01/29/2015    Charles Morelli, DPM

Unethical Behavior

This past weekend, I attended my 24th clinical
conference sponsored by the New York State
Podiatric Medical Association and I have never
felt the need to respond to some of what was said
during the final “round table” moderated by Dr.
Allen Jacobs. On the dais were Dr. Trepal and Mr.
Andrew Feldman Esq.

Mr. Feldman was, as always, was clear and succinct
and I appreciated all that he had to say and how
it was presented. When the conversation was
steered towards “ethical behavior” by a
podiatrist, that is when I started to get
uncomfortable and a bit annoyed by some of the
comments. If it wasn't for the scores of others I
had spoken to after the meeting who also had
similar feelings, I might not have posted this at
all, but that was not the case.

The moderator started by asking a question
regarding how medicine has changed and how it has
become more of a business model as opposed to the
good old days of just being able to treat
patients, bill for your service, get paid, write
your note and then go home to your family. As I
write this, I am in my office spending hours with
my charts from last week, making sure I comply
with meaningful use, and responding to 8 requests
by different insurance carriers for copies of over
45 patient’s notes. Yes, private practice has
changed and we need to do things differently.

Let me get to the point. It was stated (not
inferred) by the moderator, that it is “unethical”
for a podiatrist to dispense products to a
patient. The example was that of “a cream. Not
ill-advised or thoughtless or inappropriate, but
unethical. “Unethical” for a foot doctor to
dispense a foot care product to a patient with a
foot problem for the sole purpose of making a few
extra dollars. Really?

Not because the patient needed it, but so that we
can make an extra $6.00. This was immediately
followed up by Dr. Trepal, who tried to reinforce
this point by asking if many of us (and I am
paraphrasing) felt pressure when reps come to
visit us, to write for compounded pain medications
that are more expensive that OTC medications,
while never considering whether or not there may
have been mitigating circumstances for this
decision being made. Inability to take oral meds,
gastric bleeding, blood thinners, the failure of
other meds that had been tried or the absence of
any other appropriate product that could address
your patient’s needs and symptoms to mention a
few.

After this was said, the moderator suddenly became
very quiet and never followed up with a line of
questioning. A moderator who gave the exact same
lecture as last year on diabetic neuropathy, and
as part of his lecture tells us how important and
vital it can be for a patient to prescribe
compounded meds. And, since pain is a complicated
issue with many pathways and etiologies and not
everyone responds the same when treating pain, Dr.
Jacobs suggests that we add 4, 5, or even 6
different compounds to successfully address
painful diabetic neuropathy. Basically, hit them
with the kitchen sink (my words, not his).

It was also not lost on many in the audience that
we were told this by a doctor who I imagine makes
a good living lecturing around the country and
paid quite well for his expertise while speaking
on behalf of big pharmaceutical companies. Much
more than my $6.00 profit. Perhaps we should
redefine unethical?

Please consider your words a bit more carefully
the next time you tell a group of professionals
that they are being “unethical” if they dispense
an ankle brace to a patient who presents with an
ankle sprain or a cream for their fungal
infection. Would it be better if we had them limp
to CVS and buy one off the shelf rather than have
it dispensed and fitted professionally by a
trained and/or board certified podiatrist and/or
surgeon?

Special thanks to Google for providing me with
synonyms for unethical: immoral, amoral,
unprincipled, unscrupulous, dishonorable,
dishonest,wrong, deceitful, unconscionable,
unfair, fraudulent, underhanded, wicked, evil,
sneaky, corrupt, unprofessional, improper.

Every one of those synonyms offend me

Charles Morelli, DPM, Mamaroneck, NY

Other messages in this thread:

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06/05/2012    Lauretta M. Fernandez, LPed

Unethical Behavior By Foot Solutions (Peter M Mason, DPM)

I am the owner of the Foot Solutions store to
which Dr. Mason referred. We have always valued
our relationships with the medical community and
medical practitioners. We see ourselves as
allied professionals within those communities,
working towards the same goals – providing the
best solutions for your patients.

Foot Solutions has been a respected member of
the community for almost ten years, assisting
tens of thousands of Bay area residents. We have
great respect for the medical community and have
a long track record of working harmoniously and
successfully with not only podiatrists but also
orthopedists, physical therapists, and general
practitioners.

As it relates to this incident, we believe that
there is a misunderstanding, and welcome the
opportunity to clear up any issues. With that in
mind, I had a chance to speak with Dr. Mason on
May 28 and had a cordial and professional
discussion about his concerns. I hope we cleared
up any misunderstandings. We again offered our
help and support to Dr. Mason and his patients
and hope to be of assistance to them in the
future.

Lauretta M. Fernandez, LPed, Owner, Foot
Solutions, Largo, FL

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06/02/2012    Campbell White

Unethical Behavior by Foot Solutions (Dennis Shavelson, DPM)

There are a few errors in your rant that need to
be cleared up. You have described me as a CPed
and the national sales manager for the
Novascarpa Group. I am neither. I am not a CPed,
and I have never advertised myself as being one.
I briefly sat in as the interim national sales
manager for the Novascarpa Group, but that was
almost a year ago, and my responsibilities are
regional in nature.

The Chung Shi shoes you mention are not
distributed by the Novascarpa Group. They are
distributed by Michael Ertl & Associates in
Germany. They were briefly distributed by
Novascarpa for a few months, before being
transitioned back to Europe. Finally, I have
never been personally involved in any face-to-
face negotiations with Foot Solutions corporate
regarding the national or global distribution of
any of Novascarpa's brands.

I work with many comfort shoe and pedorthic
retailers in the Central United States. Among
these retailers are a handful of Foot Solutions
stores. Each one of these retailers that I have
visited operate under very high ethical
standards. They don't diagnose anything,
practice within the scope of their
certification, and stand behind their work. They
work their tails off at their stores, and are
respected in their community. What Dr. Lawrence
Rubin has witnessed in Las Vegas is exactly what
I am seeing in my back yard.

Dennis, you have also inferred that my YouTube
videos are a self-serving tool to make a buck.
Nothing is further from the truth. I have
produced over 100 YouTube videos covering a wide
variety of products that I have come across in
my travels that I believe could have potential
value for comfort or pain relief. I am not paid
for these videos, but I feel that is important
for the general public to be exposed to
potential solutions when I run across them.

I have produced short videos discussing Brooks,
Aetrex, Fidelio Hallux, Hoka One One, Alegria,
Extra-Wide Socks (edema), Deer Tracks, COFRA
work boots and a wide variety of other products
without compensation. I have also produced
videos for brands that I currently represent, or
have represented in the past (Joya, Ryn, Terox).
My reason for producing these videos is simple:
I believe that most people in pain are looking
for solutions, but they don't have a clue about
the options that are available to them. Footwear
and foot care technologies are constantly
evolving, and there are some excellent solutions
entering the marketplace. When I come across
these technologies, I will be sure to report
about them.

The easiest thing for me to do on this subject
would have been to say nothing at all. The point
I wanted to drive home in my initial response to
this topic was that Foot Solutions stores are
independently owned and operated. None of
the "unethical" allegations I have seen on this
topic are endorsed by Foot Solutions Corporate,
to the best of my knowledge. To complain about
one store and indict the entire network of
stores is unfair and irresponsible.

Pedorthic footwear retailers provide a valuable
service in their communities. Who else has the
knowledge to stock and fit quality footwear?
Without them, your patients in pain are
relegated to shopping at department stores and
figure out shoes for themselves. It's pretty
much guaranteed that they will choose the wrong
shoes, possibly in the wrong size. Unless you
are willing to invest thousands of dollars in
footwear styles and sizes, it's not bad to have
a store in your community that offers quality
brands, combined with proper fitting to help
provide the best outcome for your patients.

My wife and I owned a shoe store for nine years,
and we maintained strong referral relationships
with a network of podiatrists in Austin. Many of
our customers with self-diagnosed pathologies
were referred to local podiatrists to get a
proper diagnosis and treatment plan. A few DPMs
on this site were recipients of these patient
referrals.

Should I have been more forthright in disclosing
my relationship with a half-dozen Foot Solutions
retailers whom I respect? In hindsight, that
would probably have been a good idea. But I
wasn't thinking of profit when I wrote my
original post. I was coming to the defense of
about a half dozen individual business people
who pour their hearts and souls into helping
their customers enjoy life on their feet. To
suggest this is a grand form of collusion and
further evidence of unethical behavior is
patently false.

Cam White, Novascarpa Group, LLC,
camwhite.shoes@gmail.com