Potential Barriers to Diabetes Care

To examine a potential reason why physicians sometimes fail to adhere to standards of care with which they are in agreement, 103 consecutive patients with diabetes mellitus were interviewed immediately after their doctor's appointment in a general medicine clinic of a city/county hospital. The mean age of the patients was 57 yr and the average duration of diabetes was 9 yr. Sixty percent of these patients had their feet examined. A major factor in determining the physicians' behavior was whether the nurse or aide had the patient remove his shoes and socks before being seen by the physician. Physicians were more than three times as likely to perform foot examinations when patients were presented barefoot than when presented wearing shoes and socks. Rarely in medical and continuing medical education do we consider how clinic routines can influence physicians' behavior in the management of diabetes.