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12/06/2013
RESPONSES/COMMENTS (NON-CLINICAL)
RE: The CARe Approach to Medical Mistakes
From: Sarah Montgomery, DPM
The CARe approach (Communication, Apology, and Resolution for Adverse Medical Events) is based on a model developed in Michigan, where the practitioners funded their own malpractice insurance and actually saved money. Their idea was to recognize when a mistake was made, acknowledge the mistake to the patient, and take action to correct it, most likely with the patient's involvement. Here is a link with more information on the Michigan model.
I heard about this only recently at a CME lecture at a nearby hospital (Beth Israel Deaconess Medical Center) where it is being implemented. Here is a link to an article about this.
I think that it would be common sense to acknowledge a mistake as soon as you realize it occurred, because if you ignore it, it will only get worse and could lead to a malpractice suit. Apparently, there aren't many places that agree with my line of thinking as this approach has not been adopted nation-wide as of yet.
Other messages in this thread:
08/02/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Rod Tomczak, DPM, MD, EdD
Jonathan, it’s a shame you can’t help your daughter put on her white coat for the first time in public, and, yes, I think it is a form of discrimination. For years, MDs looked down on DOs and still do, but it is much more subtle. They could always use the fact that DOs took the COMLEX licensing exams instead of USMLE and supposedly the COMLEX was easier to pass than USMLE. Now DOs can take USMLE so MDs don’t have the “we take a tougher licensing exam” platform to look down from. And, there are not enough MD graduates to fill all the residency slots in MD hospitals, so MD hospitals have generously condescended to accept DOs into their residency programs.
Don’t let the MDs kid you, there are huge economic incentives to suddenly treat DOs as academically equal to MDs, about a 100,000 reasons per resident per year. This becomes very important when rural hospitals are trying to keep the doors open and it doesn’t hurt big teaching...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
08/02/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Robert A. Dale, DPM
I am responding to the question from Dr. Carlson about where to obtain cantharone. There is a compounding pharmacy in West Virginia I get that medication from. They make cantharone and cantharone plus which has an acid mixed with cantharone. The contact information for them is: Med A Save Pharmacy, 818 S Mineral St., Keyser, WV 26727.
Robert A. Dale, DPM, Clarksburg, WV
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Stephen Musser, DPM
I disagree with your daughter's school decision. If the state where her school is located includes podiatry in the definition as a physician, then I think you or your daughter can argue/refute the administration's decision. I once had an MD/DO point out to me that I shouldn't be parking in a physician designated parking spot. I politely told him I am considered a physician in the eyes of the Ohio medical board and left my car where I parked it. Nothing came of it and nothing more was said.
Stephen Musser, DPM, Cleveland, OH
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Jose Aponte, DPM
I am sorry to hear that your daughter was denied the privilege of your being able to put the white coat on her future White Coat Ceremony at her present school of osteopathy. In my opinion, this sends the wrong message to the new students. Recently, I attended my son's WCC at a medical school and was allowed to put the white coat on his shoulders without any controversy.
As I understand, the WCC was designed by The Arnold P. Gold Foundation. I would contact this foundation and let them know your situation. Maybe they have a position that you can present to the osteopathic school your daughter is attending and hopefully help change their thoughts about all this. Regardless of the outcome of this situation, your daughter should be very proud of you for being a DPM.
Jose Aponte, DPM, Caguas, PR
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: John Throckmorton, DPM
I find it interesting that the DO school which Dr. Michael’s daughter is attending won’t let him do the white coat ceremony for his daughter. I was allowed to do this for my daughter at the DO school in Michigan and also help the Dean give her diploma to her after her four years at the graduation ceremony. After being in practice 30+ years in the state, to be with our daughter, we moved to North Carolina
She was the first DO doctor to do the palliative fellowship at Vanderbilt and she was, at times, talked down to because of her DO degree. Professional degrees status varies in different states and around the world. I believe that Michigan’s DPM status is due to the fact we had the first residency in the country at Civic Hospital in the early 60s. I am hoping that the number of residencies continues to grow in the states where we lag behind in them, and through interaction with not only our colleagues, but other health professionals, i.e. MDs, DOs, and other recognized providers.
John Throckmorton, DPM, Moorseville, NC
07/31/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Amol Saxena, DPM, MPH, Jeff Carnett, DPM
It saddens me to read your post. The agenda of the AMA is to limit those who can be called physicians and surgeons to only those who are MDs or DOs, so it does not surprise me. I couldn't imagine that prejudice against me when my daughter was going through medical school. In fact, during a case on an orthopedic rotation, the resident said something to that effect to her. The attending had him call her to apologize. She graduates from orthopedic residency next year and her attendings have asked me to present grand rounds.
I think one option is to have your daughter transfer as this bias will not change. I discuss these biases in my lecture that is on PRESENT. This a good example of why we need our DPM schools to evolve to granting the MD degree. Sending empathy to you and your family from CA.
Amol Saxena, DPM, MPH, Palo Alto, CA
It is sad to read about this unnecessary discrimination against a DO student family. I know the Des Moines University DO college did a similar thing in 1984 when a son of a local DPM was not allowed to hood his son at DO graduation. The DPM had provided a free podiatry clinic to the DO school for 20 years leading up to this slap in the face. At the time, a nurse was allowed to hood her son at graduation, just to make the hurt even more. The College of Podiatric Medicine & Surgery at DMU was just starting at that time so the CPME was interested to hear about this and apparently did express concerns. If your daughter's school is at a university having a DPM program perhaps this could be something CPME might have some interest in.
The event was emotionally traumatic to the involved family. The DPM refused to teach podiatry students and residents for many years because of this snub.
Jeff Carnett, DPM, Phoenix, AZ
07/30/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Discrimination Against DPMs
From: Jonathan Michael, DPM
My daughter is a 1st year student at a college of osteopathic medicine. Next month, I am going to her white coat ceremony. They informed my daughter that they will allow parents who are MDs or DOs to coat their kids, but not a DPM as we are not considered physicians. Also consider, the 3 other schools she was accepted to would have allowed a DPM to coat a student. My daughter is very upset as she told them I am a surgeon and board certified. Their answer was we just call them doctors for respect, but we do not consider them physicians as they have a limited license. Any thoughts?
Jonathan Michael, DPM, Bayonne, NJ
07/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Student Indebtedness
From: Ira Kraus, DPM
I have been watching this item with particular interest. I think that this is an important opportunity for our colleagues not only to donate themselves through the APMA Educational Foundation, but to also impress upon the companies we support that they need to give back, using PICA as an example, to make a meaningful impact on the lives of our students pursuing careers in podiatric medicine and surgery.
When Talar Medical was founded, we made a commitment to address this issue and we to date have donated $50,000 toward student scholarships. We believe that every contribution can make a difference. However, to effectively combat student debt and promote access to education, we need more companies to join us in this cause.
I encourage you to impress upon the companies you utilize to consider how they can contribute to the APMA Educational Foundation. By donating to this worthy initiative, we can help alleviate the financial burden on students and encourage the next generation of healthcare professionals. Together, we can work toward reducing student indebtedness and fostering a brighter future for those entering the podiatric field.
Ira Kraus, DPM, Whitefish, MT
07/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Greg Caringi, DPM
I have read this thread with interest. My OCPM classmate and Kern Hospital co-resident, Dr. Eric Lauf, took on this problem and published his research in 1982, "Manual dexterity: its importance in podiatry" (J Am Podiatry Assoc. 1982 Jun;72(6):291-8.). Since Eric passed much too soon (at the age of 47), I will recall this to the best of my ability. Eric had a friend at the Case Western Reserve Dental School. Even then, dental school admissions took spatial relationships and manual dexterity testing seriously. After observing their metrics, Eric tried to apply them to the students at OCPM.
Unlike dentistry, there was a poor correlation in podiatry. His research became of practical use when Eric introduced the use of the Purdue Pegboard Test (a psychomotor test of manual dexterity and bimanual coordination) as part of the screening process in selecting residents at Kern Hospital. I later began using the Purdue Pegboard at Suburban General Hospital when we selected our surgical residents. It became an important part of our selection process. On a personal note, this reminds me how great a loss it was to our profession when we lost Dr. Eric Lauf in 2001.
Greg Caringi, DPM - North Wales, PA
07/22/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: William Long, DPM
APMA has endorsed several student debt relief bills. Your association also has worked with Congressional leaders for years to support legislation that would create new programs to provide graduates with opportunities to work in underserved areas in order to have their student loan debt entirely eliminated. There are currently several proposals before Congress to address this issue, but the costs are high, and with elections this fall, these bills have dim prospects of being passed.
APMA members are invited to review the list of APMA’s endorsed bills, including those regarding student debt, on our website (www.apma.org/FederalAdvocacy). These proposals are just that— proposals, and it will take monumental support from citizens to encourage elected officials to pass such legislation. APMA employs one full-time lobbyist to support the legislative goals of the profession, as identified by a committee of member volunteers. We strongly encourage members to become politically active. Use our eAdvocacy system (www.apma.org/eAdvocacy), get involved with state and federal candidates, and help us at the grassroots level to support the causes that are important to you.
William Long, DPM, Chair, APMA Legislative Committee
07/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Steven Kravitz, DPM
I fail to understand why there is so much attention to podiatrists or at least some podiatrists trying to expand scope of practice beyond that of our specialty area - the foot and ankle. The concept of the serving as gatekeeper brings many questions, and I agree with Dr. Rodney Tomczak. The DPM degree has served me well and the podiatrists I know. My colleagues (many in wound care) have benefitted from their education and ability to practice medicine within the scope of DPM degree they earned. That degree points to the general public and more importantly to other medical providers that we are indeed specialists in the foot and ankle pathology. We have developed very good reputations generally; we as a group provide excellent service to patients. At the end of the day, it is the patient that matters.
Becoming gatekeepers necessitates overseeing treatment of medical conditions out of our scope of...
Editor's note: Dr. Kravitz's extended-length letter can be read here
07/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Medical School Debt
From: Paul Kesselman, DPM
According to a recent report, average medical school debt now is greater than $200,000. Many states now have programs which help to erase some or all of the debt. Why is podiatry school debt which likely is as much if not more than the average medical school debt not provided with these same programs? Where are the schools or APMA with respect to obtaining the same level of financial relief for these students/residents/young practitioners?
Students are already encumbered with hundreds of thousands of dollars in undergraduate debt. The thought of taking on another $200K plus dollars in debt for podiatry school and then working as a resident for 3 more years is often a non-starter, deterring many from entering our profession.
I cannot fathom starting a family with the amount of debt these young people are faced with. The future of every practitioner and the APMA is in our students. The APMA and colleges must make this issue a priority. Podiatry school debt relief should receive the same relief programs as the MD/DO students/residents/young practitioners.
Paul Kesselman, DPM, Oceanside, NY
07/18/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Allen Jacobs, DPM
The recent “gatekeeper“ discussion in PM News is, in my opinion, reflective of the Dunning-Kruger effect in reasoning: there appears to be a failure to recognize one’s own incompetence. As noted by Dr. Tomczak and me in previous postings, the question is how far out of your lane do you wish to drive? Are you unconsciously incompetent?
The DPM degree is a restricted medical degree with restrictions on practice determined at the state level and locally by institutional delineation of privileges. A podiatrist today is exceptionally well trained for the evaluation and management of foot and ankle pathology. This is what you do. This is what you have been educated to do. This is what society, through its regulatory legislation, has determined, based on education and clinical training, has granted you permission and trust to do. You are entrusted to perform surgery, and to determine when surgery is or is not....
Editor's note: Dr. Jacobs' extended-length letter can be read here.
07/17/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Podiatric Physician Gatekeepers
From: Rod Tomczak, DPM, MD, EdD
For years, Leonard Levy, DPM advocated the role of podiatrists as gatekeepers. Afterall, the Iowa college students spent the first two years of school seated next to DO students in lectures and took the same exams. The third year of school was spent in podiatric clinics and learning diagnostic skills and formulating treatment plans with a Problem-based Learning Curriculum. The fourth year was spent in clinical rotations away from Des Moines but with a strong emphasis on both general medicine and podiatric medicine. Now, all graduates spend three years in residency and many add an additional year in a fellowship.
So, the APMA has declared what they think we, as podiatrists, ought to be, but not necessarily what we are. The state podiatric societies can opine about what they think we should be, but only the state legislatures can decide what we are at any moment. The podiatric colleges can decide what should be taught but this may not correspond to what is learned.
Our podiatric graduates are certainly equipped to be healthcare gatekeepers, opening the gates for...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
07/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Has APMA Appointed Future Action Strategists?
From: Lawrence Rubin, DPM
At all times, healthcare professional organizations responsible for public outreach and relations usually have appointed future actions strategists. These qualified persons constantly monitor the standing its members have in changing aspects within the healthcare marketplace, including any significant changes in reimbursement issues.
I have been a member of APMA since 1958, and I am hoping that the APMA has done now what it has done in the past by appointing qualified strategists during these rapidly changing times (such as was done prior to change of the name of the profession from chiropody to podiatry). If it has, these strategists are realizing that the quickly advancing Medicare spearheaded transition from fee-for-service reimbursement to value-based care (VBC) is already devaluing payment for elective, "non-life threatening” surgery, and it is increasing the reimbursement value of prevention and chronic disease management E/M services. In podiatric medicine, chronic diseases include, but are not limited to diabetes peripheral neuropathy (DPN) and peripheral artery disease (PAD).
I am concerned about this because recent board certification discussions that appear to ultimately put, "most of all of podiatry's eggs in one surgery basket" could, to say the least, be counterproductive for the profession of podiatry.
Lawrence Rubin, DPM, Las Vegas, NV
07/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Observations on the Changing Face of Medicine
From: Elliot Udell, DPM
I have a patient who is a soon-to-be retired psychiatrist. Whenever he would come into the office, we would have discussions on many topics not related to psychiatry or podiatry. He was very well aware of all facets of general medicine. If I asked this physician a medical question, he knew the answer. He later told me that he works one day a week in the ER doing emergency medicine and this helps him keep up with the entire medical field. In another case, my former GI specialist who just retired was able to comment with interest and expertise on any medical issue aside from the GI system.
I am now faced with seeing a whole new battery of young specialists in different fields and if I ask them a question outside their specialty, their answer tends to be, "It's not my field, go to an appropriate specialist." I am seeing more and more of this happening and some of these doctors are board certified in internal medicine and if the question does not directly relate to their subspecialty, the wall in the room can give me a better answer.
As a podiatrist, this may be good. We are specialized and only responsible for the foot, and so many other young specialists seem to have developed amnesia to all aspects of medicine other than their own narrow specialties. Perhaps the degree given to these physicians should not be an MD or DO but for example, "doctor of orthopedics or doctor of oncology, etc. Being a doctor of medicine is becoming less and less relevant in today’s practice.
Elliot Udell, DPM, Hicksville, NY
06/28/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Dominic Bianco
The title of “Dr.” signifies a person’s capability for analytical thinking and problem-solving, beyond just the academic qualifications displayed on a wall. No doctor, whether a brain surgeon or a dentist, should look down upon podiatrists or any other medical professionals. Considering there are approximately 18,000 podiatrists compared to 250,000 dentists in North America, podiatrists face significantly less competition.
With a population of 579 million people in North America and only 18,000 podiatrists, it is clear that podiatrists are in high demand. However, many podiatrists do not reach their full potential due to various factors such as financial setbacks, personal challenges, or a lack of passion for their work. It is crucial for podiatrists to find their niche and make their practice work to the best of their ability.
Every podiatrist should feel proud and assured of their success, having achieved a level of brilliance that many, including myself, deeply admire.
Dominic Bianco, CEO, Bianco Instruments LLC
06/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatrists Self-Identifying as" Dr." or "Physician"
From: Carl Solomon DPM
Putting aside the discussion of whether or not podiatrists are physicians, I’d like to express some thoughts about how we address ourselves in that context. I can hardly recall an instance in which one of my MD/DO friends addressed him/herself as “physician”. When asked, or introduced, it’s “I’m an oncologist, orthopedist, rheumatologist, general surgeon…”, whatever. My dentist friends aren't too proud to be identified as a dentist...perhaps when appropriate, oral surgeon. Not physician.
And when I see the use of the term “Dr.” written in front of somebody’s name without other explanation, almost without exception, that’s a de facto acknowledgement that “I am not an MD”. This was personified on the sign-in sheet at one of my hospitals’ Dept. of surgery meetings. Everyone signed in simply with their name, with the exception of two, each of whom signed “Dr. Xxxxx”. You can guess…
A podiatrist may achieve some level of recognition by assigning him/herself the title of "Dr." or "physician", and the inference is that it represents being an MD. But oftentimes once the details come out, the concealment of the identity as a podiatrist makes it apparent that there is a low level of self-esteem associated with such identity. So whatever special recognition may have been achieved by initially identifying as a Dr. or physician, is actually negated. On the other hand, if one is humble and is acknowledged by another party as being a doctor…podiatrist, the level of recognition will remain high. If you can’t take pride in being a podiatrist, you should have spent the time and effort doing something else!
Carl Solomon, DPM, Dallas, TX
06/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: A Rose by Any Other Name…
From: Rod Tomczak, DPM, MD, EdD
I hope all who read the letter by ACFAS and APMA have also looked at the history of the resolutions and position papers. It seems that in 2020 someone came up with the idea that if students of podiatric medicine could pass USMLE, they should be classified as physicians.
Out of the right side of their mouths, the MD officials are pushing our students to take the USMLE, and out of the left side, they are saying MD and DO passers of the USMLE can call themselves “physicians.” What seems very odd is that DOs can still take their COMLEX exam and be licensed as physicians.
This whole ploy is the biggest example of obfuscation I have ever seen. AOFAS would rather partner with Reiki practitioners than...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/26/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Stefan Feldman, DPM
I wholeheartedly agree with Dr. Ribotsky about forming a cancer registry for podiatrists. I too, am a cancer survivor, finding out I have lung cancer following my retirement after 41 years of practice. I am a lifelong non-smoker and can only guess what the source of my cancer is, but I think of all the carcinogens I was exposed to during my working days. My advice to younger practitioners is to protect yourself from radiation exposure and assure the air quality in your environment is as free of carcinogens as possible. Check your homes and offices for radon, considered the leading cause of lung cancer in non-smokers, and also consider having a low dose CT screening scan of your lungs if over 50 years old.
Stefan Feldman, DPM, Spring Hill, TN
06/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Elliot Udell, DPM
Kudos to Dr. Ribotsky for suggesting that there be some way of tracking podiatrists diagnosed with some form of cancer. As a cancer patient in remission, this issue is very close to me.
The medical community is grappling with another issue. Patients with breast and colon cancer are now presenting at very young ages. One patient of mine had his first colonoscopy at age forty and discovered that he had stage four colon cancer. Another young woman in her thirties is undergoing treatment for breast cancer. Are these caused by unidentified carcinogens or are people discovering these conditions earlier in life because of testing and awareness?
Elliot Udell, DPM, Hicksville, NY
06/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) -PART 2B
Dr. Ribotsky brings up an excellent point about developing a cancer registry within our profession. What becomes very concerning to me is the point he brings up about the dangers of podiatrists and their assistants breathing in nail dust, a known carcinogen. With all the OSHA regulations medical practices must adhere to, regulations regarding inhalation of dangerous nail dust does not seem to be a concern of OSHA.
I've been manufacturing and selling a nail dust extractor system for many years and I cannot begin to tell you the frustration I have when I see the infinite regulations physicians must adhere to while the nail dust produced by one of the most common procedures podiatrists do is not addressed. I have sold many vacuum units throughout the years but would conservatively estimate that 80-90% of podiatry practices doing routine podiatry do not incorporate nail dust extraction systems.
Dr. Ribotsky brings up an excellent idea about forming a cancer registry. Unfortunately, it may be an uphill battle when governmental agencies such as OSHA make demands on offices that are borderline ridiculous, while known airborne carcinogens such as nail dust go completely unregulated.
Jack Ressler, DPM, Boca Raton, FL
06/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: AI and Podiatry
From: Lawrence Rubin, DPM
As podiatry board certification matters are bringing the profession closer and closer to there being mainly surgery limited practices, we'd better figure out a way to combat present and future bad AI public information. Let's say a footsore person gives AI this question: "Where can I go to get this big, red, sore bunion taken care of?"
It surely will not be to the benefit of the patient or podiatric surgeon for the AI answer to be, "Go to the Walgreens store nearest you. Ask the pharmacist where you can find bunion shields to reduce pain and inflammation caused by shoes and also Tylenol for bouts of intense pain." Forewarned Is Forearmed. We have to prepare ourselves to deal with AI. It’s good to see that APMA will have a lecture on AI at its August meeting.
Lawrence Rubin, DPM, Las Vegas, NV
06/24/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Podiatric Cancer Registry
From: Bret M. Ribotsky, DPM
It seems that a week does not go by when I don’t hear of another colleague coming down with some type of cancer. I first wrote about this over 10 years ago on this forum asking APMA to develop a registry just to keep track of podiatrists who have come down with this awful disease. Wouldn’t it be great if we could draw some correlations to find out maybe something that our profession is exposed to is causing problems? Why would our organization not do this?
If it’s determined that chronic exposure to nail dust is carcinogenic, wouldn’t that be something that all providers should be aware of? I’m old enough to remember that Rohadur (a thermal plastic) has a correlation with testicular cancer among podiatrists. This is something that was identified approximately 40 years ago and since those days, the use of that material for biomechanical orthotics was discontinued. I believe we all need to start acquiring data so that correlations can be drawn into the future. Let’s all be safe.
Bret M. Ribotsky, DPM, Ft. Lauderdale, FL
06/21/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Allen Jacobs, DPM
I suggest that PM News readers read this discussion examining the role of profit-making in medicine.
Allen Jacobs, DPM, St. Louis, MO
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