02/12/2014    Keith L. Gurnick, DPM

What Percentage of Your Practice is Routine Foot Care?

As a 4th year podiatry student in 1979 at CCPM, I
did an externship in the office of Dr. John Weed,
who practiced in San Jose, CA. He was one of my
favorite biomechanics teachers and my expectation
was that during the two weeks in his office, I
would improve only my biomechanics skills by
observing him performing range of motion exams,
muscle testing, gait analysis and casting, Rx
writing, and dispensing orthotics on his patients.
Because this was his main teaching subject, I
naively figured that's what he probably did
exclusively in his private office practice.

He had many satisfied and happy patients and he
was a well-rounded podiatrist of his time. Sure he
did biomechanics, but he also clipped toenails, he
trimmed calluses, lots of them, and he gave
injections, he ordered x-rays, he taped feet and
he did surgery; very well I might add. He did it
all, including incorporating what he taught me;
which was the importance of biomechanics and how
the foot functioned and the relationship to the
rest of the human body. And then I also learned
from Dr. Sheldon Langer something I use every day
on virtually every patient: "Treat the patient as
a whole and not the foot." Don't focus on the
foot, focus on the patient".

The point here is that irrespective of what
skills or training each individual podiatrist may
possess or choose to employ, we should not
splinter our small profession by either
denigrating those who choose to focus on
palliation as a means of helping
their patients nor should we grant undue higher
respect for those who are more surgically
oriented. Those 50+% who responded that they do
RFC does not mean that they do not practice the
full scope of podiatry. And those who do surgery
60+% of their practice does not exclude RFC.
There is a place for both and many out there still
do it all, every day on every patient.

Also, I feel we do not need a degree change, and
we should embrace our DPM degree which will always
distinguish us from any other doctor or entity
that tries to self proclaim themselves as "foot
care specialists". We should, however have a
curriculum change, to include more of the basics
of podiatry that was taught when I was in school
and is now becoming a thing of the past.
Palliation, taping and strapping, making of
orthotics in a on-premises lab should be
mandatory.

Unless our schools include an educational and
clinical return to teaching the basics of
podiatry, our future graduates will come into a
profession that will have lots its foothold on
foot care to every other doctor, PA, NP "foot
orthopedist", orthotist, physical therapist, or
chiropractor that considers themselves experts,
because the podiatrist expert spent too much time
trying to be an MD instead of trying to be a
podiatrist.

Keith L. Gurnick, DPM, Los Angeles, CA,
keithgrnk@aol.com

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