often treated with exogenous insulin, has lots of treatment modalities. If your patient has an elevated A1C, then referral to an appropriate physician/endocrinologist would be in order, or at least sent back to primary care with referral. As for the abcess....I agree....treat it. Leaving a patient with IDDM or NIDDM with an infection only makes things worse.

 

[fancymylotus]

My diabetic patient came with an abscess.
he's refusing to regulate his blood sugar with insulin but he's suffering a severe pain because of that abscess

I tried to refer him to someone else but he refused that.

What should I do? how do I manage his case? how do I drain his abscess without causing any damage to his health?

If someone was that resistant to proper care from the start, I would probably give them an rx and refer them ASAP. Sometimes its just not worth it(and I dont mean financially) to get involved.