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Case study: A patient does not attend a hospital clinic. What would you do?

What would you do?
Richard is a 43-year-old man who has had type 2 diabetes for 11 years. He is married with two young teenage boys. He is a project engineer and divides his time between his home in the UK and North America. You rarely see him in the surgery.

You receive a letter from the consultant he was attending in the local district general hospital to say that he is discharging Richard from his diabetes clinic as he has not attended on three ocasions in spite of appointments being sent out. As part of this letter the consultant sends you the last clinic details from 18 months previous (see Box 1).

At that clinic he had seen the dietitian and been supplied with a 1500kcal diet and his foot and eye examinations had been normal. His medications are shown in Box 2.

You recall seeing Richard 2 years ago for a medical and he disclosed that he had difficulty keeping appointments, he was under stress with a very large project, and he particularly wanted to avoid hypoglycaemia when traveling.

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