06/14/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Vision 2015, Vision 20/20 (Ed Davis, DPM)
From: Samuel S. Mendicino, DPM
I read all of the posts regarding post-graduate training and it makes me chuckle. I just attended a conference, and at a roundtable discussion I heard many senior DPMs complain that “today’s graduates can’t even trim a toenail, diagnose a wart, or even strap a foot.”
Then I move to the next table and I hear how our students are all mainstreaming with allopathic/osteopathic students, and they should be taking the USMLE exams. Move one table over, and a group of residency directors who have high volume surgical programs are complaining that there isn’t enough time to teach all facets of surgery in the combined models; and what do you do with the resident who has poor surgical skills? At the next table, I see directors who teach at excellent medical facilities with phenomenal wound care clinics, and biomechanics experts complain about having to find all of these rearfoot and ankle reconstructions to meet MAVs.
The problem is what it has been for decades: we can not define who we are and...
Editor's note: Dr. Mendicino's extended-length letter can be read here.
05/10/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)
From: Jeffrey Conforti, DPM
There are three options for this issue.
1) Have enough bits on hand for the day's patients and sterilize them at the end of the day.
2) Sterilize bits between patients with a bead sterilizer.
3) Use individual sanding disks that are disposable.
In our office, we use a new sanding disk for each patient. The patient sees a new disk put on, and when we are done, sees us throw it in the trash. They are very efficient to use and come in different grades: X-coarse, coarse, medium, and fine; they work well on callus and nails.
Jeffrey Conforti, DPM, Paramus, NJ, jconfortiusa@yahoo.com
05/08/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)
From: Paul Clint Jones, DPM
I have seen a lot of arguments in both directions on the pros and cons of nail grinding, but the original dilemma was Dr. Kittay being formally reprimanded by his state board for using a grinder in his office without having officially sterilized the bits between each and every patient. The real concern I see here is a state board moving forward into a territory that I have yet to see any formal EBM on either side. What is the standard? What should be the standard, and who gets to decide? Is there evidence upon which to base the decision?
Either way, surely there is more to this than a state board deciding that they did not like something someone was doing. Or maybe they wanted to make an example out of someone. Precedence is a major issue here. Where is the standard? If it is such a horrible thing that Dr. Kittay has done, why do all the salons do it, all over this nation? If it is such a horrible thing, is there a published standard? Who is the next doctor to go down for a standard that does not exist? Are we giving birth to the next legal tort? Maybe we should be grownup professionals and establish the standard by being the leaders, we, as podiatric physicians, are supposed to be in footcare.
Paul Clint Jones, DPM, Spokane, WA, drwring@gmail.com
05/05/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3B
RE: Recent Research Confirms Therapeutic Effect of Foot Orthoses for Anterior Knee Pain (Jeffrey Root)
From: Dennis Shavelson, DPM
Mr. Root: The fact that “Kevin Kirby is one of the most knowledgeable people in the world when it comes to research related to foot orthotic therapy” makes his evidentiary suggestions powerful here on PM News. I was not questioning "the methodology of the study” as you suggest; rather I was questioning Dr. Kirby’s exaggerations when calling it “recent and significant.” As one who follows the biomechanical literature and Dr. Kirby’s suggestions closely, I cannot count on one hand recent additions to the biomechanical literature that have direct clinical EBM application or that prove or disprove any current theory of biomechanics, thereby making them significant.
To that end, Kevin, can you name and list 4-5 recent, significant high-level articles that either have clinical validity or applicability as per “The Levels of EBM”, or ones that prove or disprove any of the modern theories of biomechanics?
Dennis Shavelson, DPM, NY, NY, drsha@foothelpers.com
05/05/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3A
RE: Recent Research Confirms Therapeutic Effect of Foot Orthoses for Anterior Knee Pain (Robert Bijak, DPM)
From: David E. Gurvis, DPM
As Dr. Bijak states, we should never accept a poorly designed study as fact; however, Dr. Bijak fails to see any difference between a poorly designed study and one with either preliminary results, or results limited by the study design itself. There is a difference. But since, as he has stated numerous times in PM News, he hates orthotics, and as a matter-of-fact refers to them disparagingly as arch supports, I dare say there is not study sufficiently appropriate to his criteria that we would believe unless it proved orthotics did no good at all. Any study at all showing this result would please him and be accepted.
David E. Gurvis, DPM, Avon IN, deg1@comcast.net
03/23/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Socks with Malleolar Padding? (Tip Sullivan, DPM)
From: Josh White, DPM
The Bauerfeind MalleoTrain is a knitted ankle support, which incorporates an anatomically-contoured silicone insert around each ankle bone. The lightweight, breathable knit will not retain heat and is completely machine washable.
Josh White, DPM, CPed, Safestep, joshwhite@ssafestep.net
03/22/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: ABPS Name Change (M. W. Aiken, DPM)
From: Brian Gale, DPM
I support the change in name of ABPS to ABFAS. I think this will be helpful for our surgical specialty and identity. My practice has experienced some noteworthy situations here in North Dakota regarding professional recognition for foot and ankle surgery by a doctor of podiatric medicine. There has been difficult interference by local orthopedists that has been practically impossible to overcome. Proper recognition of who we are and what we do by the name change seems logical and important.
The hospital does not really recognize us as...
Editor's note: Dr. Gale's extended-length letter can be read here.
03/19/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3B
RE: ICD-10 Preparation (Joseph Borreggine, DPM)
From: H. David Gottlieb, DPM, Jack Sasiene, DPM
First, some history. The ICD-10 [International Classification of Diseases, v.10] is developed by the World Health Organization [and can be downloaded directly from their website at who.int/classifications/icd/en/.] It has nothing to do with the U.S. government or insurance companies. It is the standard international ‘language’ of medicine and allows for standardization of medical research and epidemiology. The rest of the world has essentially already adopted ICD-10.
The first ICD was developed in the late 1800’s. From the WHO website you will find “ICD-10 was endorsed by...
Editor's Note: Dr. Gottliebs' extended-length letter can be read here.
I am happy to see some doctors writing in about what is going on with Medicare/Medicaid and private insurance. The last postings have quoted $80K for implementation, training costs, putting aside anywhere from 6-12 months of overhead expenses per the expert from UHC and the TPMA president. That's only about $2,631 per month extra you need to start setting aside per every $100K of overhead per year over the next 19 months until Oct 2013. But let's not forget Dr. Brody's statement here on PM News regarding Phase 2 of meaningful use on 3-5-12: "You need to have a fully DICOM- compliant digital x-ray system."
I think I'll just take my money and invest it in healthcare with all the cash they will be holding on claims they just can't seem to process ...without penalty I'm sure. The real concern is that...
Editor's note: Dr. Sasiene's extended-length letter can be read here.
03/19/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3A
RE: ICD-10 Preparation (Carl Ganio, DPM)
From: Harry Goldsmith, DPM, David J. Freedman, DPM
"I have become aware over the years that the ICD codes are owned by the AMA, not HHS." - Carl Ganio, DPM
The ICD-9 and ICD-10 are not owned by the AMA. ICD-10 is owned by the World Health Organization (WHO). The National Center for Health Statistics (NCHS) is responsible for coordination of all official disease classification activities (use, interpretation, and periodic revision) in the United States related to the ICD. NCHS is part of the Centers for Disease Control and Prevention which is part of the Department of Health and Human Services.
Harry Goldsmith, DPM, Cerritos, CA, hgfca@verizon.net
ICD (International Classification of Diseases) coding is owned by the WHO (World Health Organization). In the United States, patient diagnosis codes for the ICD10-CM and ICD9 CM are developed and administrated by the CDC (Centers for Disease Control) based in Hyattsville, MD. ICD10 PCS and ICD9 PCS are developed and administrated by CMS (Centers of Medicare and Medicaid) based in Baltimore, MD.
The AMA does not own the ICD, they may publish textbooks and sell them, but they only own CPT. The AMA makes their money off of selling the CPT codes in all forms of media only and interestingly, without CPT, the AMA would probably not exist. We should be promoting the federal government to use both ICD PCS and CM, and then CPT and AMA would have no value in coding of medicine for procedures. This would lead to the downfall of the AMA, but no one is pushing this agenda. In the hospital system, they have to use ICD PCS and ICD CM, so why not the rest of U.S. medicine?
David J. Freedman, DPM, Silver Spring, MD, DJFREEDMAN@aol.com
03/16/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3B
RE: ABPS Name Change (Craig Breslauer, DPM)
From: Andrew I. Levy, DPM
We have always moved forward as a profession and a society. Without those who moved boldly forward before us, we who practice now would not be able to be where we are today. It is therefore incumbent upon us to move forward as a profession and as a society.
Andrew I. Levy, DPM, Jupiter, FL, rcpilot48@gmail.com
The ABPS name change to ABFAS represents exactly that—only a name change as it was presented. One would expect that the ABPS would deal with the required paperwork to place the name change in effect but only if we, the membership, desire for this to happen. We have been discussing such a change for several years and are finally on the brink of seeing it come to fruition.
The name change is by no means meant to be exclusionary and would not change in any way the individual state’s scope of practice or privileging for hospitals. On the contrary, it could help states struggling with these efforts by ...
Editor's Note: Dr. Cohen's extended-length letter can be read here.
03/14/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: ICD-10 Preparation (Joseph Borreggine, DPM)
From: Chris Orlando, DPM
I'd like to know who is behind the ICD-10 movement and how we can stop it....Now. It seems to me that it is the insurance carriers and CMS who are waging a beautifully orchestrated campaign to avoid paying claims and punishing "evil" doctors and hospitals. Why is the medical community accepting this? What are all the alphabet groups (AMA, APMA, etc.) that represent the medical community doing? It seems to me that our leadership is okay with this, the same way politicians are okay with $5 a gallon for gasoline. What about us? Why can't we just say NO? The excuse that the new codes will be more accurate is hogwash and propaganda.
Chris Orlando, DPM, Hartsdale, NY, cao252@aol.com
03/12/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: ICD-10 Preparation (Arthur Lukoff, DPM)
From: Dennis Shavelson, DPM
I agree with Dr. Lukoff that smaller providers will not and should not have to carry that kind of financial burden and put up with that type of payment delay. However, I disagree with his gloom and doom prediction that that will mean adios to personalized medicine. Practitioners who are not insurance-bound will thrive. Practitioners that do not let their treatments be dictated by insurance coverage will need guards at their doors.
Interventional DPMs who offer narrative, experiential diagnosis, and treatment that include prevention, performance enhancement, and quality of life upgrading of all medical professions will form the core of a new alternative to patient care I call “Patient-Based Medicine.” I have and will continue to prepare myself for that time. Any of you wish to join?
Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com
03/07/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: The Technological Imperative: A Warning (Allen Jacobs, DPM)
From: Michael M. Rosenblatt, DPM
When I was in podiatry school, one of our professors, Dr. Vinocur, an allergist teaching us pharmacology, was known for his common-sense approach to many issues. He advised us against using new drugs or drugs that had not been thoroughly tested, especially those that were not commonly used in our area of practice.
His sage advice: “Let others shoulder the risk of new drugs and medical technologies. You have enough to worry about.” The “others” he was referring to might be university-based, medical school-backed programs that have their own built-in legal protections and attorneys on retainer. He further advised us to use only medications that...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here.
02/28/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From: Karen Malley Banks, DPM
I have been a podiatrist for 20 plus years and wear many hats. I go by the following: Christian, wife, mother, Facebook fanatic, encourager, etc. I am sure there are some that I don’t want to admit to. My point is this. Be who you are and love the moment you’re in. It will show. Your business will prosper. I don’t care when someone calls me a foot doctor, toenail clipper, chick with a foot fetish, etc. I think it is funny, and laugh all the way to the bank. I perform surgery, but try to talk folks out of the ones that are more painful than they are worth.
There is a wonderful life out there worth enjoying. Do your version of the foot job thing and go home and play with your kids. Hug your spouse. We have a wonderful profession that is something I am proud to be a part of... but it is WHAT I do.. not WHO I am. When you adapt an attitude of gratitude, it will show. Take the time to look at the pictures of your patients’ grandkids. Tell them they are cute even when they are ugly as dirt. Be kind to the old folks who take forever to get up and down the halls. You will be old soon enough. Join a civic group you like, not just one that would bring you good business. You have a life to live. Live it well.
Karen Malley Banks, DPM, Thomasville, GA, kmbwwjd@rose.net
02/27/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From: Jeanne Arnold, DPM
Ah, you say tomato, I say "tomoto"; he's a podiatric physician and surgeon; she's a podiatrist. The fact remains that we all practice the same profession. Respect among our medical colleagues and patients is earned, not bestowed by a title. Regardless of what you call yourself, if you practice honestly, ethically, and to the best of your ability, you will find yourself treated well in the general medical community, and your services will be sought after by patients. And remember, it's not just podiatry that is dying; the entire medical profession is along for the ride.
Jeanne Arnold, DPM, Coeur d'Alene, ID, jarnolddpm3@frontier.com
02/20/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: New MD Shoe Company Tells People to "Ditch Your Orthotics" (Juliet Burk, DPM)
From: Lloyd Nesbitt DPM
While Dr. Burk may have found the OESH shoes to be “great” and wants to wave their flag, the shoe company is shooting itself in the foot with their negative comments that reflect upon each and every podiatrist. Their opinion on orthotics, as stated clearly on their website, goes against what has been taught in the colleges of podiatric medicine and has been proven clinically with hundreds of thousands of podiatry patients in the past forty years. Their website is an insult to the podiatry profession. To say that orthotics will cause increased stresses and essentially do more harm than good is bordering on slanderous.
This is one company that I personally won’t be in a hurry to promote. Fifteen thousand podiatrists can influence the shoe-buying decisions of a great deal of Americans and our profession should think twice about supporting their rhetoric.
Lloyd Nesbitt DPM, Toronto, Ont, foothealth@lloydnesbitt.com
01/17/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Wood Laminate Flooring in the Office (Arthur Lukoff, DPM)
From: From: Ellen Wenzel, DPM
We have had laminate in our office for two years, and it still looks great; plus, our expense to purchase and install it wasn't enormous. I recommend checking to see if what you select has a commercial grade warranty.
We do take great pains, however, to ensure we care for it properly. It is absolutely NEVER mopped in the standard fashion (mop & bucket or standing water). We use cleansers and disinfectants that are designed specifically for laminate to prevent lifting of the seams and damage to the photo layers. Rooms are swept and/or Swiffered after EVERY patient to ensure no debris can be ground into them. We also keep a heavy duty floor rug at our office's entrance to trap outside muck and the Washington rain, so it isn't tracked into the treatment rooms. Most importantly, we never let spills sit on the floors for any length of time; we take care of them immediately.
For us, the extra work has been worth being able to show my patients just how clean we keep our office, and we are complemented on it regularly.
Ellen Wenzel DPM, Vancouver, WA, wenzeldpm@gmail.com
01/06/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Medicaid Change for Orthotics in NY (Nicholas D'angelo, DPM)
From: Barry Mullen, DPM
I believe several inaccuracies exist in Dr. D'Angelo's response that need clarification. First, Dr. D'Angelo's Cipro to Naprosyn analogy is not germane to a discussion comparing similar treatments utilized for similar pathologies; yet, he attempts to compare that scenario to 2 different medications, with completely different pharmacokinetics, utilized for completely different indications. There's zero connection.
Second, how do you know a participating lab's product will be inferior until you actually prescribe it? You cannot presume that.
Third, I disagree with the statement that healthcare providers are responsible for...
Editor's Note: Dr. Mullen's extended-length letter can be read here.
