Care stops at
the clinic door.

If it mattered, they would come back.

Nearly three in ten podiatry patients never return after a first visit. Nobody tells the clinic they have stopped.

The advice was clear when she left.

Most of what is said in an appointment is reconstructed later, at home, from memory, without the clinician there.

We gave her a leaflet.

A leaflet cannot tell you whether it was read, understood, or acted on. Nothing comes back.

An amputation is the end of a disease.

Up to eighty-five per cent of diabetes-related amputations are avoidable. The path to one runs for months.

The wound healed, so the episode is over.

Around four in ten healed diabetic foot ulcers return within a year of healing.

The boot works because it takes the pressure off.

Removable boots offload as well as casts do. Casts heal better because they cannot be taken off.

Reminders fix missed appointments.

Clinic software has sent reminders for years. Across seven hundred clinics, automation moved rebooking by under three points.

Better software keeps patients.

In the same seven hundred clinics, price, rating and technology showed almost no relationship with whether a patient returned.

The diary is full.

Average diary use runs at seventy-two per cent, while a quarter of owners believe they are full ninety per cent of the time.

Patients do the exercises they are given.

Only about a third follow a home programme fully. Most who stop do so within the first month.

She will ring if something changes.

People wait. The foot examined at the next appointment has been deteriorating since the last one.

The clinician knows how it is going.

Between appointments there is no information at all. The record restarts at the next visit.

Notes are for the clinician.

The patient receives nothing from the record that shaped their own treatment.

They can look it up.

A search engine does not know her diagnosis, her medication, or what her clinician decided last week.

The system has continuity.

Care is a run of appointments with nothing joining them. Each visit starts again from the beginning.

Private clinics have solved this.

Private clinics run the same open loop, and pay for it in patients who quietly stop booking.

It is only a missed appointment.

A missed review on a diabetic foot is not a gap in the diary. It is a limb.

Longer appointments would fix it.

The appointment is an hour at most. The outcome is decided in the other hundred and sixty-seven.

She understood the plan.

Understanding something in the room and remembering it on Tuesday morning are different things.

Clinics know their lapse rate.

Almost none measure it. The patients who stop coming never appear in the figures.

Health literacy is the patient's problem.

Comprehension depends on how information is given, far more than on who is receiving it.

Someone is watching the gap.

No one is. That is the whole problem.