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Untruthful & Hurtful Hospital Letters

M

MikeyBikey

Well-Known Member
Relationship to Diabetes
Type 1
The day after I came home I got a copy of a discharge letter from the acute hospital. It included a short sentence "Poorly controlled diabetes"! Today there was a second one from a different consultant that contained "Foot ulcer caused by badly managed DM".. It is a total eff'ing cheek putting those sort of comments in letters when they dictated my insulin dose for food whose carb content I rarely knew. Currently junior doctors have no sympathy from me as many randomly changed my medication without telling me besides coming up with bizarre ruled for insulin. The head of the ward who had chang d in the second claimed to be an endocrinologist but seemed to have little hands on knowledge of Type 1 as many on the ward seemed Type 2 on high carbs! I am beyond LIVID!
 
I am fuming on your behalf Mikey! Seething in fact, so I dread to think how you feel and how high your blood pressure has likely gone reading that letter! It is really beyond belief!

I hope you are able to compose yourself enough to write a letter not so much contesting their findings but putting the blame squarely back in their court since it is their negligent treating of your ulcer over the last 2+ (probably 3) years now which has resulted in it not healing. Your unmanaged levels during your very extensive stay in hospital were entirely down to them since they took your autonomy away.
Sending (((HUGS))).
 
MikeyBikey said:
The day after I came home I got a copy of a discharge letter from the acute hospital. It included a short sentence "Poorly controlled diabetes"
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What’s your a1c? Poorly controlled and well controlled diabetes are factual statements determined by your a1c level
 
I am so shocked Mikey. I agree with Barbara that the inconsistent and irregular treatment and poor dressing changes have made a major impact towards the eventual amputation.
The NHS staff responsible for your care in hospital took away your autonomy to manage your diabetes and insulin injections.
Have you spoken to the consultant who normally oversees your diabetes reviews? I am sure his/her records will reflect the reality.
In your situation I would seriously consider a formal complaint about the whole sorry saga.😡😡
 
MikeyBikey said:
I believe it was 70 on transfer but only had a glance. In recent months fighting infection, and being messed around with antibiotics and diuretics 50 -:55!
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That makes sense then. No judgement from me but well controlled is defined as 48 or below.
 
As I understand it, well managed Type 1 is under 56 or 58. My consultant is very happy indeed for me to achieve low 50s although I am disappointed if I don't achieve sub 50 and I haven't been above that for several years. As Mikey is an amputee I would expect that his target HbA1c will be a bit higher because of the risk of a fall.
 
rebrascora said:
As I understand it, well managed Type 1 is under 56 or 58.
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Do you have any evidence for that? Both NICE, BNF, and Diabetes UK say under 48. Obviously in elderly etc higher is accepted but 48 is the well controlled target.

Diabetes UK: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/hba1c

NICE: https://www.nice.org.uk/guidance/ng17/chapter/Recommendations#support-and-individualised-care

GP Notebook: https://gpnotebook.com/en-GB/pages/diabetes-and-endocrinology/nice-guidance-glucose-control-levels

BNF: https://bnf.nice.org.uk/treatment-s...target glycated,patients with type 1 diabetes.
 
MikeyBikey said:
I got a phone call from the GP practice early. They have got the discharge letter from rehab and wish to discuss it. I will see what they have to say first before any letters or complaints.
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Good call @MikeyBikey . See what another set of pros think and go from there. If you do make a complaint, make sure your MP gets a copy.
 
Lucyr said:
Do you have any evidence for that? Both NICE, BNF, and Diabetes UK say under 48. Obviously in elderly etc higher is accepted but 48 is the well controlled target
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Yes, it’s a target. A target is something you aim for, but not necessarily what you are able to achieve. I think it’s significant that in the same chapter on targets, in the NICE guidelines (1.6.6 - 1.6.9) it also states that HCPs should collect data on patients who achieve 53 or lower.
 
Lucyr said:
That makes sense then. No judgement from me but well controlled is defined as 48 or below.
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I'm astonished your
Tom1982 said:
Is there some sort of Ombudsman service for this kind of thing? We had a bit of drama at the consultant meeting last week that I’m not happy with either.
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As far as Ombudsmen are concerned they will only look at/hear issues where all other avenues to resolve have been exhausted. So that mean a requirement to raise concerns locally first.
 
Lucyr said:
Do you have any evidence for that? Both NICE, BNF, and Diabetes UK say under 48. Obviously in elderly etc higher is accepted but 48 is the well controlled target.

Diabetes UK: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/hba1c

NICE: https://www.nice.org.uk/guidance/ng17/chapter/Recommendations#support-and-individualised-care

GP Notebook: https://gpnotebook.com/en-GB/pages/diabetes-and-endocrinology/nice-guidance-glucose-control-levels

BNF: https://bnf.nice.org.uk/treatment-summaries/type-1-diabetes/#:~:text=Aim for a target glycated,patients with type 1 diabetes.
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I'm reading targets of 48 are the ideal, but that targets should be individual.

I find it a bit of a stretch that only anyone (as in T1) living with an HbA1c in the diabetes diagnostic range would be considered as having poorly controlled diabetes.
 
AndBreathe said:
I'm reading targets of 48 are the ideal, but that targets should be individual.

I find it a bit of a stretch that only anyone (as in T1) living with an HbA1c in the diabetes diagnostic range would be considered as having poorly controlled diabetes.
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That might be your opinion but diabetes uk website uses the word high to describe anything above the target of 48, and the AI overview also says well controlled is under 48 (know that AI can be ropey sometimes but I’ve given multiple links evidencing that well controlled is under 48)

I’m not criticising anyone here, my own a1c is above that, I’m simply saying that “poorly controlled” and “well controlled” are just terms describing your a1c relative to the target and not personal judgments
 

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I think that figure I am thinking of be it 56 or 58 may be something to do with pump qualification, in that if you are under 58 your diabetes management is too good to warrant a pump, so surely that can hardly be considered poorly controlled.
I agree with others that a target is something to aim for but it should be an individually agreed target not an arbitrary figure and not achieving it certainly doesn't mean your diabetes is poorly managed.
 
Even though I am suggesting 58 may be considered well managed that doesn't mean 59 is poorly managed.
 
rebrascora said:
I think that figure I am thinking of be it 56 or 58 may be something to do with pump qualification, in that if you are under 58 your diabetes management is too good to warrant a pump, so surely that can hardly be considered poorly controlled.
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That’s a financial rollout strategy decision I expect
 
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