Complexity in dizziness
The patient scheduled an appointment to address concerns about dizziness. During the pre-consultation review, our Quality Outcomes Framework (QOF) team highlighted the necessity for an albumin-to-creatinine ratio test. It was also noted that the patient was overdue for a cognitive assessment, his last blood sugar level was poorly managed at 83, he had not received his pneumococcal vaccination, and his blood pressure was uncontrolled, with a reading of 150/71.
During our last encounter in August 2023, his HbA1c level was significantly elevated at 89. His medical history includes diabetes, gout, hyperlipidemia, diabetic retinopathy, depression, urinary frequency, and erectile dysfunction. In this visit, he expressed concerns about discoloration on his foot and heel, as well as dry mouth potentially linked to his medications. Additionally, discoloration was observed on his shin.
Despite discussing the importance of vaccinations, the patient was hesitant about receiving the pneumococcal, influenza, and COVID-19 vaccines, without providing specific reasons for his refusal. A comprehensive examination of his leg issues revealed heel cracking and concerns for diabetic neuropathy and related foot complications. Despite the absence of recent podiatry consultations, an emollient was prescribed to manage his symptoms. The shin discoloration, suspected to be either chronic venous insufficiency or diabetic dermopathy, was reviewed online with the patient, leading to a consensus on the latter diagnosis, which required no specific treatment. The patient was content with this outcome.
A recommendation for a repeat blood test, including a urine albumin-to-creatinine ratio (ACR), was made. A cognitive function test was conducted, and a review of his medication, which was overdue, was performed. I advised the patient to complete the blood and urine tests before addressing his remaining concerns.
Regrettably, the consultation was delayed by 20 minutes, affecting the waiting times for other patients. Following the session, I dedicated time to document these findings for educational purposes.
In another aspect of his care, the patient had previously discussed an ear issue. Numerous alerts regarding his cough, potential dementia, and anticipated care plans were noted. His last interaction was with a care coordinator concerning his living conditions, yet no clear plan was discernible despite multiple alerts and messages directed to the patient. My last consultation with him in July 2023 revealed noticeable memory issues, underscoring the need for a comprehensive approach to his multifaceted health concerns.