First and foremost, I document everything I discuss. This may make for a longer and more expensive dictation, but so be it. I'd rather pay for dictation than lose a lawsuit.

With this aside, my overall philosophy is "doctor as educator." I feel it's my responsibility to educate patients on all the options they have and allow them to make the final decision. As the "expert" in their problem, I provide a somewhat unbiased source of information to help them make their decision. Just as the President of the United States doesn't make a decision to go to war without the aid of "experts," so can't my patients make a choice to undertake surgical correction of their foot problem without knowledgeable support.

You may argue there are some instances where a patient has no choice, such as infection. I would disagree. A patient may choose not to treat a limb or life threatening infection—and die in the process. That is their choice, albeit a foolish one. But it's their choice nonetheless. It would be your job as physician educator to inform them of the dire consequences of their action.

What methods do I use, then, to convince my patients? Statistics work well.  I've mentioned previously that I like to use stats on my diabetic patients. Nothing puts the risk of diabetes in perspective than telling a patient, "If your ulcer becomes infected and you have a major limb amputation, then you have a 50% chance of being dead in 3 years."

I also try to bring family into the process. If I want to be sure a patient is compliant, I'll enlist the help of family. They'll always tell me if their family member has been noncompliant. They also provide daily pressure on their loved one, which is usually more effective than my intermittent visits.

Referrals to other physicians provide an outside uninvolved opinion that will assist your patients in the decision process. Be sure, though, the other doctor understands the situation and your proposed treatment.

Finally, a picture really is worth a thousand words. Show your neuropathic ulcer patient a few of your past wound patients and some BKA pictures and they'll be more likely to comply. Be careful, though, not to give an unrealistic impression on what to expect, especially with your elective surgical patients. Will they be happy with a slight hallux valgus postoperatively if you've shown them pictures of ram-rod-straight toes?

My goal, then, is to provide the patient the information necessary to convince him or herself that I'm right. I know, it sounds a bit arrogant and manipulative. Maybe I am. Perhaps others think differently. Each of us has an opinion on the "best" way to treat something. Interestingly, that "best" way is usually our own way. What do you think? Persuasion or manipulation? What other persuasive methods do you use? Let's start a conversation. Best wishes.

By the way, PRESENT Diabetes went live this week with its NEW VERSION and it's quite AMAZING. They really have brought Facebook and LinkedIn networking to diabetes care professionals. After you fill out a brief profile, they show you all of the other members with training, interests and experiences similar to your own, and one-click LINKs you to them. You'll have a very useful professional network in no time, and it's not only podiatrists. They already have over 57,000 physician, nursing, dietitian members. Try it by going to https://presentdiabetes.com and make sure you add me to your colleague list!