04/27/2013
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: Purchasing a Digital X-Ray System (Laura R Lefkowitz, DPM)
From: Michael L. Brody, DPM
Your X-Cel x-ray machine is the source of the x-rays. When you take an x-ray of a patient, the rays go from the X-Cel to a "plate". When discussing digital x-rays, it is the plate and the method of developing the plate that is digital. You can use your existing X-Cel with any digital x-ray system. You will be replacing the plates, films, and processor with a digital system.
There are two types of systems available: CR and DR. Each system will claim it is better than...
Editor's note: Dr. Brody's extended-length letter can be read here.
04/18/2013
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: Unnecessary Testing
From: Paul Kesselman, DPM
An initiative called Choosing Wisely® was recently created by the non-profit American Board of Internal Medicine (ABIM) Foundation in conjunction with Consumer Reports. There are a myriad of about 90 medical procedures and tests listed with opinions on when and/or whether these procedures should be performed. While ABIM had a large role, there are many specialty societies which participated in this review.
There appears to be only a few procedures which podiatrists usually perform or order. The intent of this posting is to stir debate on whether or not organizations representing podiatrists (e.g. APMA, ACFOAM, ASPS, etc.) should in the future take a more active role in participating in this review (I admit I don't know whether they were ever asked). More information can be found at: choosingwisely.org/doctor-patient-lists/
If nothing else, reviewing this material may make all of us better informed medical consumers.
Paul Kesselman, DPM, Woodside, NY, drkesselmandpm1@hotmail.com
03/29/2013
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: Kudos to Dr. Pollak
From: Bret Ribotsky, DPM
A tremendous sense of pride overcame me as I was "thumbing through" journals yesterday. I saw a game-changing article in dermatology's most respected journal (the "Blue Journal" as it's known) authored in part by my friend, and previous Meet the Master guest, Richard Pollak, DPM. This article demonstrates that there is a new topical for onychomycosis that works as well as Lamisil. Thank you, Dr. Pollak for keeping podiatry within mainstream research on a topic that our profession should really own.
Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@gmail.com
03/08/2013
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: Vacation Policy (John Scholl, DPM)
From: Joel Lang, DPM, Art Gudeon, DPM
After one full year of continuous employment, my employees got one week of paid vacation. Each year thereafter, they earned an additional week of paid vacation until they reached 4 weeks. That was maximum.
Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net
My office manager of almost 34 years now (that's THIRTY-FOUR years!), takes her vacations any time she damn pleases...hey, we know who the real boss is in my office!
Art Gudeon, DPM, Rego Park, NY, afootdoc@hotmail.com
03/02/2013
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: Diagnostic Tests in the New Healthcare Environment
From: Wm. Barry Turner, BSN, DPM
A year or so back, I found I was unable to order WBC-tagged bone scans to differentiate a diagnosis of osteomylitis from a possible Charcot event. When I contacted my local hospital's nuclear medicine department, I was told that the Medicare-approved payment was less than half of the procedure cost and the hospitals could no longer afford to provide this service.
I acknowledge that most radiologists will tell you they can differentiate between Charcot and osteomylitis with an MRI, but you must keep in mind that...
Editor's note: Dr. Turner's extended-length letter can be read here.
01/24/2013
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: Sharon Diaz, CaFFE Student Scholarship Fund
From: David Mullens, DPM
Sharon Diaz, the President and CEO of Samuel Merritt University, saved podiatric medical education in California at a time when our future was not certain. And as though rescuing us from the edge of the abyss wasn't enough, she has since suffered through literally thousands of hours of meetings with various podiatrists/podiatric groups in order to steer the California School of Podiatric Medicine (CSPM) ship in the right direction. Well, now we have the perfect opportunity and the perfect way to say "thank you."
As of 2013, Sharon is celebrating 40 years of service at SMU. If you ask her how she would like to be honored for this milestone moment, she will reply by asking you to...
Editor's note: Dr. Mullens' extended-length letter can be read here.
12/14/2012
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: Adding a Pedorthist to a Podiatry Office (Hal Ornstein, DPM)
From: Sarah Goldberg, CPed
I am responding to Dr. Ornstein's query as a pedorthist who works in a retail environment (Eneslow, the Foot Comfort Center in New York City) and enjoys a strong relationship with many referring podiatrists. If your practice is expanding/has expanded to offer shoes, ready-made orthotics, a greater number of custom made orthotics, and adjustments and modifications to custom made orthotics and shoes, having a pedorthist on staff would be very helpful to your practice.
When I take NYCPM students on their pedorthic rotations, I emphasize to them that pedorthists are like pharmacists to podiatrists and that our services are designed to complement your services. If you are able to invest in sufficient inventory, adding a pedorthist can turn your office into a convenient one-stop place for your patients' footwear and footcare needs.
Sarah Goldberg, CPed, New York, NY, sarah@eneslow.com
12/07/2012
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: Source for Dehydrated Alcohol (Ed Dosremedios, DPM)
From: Paul Galluzzo, DPM
I have been using Delta Pharma, Inc. located in Ripley, Mississippi. Usually, Cindy will answer the phone and is very helpful. She'll even call you back when she says she will. Their phone # is: 662-512-5191.
Paul Galluzzo, DPM, Rockford, IL, FTSURG1@aol.com
11/30/2012
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: Source for Accuzyme and Panafil (Jim Fisher, DPM)
From: Allen Jacobs, DPM, Jay Wenig, DPM
Accuzyme and Panafil are available in generic form from Bellevue pharmacy in St Louis. You may also add other agents to them if you wish (e.g., antibiotics, or other agents you wish to compound).
Allen Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net
Both are off the market and have been off the market for about 3 years. Neither had shown evidence acceptable to the FDA that they are effective. No company was going to even try and do the research necessary to keep them on the market because both were available generically. Colchicine was going to be taken off the market for the same reason but a compnay did do the research to prove its effectiveness and now they have a new patent.
Santyl is the only available debriding agent now.
Jay Wenig, DPM, Upper Marlboro MD, jaywenig@aol.com
11/21/2012
RESPONSES / COMMENTS (NON -CLINICAL) - PART 1
RE: EMR Auditing
From: James Breedlove, DPM
The support staff at my electronic health record company just brought up some disturbing information. It seems that now, CMS is performing audits on doctors that got their stimulus check for using electronic health records. According to the support staff, everyone knew that there was going to be certain security protocols for using an EMR program, but when CMS was called last year (by mulitple EMR vendors), CMS said that they either hadn't decided on what the rules were going to be or that they had not been published yet. Now, they are published and apparently some doctors have been audited. If they do not meet audit criteria, they may have to give the money back.
I have been reviewing the audit listing. This borders on insane. I don't have the launch codes for ICBMs. I agree that measures should be taken, and offices should be made aware, but the format laid out by CMS and the gross range is crazy. In one document, it suggests that we "hire" a security firm or appoint someone a "security officer" (this actually has to be in print). Many offices can't hire a security firm, etc. due to finances.
If there was ever a time for the APMA, AMA and others to unite against something, this is it. My security is better than most, but if I get "dinged" for this, I'm going back to paper and there isn't a damned thing they can do about it.
James Breedlove, DPM, San Luis Obispo, CA, bigmanzotz@aol.com
