The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 23, 2012 #4,417 Publisher-Barry Block, DPM, JD

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Clarification

The caption for the photo in the "Residents in The News" section of yesterday's PM News should have read "Greater Texas Education Foundation supports the residencies sponsored by Kingwood and West Houston Medical Centers."

IL Podiatrist Recommends Runners Visit a Running Clinic Before Buying Shoes

Thousands of people will kick off Chicago’s running season this Sunday when they step out for the City’s most popular 8K race. Having the proper footwear will be important to protect their feet and prevent injuries, according to podiatrists at Loyola University Health System (LUHS). 

Dr. Katherine Schimka

“This is the first outdoor race of the season, so many people may attempt to run without properly preparing for it,” said Kate Schimka, DPM. “Preparation includes having the right shoes for your foot type and running style." Dr. Schimka, who will staff the medical tent at the 8K race, recommends that runners of all levels visit a running clinic before shopping for new shoes, so that a podiatrist can evaluate their gait.

NJ Podiatrist Embroiled in Lawsuit After Partnership Blowout

A plastic surgery center removed podiatrist Dr. Patrick Caputo from ownership and refused to return his share, saying he violated ownership rules by wooing a competing surgical center. The podiatrist sued the center to recover his investment. But when he questioned the veracity of the center's medical director in an e-mail to current owners, the medical director sued him for defamation.

Dr. Patrick Caputo

Interpreting the terms of the operating agreement, the trial court determined that Dr. Caputo should get his original investment back, plus his share of ASC profits, for a total of $37,000, which was about half of what Dr. Caputo sought. The court threw out the defamation charge but the plastic surgeon appealed the decision. The appeals court upheld the award of damages, but the money is being held in escrow until the defamation lawsuit is decided.

Source: Outpatient Surgery Magazine [3/20/12]

Medical Boards Discipline Physicians for Online Behavior

Most medical licensing boards have received at least one complaint about unprofessional online behavior by physicians, and many of these complaints resulted in serious disciplinary actions, including license revocation, according to a research letter published in the March 21 issue of JAMA.

The most common complaints reported include inappropriate communication with a patient, such as sexual misconduct, which was reported to 33 (69%) of 48 boards (95% CI, 58% - 80%); inappropriate practice, such as Internet prescribing without an established clinical relationship, reported to 30 (63%) of 48 boards (95% CI, 52%-74%); and online misrepresentation of credentials, reported to 29 (60%) of 48 boards (95% CI, 48%-72%). Thirty-one boards indicated that reports were made by patients or their families (31/48; 65%), and 24 (50%) of 48 boards said other physicians made the complaint.

Source: Jenni Laidman, Medscape Family Medicine [3/20/12]

Alleged Negligent Bunionectomy (MN)

Facts: On November 24, 2003, Plaintiff Jennifer B. Redmond underwent surgery while under the care of Defendants. The procedures involved a Chevron Bunionectomy, together with second and third hammertoe repair of the left foot. During surgery, Defendant, an orthopedic surgeon, resected the second left metatarsal head, contrary to any diagnosis indicating the necessity for such a procedure. Plaintiff alleged that defendant negligently performed an overly aggressive soft tissue release and, in doing so, deviated from the standard of care. The Plaintiffs alleged that defendant was negligent because of an alleged overcorrection of Ms. Redmond's hallux valgus.

Defendant denied plaintiff's claim. Overcorrection of a hallux valgus is a recognized risk of this surgery. Hallux valgus can occur even with good surgical technique.

Result: Jury verdict in favor of defendant ($0).

Plaintiff Experts: Richard A. Lochner, DPM, Crookston, MN, Scott R. McGarvey, MD, Orthopedics, Edina, MN, Fernando A. Pena, MD, Orthopaedics, Bloomington, MN

Defendant Experts: Troy J. Boffeli, DPM and Schelli McCabe, DPM    

Source: Mealey's Jury Verdicts & Settlements [ Dec 2011]

Full-Force Praise

While congratulating an employee on a job well done, you could simultaneously undercut the value of your words. Avoid making comments that diminish your praise. Hold your tongue to accomplish these goals:

•  Spotlight the employee’s role. Saying something like “I knew my idea would work” steals the credit. Reinforce what the employee did by inquiring “Tell me how you managed to do that.” Let the employee bask in the glory without your relating tales of your own accomplishments.
  • Treat them like professionals. Don’t make comments that the employee could consider condescending or offensive, like “You’re a really smart chick!”
  • Let the praise linger. If you immediately follow a compliment with a criticism or assignment, the employee has no opportunity to savor the moment. If you say “That was good, but you could have …” what comes after the “but” will negate the positive words.

Source: Adapted from “5 ‘Praise Erasers’ Reveal How Bosses Undermine Positive Feedback,” Jill Geisler, Poynter via Communication Briefings

Query: Delta Phalanx

My patient is a 9 y/o boy who has had a problem with his second toe. It appears to be a "delta phalanx", with frontal and sagittal plane deviation at the DIPJ. X-rays show open growth plates.

Delta Phalanx

What surgical corrective procedure would be best? I am hesitant in doing an FDL release at his age, and think a DIPJ arthrodesis/pinning would be best.

David Weiss, DPM, Richmond, VA

Query: Office Inventory Control
 
Dispensing medical items to our patients is convenient for them, as well as a potential profit source if done correctly. I would like to initiate better control of my office medical and DME supplies with some type of automated software program. Some companies will offer bar code and inventory control programs, but most are much too sophisticated for medical office purposes. Some medical supply companies offer inventory control systems, but you are limited to ordering the supplies from them, leaving you with no competitive purchasing price alternatives. I am interested in finding out what has been successful in other offices.

Jerry Cosentino, DPM, Tampa, FL

RE: CROW Walker vs. Patellar Tendon Brace (Jeffrey Kass, DPM)
From: Freddie Edelman, DPM, Jeff Mennuti, DPM

I have used the patellar tendon brace and found it VERY effective, but more difficult for the patient to put on.  

Freddie Edelman, DPM, N. Syracuse, NY, FOOTGRP1@aol.com

The CROW walker distributes weight from the entire foot. The PTB will distribute more weight from the heel. If you are treating a patient with Charcot of the heel, a PTB can be incorporated into a CROW. The PTB is only indicated for the heel ulcer, and heel off-loading. I reserve the PTB for those patients who are in calcaneus gait.

Jeff Mennuti, DPM,  Orange City, FL, dr.mennuti@gmail.com

RE: Appoint an Inspectress (Hal Ornstein, DPM)
From: Sam Bell, DPM

Back in the late 1960's, Dr. Leonard Hymes taught a wonderful practice management section at PCPM. One of the things he stressed was to sit in the exam chair and observe the treatment room from the patient's point of view, and then do the same with the rest of the office. 40 plus years later, it is still great advice.

Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

RE: Socks with Malleolar Padding? (Tip Sullivan, DPM)
From: Josh White, DPM

The Bauerfeind MalleoTrain is a knitted ankle support, which incorporates an anatomically-contoured silicone insert around each ankle bone. The lightweight, breathable knit will not retain heat and is completely machine washable.

Josh White, DPM, CPed, Safestep, joshwhite@ssafestep.net

RE: Taking X-Rays on Patients with Ingrown Nails
From: Jon Purdy, DPM, Neil A Burrell, DPM

In this day and age of tort law let off its leash, I don’t think anyone could fault a practitioner for taking an x-ray of a toe that has purulent drainage present for months. How many of us have taken out painful subungual spurs? They exist; so how are they diagnosed? In the art of medicine, there are very few of us that could throw stones at others in one area and not have them thrown back at us in others. Chronic nail infections and tented nails deserve a closer look. Taking x-rays on the majority of these is most likely out of line, but I would not be willing to incur a practitioner’s liability by drawing a line for them.

Jon Purdy, DPM, New Iberia, LA, jpurdy@mindspring.com

Twenty-two years ago, I was running late getting back to the office, so my nurse took an x-ray of the patient's toe to buy some time. The patient was the son of a plaintiffs' attorney. The x-ray showed an enchondroma which we  successfully removed. I have not taken an x-ray for an ingrown since then. This was the first and only time. That young patient is now a local plaintiffs' attorney. I see his parents out in public all the time. They never fail to thank me for taking such good care of their son 22 years ago. 

Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com

RE: ICD-10 Preparation (Jack Sasiene, DPM)
From: Michael Brody, DPM

In a post on March 19, Dr. Sasiene took one of my statements out of context. He quotes me as saying, "You need to have a fully DICOM- compliant digital x-ray system." That statement is in reference to making a decision when purchasing a new system. It is perfectly acceptable to send out referrals for radiographs to a radiology facility and receive DICOM files back from the x-ray facility.

My post was intended to give guidance when a podiatrist is considering upgrading or purchasing an x-ray system, and it was in the context of which software platform the digital x-ray system should utilize. If you want to be interoperable, and easily share images between your x-ray system and your EMR and with other doctors, then "You need to have a fully DICOM-compliant digital x-ray system." Purchasing anything else will result in limited functionality or the need to upgrade again in the near future.

Dr. Sasiene seems to think that I am posting doom and gloom, which is exactly the opposite of the purpose of my post. Many podiatrists realize the value of digital images, both from the ability to manipulate the images to allow for better diagnostic abilities to the ability to share those images, let alone the environmental benefits of not utilizing fixer and developer. I want to ensure that the doctors who select to go digital select a modality that is most in line with the path of meaningful use and interoperability.

Michael Brody, DPM, Commack, NY, mbrody@tldsystems.com

Codingline & PM News
In conjunction with AAPPM Present
The Greenbrier Coding & Practice Management Workshop - August 20-22
(Following the 2012 APMA Annual Scientific Meeting in Washington, DC)  

The Greenbrier, White Sulphur Springs, WV

Speakers: Harry Goldsmith, John Guiliana, Barry Block, Michael Brody, Paul Kesselman, Jonathan Moore, Rem Jackson, Chad Schwarz, and other nationally-known authorities. 

Earlybird Bonus Until April 1 - Save $50 

Click Here for information or to Register

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