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12/19/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Standard of Care - Neuromas (Michael Rosenblatt, DPM)
From: Donald Brann, DPM
Dr. Rosenblatt wrote, “An interesting example is absolute alcohol injection for neuroma. When I was in practice, cortisone injection, padding, and surgery were the standard of care. That has been replaced now with absolute alcohol injection in various dilutions.”
What scientific study/peer-reviewed literature documents the certain clinical effectiveness of dilute alcohol injections as compared to other modalities for the treatment of intermetatarsal neuromas? This is no more the standard of care for intermetatarsal neuromas than ultrasound-guided injections are for plantar fasciitis. Where is the science? Where are the clinical trials comparing similar groups of patients with different modalities and measuring outcomes? More than one practitioner utilizing a particular modality with some success hardly qualifies as “Standard of Care.”
Donald Brann, DPM, Orland Park, IL, d.brann@comcast.net
Other messages in this thread:
05/28/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Coding Verification Reviews for Custom Fabricated AFOs (Robert Gaynor, DPM)
From: Paul Kesselman, DPM
First, I suggest that in the future, the use of "brand or proprietary name" devices not be used in what should be an educational forum. The manner in which the original letter to the editor was written suggests that instead of attempting to educate our colleagues, it was used as a tool to provide a competitive edge for one product over another. This has resulted in many podiatrists being unduly concerned over their risks of being audited for their current purchasing practices.
Second is that research on this matter reveals that Dr. Gaynor is the owner of DiaFoot and his company advertises a PDAC-approved L1970 device on DiaFoot's website. A disclaimer by Dr. Gaynor...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
05/08/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
From: Robert Bijak, DPM
I will accept criticism but not lies. Dr. Gurvis said that I hate orthotics. I do not want this falsehood attached to my name. I may challenge orthotic theory and/or study protocol, but I have NEVER said I hate orthotics.
As for his claim that I disparagingly call orthotics arch supports, I maintain that IS their main function, and therefore a correct operative definition. If he chooses to euphemize the devices and call them antipronatory decelerators, talonavicular orthtoics, contact lenses for the feet, or whatever to assuage his ego, that's his choice.
Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com
03/19/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Keeping Track of Inventory for Separate Offices (Charles Morelli, DPM)
From: Farshid Nejad, DPM
Traknet EHR offers a robust inventory tracking system with the use of barcodes. You can have a single database that you can access from different offices. It will allow you to set prices and notify you when you are running low on a product.
Farshid Nejad, DPM, Beverly Hills, CA, drnejad@footnankledoc.com
03/16/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: ICD-10 Preparation (Edmond F. Mertzenich, DPM, MBA)
From: Harry Goldsmith, DPM, Michael Rothman, MS, DPM
"What bothers me is that for a coding system that has been used internationally for many years, there are so few sources in this country to get the actual codes, let along information on how to code properly. It seems to me that there are a few proprietary companies out to make a good profit from this doom and gloom."
CMS has for several years now offered not only the complete draft ICD-10-CM database (currently 2012), but also ICD-10-CM guidelines, GEMS (sort of crosswalk), and a whole host of ICD-10-CM information…for free on its site. What you get from commercial products is the same thing in a prettier, more convenient (maybe) package along with expert commentary, pointers, etc.
Go to cms.gov/ICD10/ for a tremendous amount of free information.
NOTE: My previous response listing the estimated costs for implementation of ICD-10 and how those costs are broken down is still relevant. It will be a costly transition for practices.
Harry Goldsmith, DPM, Cerritos, CA, hgfca@verizon.net
Ah, another government conspiracy, just like that foreign metric system thing. Just because every country in the world uses ICD-10 and it's backed by the WHO doesn't mean the good old USA has to.
Michael Rothman, MS, DPM, Skokie, IL, michael.rothman1@gmail.com
02/28/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Overburdened by Paperwork (Howard Fox, DPM)
From: Frank Lattarulo, DPM
I read with interest the response by Dr Fox. I too, like Dr. Fox, would have a brief patient info sheet, then a privacy policy. I would see the patient in the consultation/treatment room also, and do a more complete H&P. I would document these findings in my chart and then dictate my complete and final note. It's pretty efficient and highly effective. However, now that I have made the jump into EMR, I somewhat feel Dr. Borreggine's pain.
Take medications as an example. To meet meaningful use, it's simply not enough to list medications. You must list the complete list of meds taken by the patient, as well as dosage and frequency. In some patients, that can be quite a list. Once these patients return to the office, it's...
Editor's note: Dr. Lattarulo's extended-length letter can be read here.
02/07/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Walk for the Cure...NOT! (Robert Scott Steinberg, DPM)
From: Arthur Gudeon, DPM
I toe-tally agree with Dr. Steinberg. The Komen organization, even though overwhelmingly forced to recant their position, should be ashamed of having bowed to political activists at the expense of women's health in the first place. I'm also aware of the lawsuits they've generated against well-meaning charitable organizations that tried to use the "for the Cure" statement in raising funds for various breast and other cancer research walks.
The Komen Foundation also happens to have a much higher percentage of their donations going for "administrative" costs than many other legitimate charitable organizations, such as the Lustgarten Foundation for Pancreatic Cancer Research, whose administrative costs are FULLY covered by Cable Vision, so ALL donated funds go towards research and development. I've played in a tennis event called Play for Pink for the past few years, with donated funds going to Komen. I'll be asking them to change to Play for Purple from now on, with funds going to Lustgarten or the Pancreatic Cancer Action Network (PanCan.org) !
Disclaimer: I do have a personal interest in the Lustgarten Foundation, as my wife, Susan, has been bravely battling pancreatic cancer for over 1 1/2 years now, and I'd like research to find a way to keep her around for many more years.
Arthur Gudeon, DPM, Rego Park, NY, afootdoc@hotmail.com
01/07/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Bone Mineral Density Testing (Robert Bijak, DPM)
From: Sloan Gordon, DPM
One wonders why insurers and others mock our profession. We can't agree, we don't have standardized EBM, and we chastize each other publicly in listservs such as this one. Bone densitometry using the calcaneus is nothing new. See: onlinelibrary.wiley.com/doi/10.1359/jbmr.1997.12.8.1303/full
I believe that if you see a patient with significant osteopenia in the foot and ankle, the DPM has a right, perhaps even an obligation, to treat his/her findings. In addition there is evidence that biphosphanates (Fosamax, Actonel, Forteo) are useful in treating Charcot joints. I know we use them successfully pre- and post-operatively in our Charcot reconstructions.
I am so tired of reading what we CANNOT do by our colleagues; how about using our complete education and training, and thinking out of the box. I am so tired of our negativity towards one another. We are not one another's enemies. And, yes, if you have a calcaneal bone densitometer, you should get paid for your services.
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net
01/04/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Bone Mineral Density Testing (Joe Agostinelli, DPM)
From: Elliot Udell DPM
Bone density scans generally evaluate the bone density of the hip and spine. Hence, it would seem reasonable that an orthopedic surgeon who owns the machine and takes the test would be reimbursed for taking it, while a podiatrist would not, because the anatomic areas studied are clearly out of scope for podiatry in every state.
When evaluating a radiograph of the foot where osteopenia is noted, not only is it prudent to send a patient to a radiologist for a bone density scan, but it is imperative that we send the patient to a blood lab to evaluate serum vitamin D 25 levels. In our office, a month does not go by where do not pick up a case of a patient presenting pedal bone loss who was unaware that he or she had dangerously low levels of vitamin D.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
01/03/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Bone Mineral Density Testing
From: Joe Agostinelli, DPM
In the orthopaedic practice that I work in, we are fortunate to have many ancillaries, such as MRI, vascular analysis, physical therapy, and bone mineral density testing (DexaScan). All of these ancillaries provide for reimbursement in the state of Florida for DPMs except the bone mineral density exam. My orthopaedic surgeon partners are reimbursed for this.
I know that many of you treat patients who need a bone mineral density examination to assess for healing of bone reconstructive surgeries and to assess risk for fracture. We also see patients with moderate to severe osteopenia as seen...
Editor's note: Dr. Agostinelli's extended-length letter can be read here.
12/24/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Standard of Care - Neuromas (Michael DeBrule, DPM)
From: Peter Bregman, DPM
I think it is important to try to set the standards and treatment guidelines for nerve pathology from a surgeon's standpoint. First, let me state that a neuroma is not a normal nerve by definition. The only way you can call a nerve condition a neuroma in an interspace is if there has been prior surgery that resulted in damage to that nerve that created the neuroma and/or injury to the nerve occurred.
So, in fact, these are nerve entrapments as indicated by Dr. DeBrule and not neuromas and thus should be treated differently. Dr. DeBrule implies that...
Editor's Note: Dr. Bregman's extended-length letter can be read here.
12/21/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Concierge Medical Care on Demand (Eric Edelman, DPM)
From: Robert Kornfeld, DPM
Dr. Edelman's sarcasm regarding concierge medicine is understandable, but in my mind misses the critical point of why concierge medicine exists in the first place. Does shrinking income and increased costs ring a bell? Yes, we are doctors, but anyone who thinks he/she is not running a business that relies on covering expenses and making sufficient profit to make it all worthwhile, is missing the forest for the trees. I applaud doctors whose creative thinking is enabling them to survive and prosper in this extremely challenging medical climate.
Why is it so easy for us to look at a Steve Jobs or a Warren Buffet and marvel at the success and billions, but every time we hear of a doctor who has been able to make an amazing living in spite of all the challenges, we are so quick to criticize. Dr. Edelman, don't kid yourself into thinking that the "system" will come along and fix what is wrong. That simply will not happen. You must be proactive on your own behalf, just as these physicians have been. I think it is a sorry state of affairs when everyone celebrates because Medicare is not going to make any cuts in fees while they ignore the fact that their cooperation with the system allows their "frozen" fees to dwindle in the light of inflation. A freeze is actually a cut. Plain and simple. Nothing to celebrate there.
Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com
12/06/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Who Gets to Cast (Barry Mullen, DPM)
From: Robert Scott Steinberg, DPM
Dr. Mullen makes my case. His assistants can't perform a biomechanical exam, and I say that disqualifies them from making casts, period. His rationalization is that it's okay because it's good practice management. I say it is bad patient care. I have asked him how he bills for his assistants doing the cast. He has avoided revealing that.
If you do not respect the profession, and you feel your office does not have to offer a higher level of care than a patient can get at the pseudo foot doctors out there, then by all means, follow Dr. Mullen's practice management style.
Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com
11/29/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatric "Physician"
From: Robert Bijak, DPM
Nails grate across a chalk board when I read the term "podiatric physician". Not that I don't think we should be, but it's an oxymoron - like dental physician. We can't just add a word and imply an increased scope! I said "imply", not "practice."
Webster's Dictionary defines a physician with 3 subtitles, 1. a medical doctor, 2. a general medical practitoner, as distinguished from a surgeon and 3. (where we may slip in) any person or THING who heals, relieves, or comforts. My point is, denotatively, we can fit in the third definition, so can an aspirin, a prostitute, and a lot of allied health fields. But, connotatively, it is commonly accepted as being an MD/DO or someone who treats the entire body and is not limited in scope.
We have some podiatrists who are naturopathic physicians. They treat the whole body with herbs and nutraceuticals. To me, that's pushing it just like the MDs see us trying to appear more than we are. My real point is, let us stop the euphemisms like physician, limb salvagers, leg surgeons in an effort to retain the limited DPM with the implication that it is more. The profession is "busting" with the desire to increase its scope. Assuaging your own ego by aggrandizing your title fools only you. An MD after your name is all you need. Changing to this should be the one and only thrust of the podiatric politicians. Then you can honestly call yourself a physician.
Robert Bijak,DPM, Clarence Center, NY rbijak@aol.com
11/26/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: The Blood Pressure Discussion (Leonard A. Levy, DPM, MPH)
From: Randall Brower, DPM
I've worked as a partner in two different orthopedic groups and one multi-specialty group. Taking blood pressures has nothing to do with advocating that podiatry is mainstream medicine. Most ortho groups don't take blood pressures. There's nothing medical or mainstream about taking a blood pressure that validates anyone medically. A machine at Walgreens can do one for you.
My previous internal medicine colleagues were frustrated that they had to squeeze in a pre-operative visit for my ankle fusion patient. I can only imagine them having to squeeze in an extra patient who had a high diastolic one time in my office. Taking pressures isn't difficult. Filling out a referral isn't difficult. It doesn't prove anything to our allopathic colleagues. It creates liability. It forces extra work. It frustrates our PCPs. I'm all about decreasing liability. We are specialists. We shouldn't test what we aren't going to treat. Should we all be ordering baseline CBC and CMPs? Where does it end? A high blood pressure, in and of itself, is diagnostic of nothing. A documented recommendation for my patients to seek regular check-ups to their PCPs is all I do as their specialist. If they want a BP, they can go to Walgreens.
Randall Brower, DPM, Avondale, AZ, footdoctor33@yahoo.com
11/25/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: The Blood Pressure Discussion (Leonard A. Levy, DPM, MPH)
From: Sloan Gordon, DPM
I could not agree more with the comments made by Dr. Levy, albeit, it was hard to believe anyone would even raise this question. Thanks to people like Dr. Levy, who have mainstreamed podiatry into the allopathic world and shown our strengths, we should rise to that standard. This is a wake-up call to all of us DPMs who see Wal-Mart, Walgreens, and CVS opening nurse practitioner clinics (trust me, they will all treat ingrown toenails) to threaten our extinction. Let's stick to being physicians and surgeons who practice according to our scope and education.
In Texas, which certainly has its issues, at least many institutions allow us to perform our own H&Ps and admissions. If we are going to do that, we must...
Editor's note: Dr. Gordon's extended-length can be read here.
11/24/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Foot Strike Patterns in Recreational Runners
From: Kevin A. Kirby, DPM
In my posting yesterday, I unfortunately failed to include the full reference for the paper I mentioned on foot strike patterns in recreational and sub-elite runners. Here it is: Larson P., Higgins E., et al.: Foot strike patterns of recreational and sub-elite runners in a long-distance road race. J Sports Sciences, 2011 Nov 18, Epub ahead of print. For those who are interested, here are the percentages and references for only two other scientific studies that have measured the percentages of heel striking, midfoot striking, and forefoot striking runners in road races.
753 runners were analyzed at the 9 km point of 10 km, and the 20 km point of marathon races and were found to be 81% RF strikers, 19% MF strikers & 0% FF strikers (Kerr BA, Beauchamp L., et al.: Footstrike patterns in distance running. In Nigg BM (Ed.), Biomechanical Aspects of Sport Shoes and Playing Surfaces, University Press, Calgary, 1983, pp. 135-142).
283 elite international runners were analyzed at the 9.3 mile mark of a half-marathon and were found to be 74.9% RF strikers, 23.7% MF strikers and 1.4% FF strikers (Hasegawa H, Yamauchi T, Kraemer WJ: Foot strike patterns of runners at the 15-km point during an elite-level half marathon. J Strength Cond Res, 21:888-893, 2007).
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
10/28/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Stay Away from Trimming Toenails (Michael Forman, DPM)
From: Howard J. Lepolstat, DPM
In his comments concerning the trimming of toenails, Dr. Forman references dentistry. The fact is that the entire dental profession is built upon a well established system of referrals to which most, if not all, dentists adhere. Specialists do no general work and generalists do no specialty work. I know there are certain minor exceptions to this (e.g. general dentists doing simple extractions and root canal, etc.). However, for the most part, this work is referred. In exchange, the specialist returns the patient to the referring dentist for the general work needed to complete the treatment.
The entire system is based on the trust that a referred patient will return to the referring office ASAP. I am retired from active practice for quite some time. But, I do remember that this type of referring was not the safest thing to do. Perhaps podiatry has reached the point where this type of system is appropriate. It would require some restructuring of protocols, but the benefits might very well be worth the effort.
Howard J. Lepolstat, DPM, Sun City West, AZ, TeachrComp@aol.com
10/27/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: SuperGroup Formation In Maryland (M. W. Aiken, DPM)
From: Ira M. Baum, DPM
I have experience in developing a “supergroup” in S. Florida. There are no guarantees that the group will be able to negotiate improved re-imbursement rates. From my experience, reimbursement rates are market driven. If there are a limited number of podiatrists in a given geographical area, and your group has almost every podiatrist within that area, then the group may have a chance to negotiate better rates. If you don’t, they won’t.
I don’t want to sound callous, but insurance companies are in business to make profit. Their only obligation is to provide a service, not necessarily the best quality service. If an insurance company can circumvent your group, they will. Unlike essential allopathic and osteopathic medical specialties, our specialty is not perceived as essential and, although we provide a much needed service, the impact of our patients on their carriers to modify their position is minimal.
As an aside, upfront costs of $2K, is not the cost to join a group. Guaranteeing a loan to capitalize the group is the cost of joining a group. The % of operating costs is a different cost. Don’t be discouraged. Without legal collective bargaining, single-specialty groups have been a method for some specialties to improve reimbursements.
Ira M. Baum, DPM, Miami, FL, miamifootandanklecare.com
10/26/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Stay Away from Trimming Toenails (Peter Vannucchi, DPM)
From: Paul Busman DPM, RN
A most elegant and touching testimony to the value of the humble act of toenail cutting is found in the short story "Toenails" by Dr. Richard Selzer in his collection "Letters To A Young Doctor." He's an M.D. but he gets it. I heartily recommend any and all of his books.
Paul Busman DPM, RN, Clifton Park, NY, paul@busmanwhistles.com
One point of significant clarification pointed out by an astute colleague relative to my recent post is the importance of checking state regulatory guidelines regarding the legality of podiatric medical assistants performing "routine foot care" services. These guidelines likely vary from state to state, so please check before delegating those responsibilities to qualified assistants.
10/06/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Is Podiatry Turning Away from Biomechanics? (Jason Kraus)
From: Dennis Shavelson, DPM
Mr. Kraus, I also believe it is better to inspire productive debate than to have only a pedestrian interest in biomechanics. Let’s debate the impact of orthotic labs on podiatry as another reason for biomechanical demise.
1. Why do labs accept “post-to-cast” prescriptions, reducing need for busy DPM’s to hone their biomechanical skills while promoting other professions to “practice” podiatry?
2. Why do orthotic labs accept prescriptions from other professionals whose...
Editor's note: Dr. Shavelson's extended-length letter can be read here.
09/26/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: CPMA's Physician & Surgeon Certication Quest (Devon Glazer, DPM)
From: Ivar E. Roth, DPM, MPH
I sent a check as soon as I received the letter from the CPMA. I encourage every podiatrist in the U.S. to send their financial support for this important legislation that will help podiatrists across the country.
Ivar E. Roth, DPM, MPH, Newport Beach, CA, ifabs@earthlink.net
09/24/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: CPMA's Physician & Surgeon Certication Quest (Ivar Roth, DPM, MPH)
From: Devon Glazer, DPM
I am happy to see that Dr. Ivar Roth sees the value in what CPMA is doing in California. That being said, we do need funding to make this happen. CPMA has started a fund to support this Task Force, and I encourage all to donate what you can, as this will help all DPMs in the nation. Dr. Roth, I look forward to seeing your check and leading the way for all DPMs to contribute to our great future.
Devon Glazer, DPM, Newport Beach, CA, drdev01@yahoo.com
09/22/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Source for In-Shoe Heel Lifts (Meyer Arbit, DPM)
From: Mark Weinstock DPM
I have found Dr. Jill's Foot Pads Inc. (1-866-FOOT PAD) to be the "Go To" place for any type of heel lifts at modest prices. They stock a large variety: Felt, Foam, Cork, Poron, PPT, Red Rubber and even Adjustable Height Heel Lifts. Ask for Jay; he is always extremely helpful and very well-versed on all your padding/strapping needs as well.
Mark Weinstock, DPM Maywood, NJ, drweinstock@afcsnj.com
09/15/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Posting Cases On-Line (Tip Sullivan, DPM)
From: Nat Chotechuang, DPM, Barry Mullen, DPM
Thank you, Dr. Sullivan for pointing out the need to use tact when formulating responses to others' queries. Queries on this particular forum end up in print form, and I have found my own responses from a decade previous during Google searches. The last thing any of us want is to have a patient Google our name and find a query in which a colleague referred to us as "laughable" or "dead wrong." I'm sure some of us have refrained from posting our more challenging patient care problems here due to the risk of being eternally flamed.
Nat Chotechuang, DPM, Bend, OR, natchot@hotmail.com
To set any records that need setting straight, I never slammed "the forum." I have a great deal of respect for PM News and its editor who creates unique opportunities for podiatric idea exchange. My response was specifically directed to those posts regarding the desire for a degree designation change, and my thoughts related to what must take place within the podiatric education process and school and residency curriculum in order for the powers that be to acknowledge our expertise to ratify that degree designation change.
The comments Dr. Sullivan eludes to are just generic examples, exactly why that curriculum needs adjusting! I have no issue with anyone posting an opinion provided they validate their opinion with documented EBM.
But, when a podiatric colleague opines how "they treat" specific conditions that those who do know understand the necessity for multidisciplinary specialist involvement, what that tells me is they have absolutely no clue of the magnitude of what that condition is, nor what is required to resolve it. As such, those individuals are not educationally positioned to render such opinions and become quite dangerous to the general public, especially when they attempt to single handedly try and resolve the problem. CRPS is the perfect example. You don't know what you don't know. If you don't know it, refer. When you don't, you pose the single largest threat to the integrity of our profession's reputation...not to mention raise all of your colleague's malpractice premiums. It's in that light, relative to the degree designation change and our current podiatric medical school and residency curriculum that those comments were made.
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com
09/13/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Professional Attire (Alan Mauser, DPM)
From: Kenneth L. James, DPM, MPA
As an interesting side note to professionalism: Dr. Jeff Schmidt has written that the process of professional training, while it appears to be ideologically neutral, is in fact biased towards those with superior class background and formal education, and more conservative political opinions, who are unlikely to challenge the orthodoxy of the profession. His 2000 book, Disciplined Minds is subtitled "A Critical Look at Salaried Professionals and the Soul-Battering System that Shapes their Lives." Schmidt begins his attack on professionalism by observing that qualified professionals are less creative and diverse in their opinions and habits than non-professionals, which he attributes to the subtle indoctrination and filtering which accompanies the process of professional training. His evidence is both qualitative and quantitative, including professional examinations, industry statistics, and personal accounts of trainees and professionals.
Podiatry is one of my forms, not my substance; it is what I do, not who I am. I would be cautious to not advise being "professional" in all aspects of living as this can easily become pathological behavior. We've all witnessed brilliant and highly "successful" physicians and other professionals whose personal lives are train wrecks. Attempting to apply love for my fellow man, while living in the present moment, has been working for me, and has kept me adaptable, creative, and genuine in my relationships. Practice, as life, has been a journey, not a destination.
Kenneth L. James, DPM, MPA, Fort Worth, TX, docjammin@sbcglobal.net
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