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I spent a large portion of my afternoon yesterday helping two people navigate end of life issues. June, a 93 year old woman presented with her daughter from a local rehabilitation center with an ischemic limb. Although June had been complaining about left foot pain for days, her rehab was for a right hip fracture. Therefore, the focus of care was on the hip fracture. Her referral to our wound center was made by her cardiologist who recognized the signs of critical limb ischemia.

Diabetes is renown as the primary disease that contributes to a loss of sensation in the feet. This loss of sensation is called diabetic peripheral neuropathy, abbreviated DPN. DPN is a symmetrical loss of sensation often described as a stocking/glove distribution, affected the feet and to a lesser degree, the hands. The loss of sensation that results from DPN is greater distal to proximal, meaning that the loss of sensation will typically be worse in the toes.

Conversation is one of the most fundamental tools we use each and every day, to guide us in our lives. We gain and relay knowledge through conversation. We share our life's experiences, whether happy or sad. Simply put, conversation is what guides us through our lives. In medicine, the conversation between a patient and their doctor can be a life changing experience. A good patient will be a good listener and will interact, asking questions to insure they understand the plan for their health care.

When I speak about health care literacy and refer to 'the conversation', what exactly do I mean? The conversation is the discussion that takes place between a health care worker and a patient. A health care worker may be a nurse, a doctor, a receptionist at a doctor's office or a therapist.

When was the last time that you were in the presence of someone who listened? I mean really listened. They looked you in the eye and thought about what you said. They asked you questions. Maybe they even laughed a bit with you. They shared a joke or a personal anecdote from their life that related to the point you were trying to make.