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09/07/2013 Bryan C. Markinson, DPM
Podiatrists and Hospital Privileges
The notion that non-surgical podiatrists do not need hospital privileges keeps popping up in the discussions involving the residency crisis. This immature notion is only propagated by selfish colleagues, period. While our profession, colleges, and APMA markets podiatry as the "guardians of foot health," I ask the following: Doesn't a diabetic foot specialist, who does not do surgery, have a need to admit patients for infections, wounds, etc.
Does the removal of a metatarsal head or toe amputation require 46 initials after your name? And what of the poor lot of us who have distinguished ourselves in sports medicine, dermatology, wound care, infectious disease, etc.? No role for us in the hospital environment? WRONG.
Every time this is addressed, chiefs of service of hospitals state that they exclude no one and that their colleagues are credentialed according to documented training and experience. If that is true, then the discussion about who does not and who does need hospital privileges should cease, because just the expression that some don't is at the core of most of our problems....and that is that we treat each other poorly.
Let the practitioner decide if he or she needs the hospital, and let us credential them fairly, leaning towards their success. Hiding behind policies in the name of credentials and protecting the public is a cop-out.
On the other hand, I also think it is wrong to take on serious diabetic foot cases in your office without informing the patient that if they need hospitalization, that you will not be able to take care of them. This results in a dumping on colleagues in the hospital with a patient unknown to us and the need to engage other medical specialists not familiar with the patient. This too is extremely selfish.
I suggest that if you are in that situation, that you identify a colleague who can take the patient to the hospital and recommend that the patient see that doctor for at least an introductory visit while you continue your care so that you can discuss your intended treatment (s). Then if it does not go well, the "admission" will not be a "back against the wall situation" for the patient, resulting in a dumping to the emergency room.
I have seen way too many needless amputations occur as a direct result of merely sending a patient to the emergency room to unfamiliar doctors.
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
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