Abstract

Mr. Jones is a retired 75-year-old building contractor who lives alone and has had few social contacts since he stopped attending church after his wife died. He is seeing his internist today for treatment of chronic leg pain, diabetes, and hypertension. Noncompliant for months on his diabetes regimen, his HgB A1c is 9.0 with blood sugars running in the 150 to 200 range. Dr. Smith tells Mr. Jones that he is developing peripheral vascular disease in his right foot, which is cool and has undetectable dorsal pedal and posterior tibial pulses. Mr. Jones, in an irritable mood, tells his doctor that he hates the diet he is supposed to be on and is getting fed up with having to take all of his medicines. Dr. Smith notices a faint smell of alcohol on Mr. Jones' breath, and confronts him about it. Mr. Jones denies drinking heavily. Dr. Smith encourages Mr. Jones to take his medication, stay on his diet, avoid alcohol and make an appointment with a vascular surgeon to have his foot and leg examined. He asks Mr. Jones to come back for a return visit in about one month.