The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 22, 2010 #3,838 Publisher-Barry Block, DPM, JD

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Losing Toenails is Occupational Hazard of Runners: MA Podiatrist

For many of the nearly 27,000 runners in the 114th Boston Marathon, simply getting to the starting line is an accomplishment. Crossing the finish line will be monumental — and, for some, painful.

Dr. John Giurini

Most common in the medical tent are blisters and damaged toenails. Friction is the culprit in both cases, from the foot sliding in the shoe or banging against the front of the shoe, said Dr. John Giurini, chief of podiatry at Beth Israel Deaconess Medical Center. Losing a toenail “is almost an occupational hazard for runners," he said.

Source: Elizabeth Cooney, Boston Globe [4/19/10]

IA Podiatrist Named Alumna of the Year

Dr. K. Linda Bratkiewicz was presented with the 2010 College of Podiatric Medicine and Surgery Alumna of the Year Award at this year’s Rite of Passage Ceremony April 10th on the Des Moines University Campus. She is a very well-respected member of the Alumni Community, and is very active in current educational activities with CPMS students, including acting as an attending for third-year student podiatric rotations. Dr. Bratkiewicz is a Board Certified Podiatric Surgeon with The Iowa Clinic, P.C. She received her DPM from the College of Podiatric Medicine and Surgery at Des Moines University – Osteopathic Medical Center in Des Moines, IA and completed her Podiatric Surgery residency at Broadlawns Medical Center in Des Moines.

Dr. K. Linda Bratkiewicz

Dr. Bratkiewicz is currently the Director of Podiatric Surgical Residency at Iowa Methodist Medical Center. She also serves in a number of leadership roles at The Iowa Clinic including Chair of the Compliance Committee, member of the Patient Care Committee and member of the Lakeview Surgery Center Medical Executive Board. Dr. Bratkiewicz is also active in many podiatric organizations including the American College of Foot and Ankle Surgeons, American Podiatric Medical Association, Iowa Podiatric Medical Society and the American Association of Women Podiatrists.

Source: Des Moines Register, [4/20/10]

More Doctors Are Prescribing Medicines Online

Doctors are increasingly prescribing medications electronically, abandoning the traditional paper scripts that can result in drug errors due to hard-to-read writing or coverage denials by a patient's insurer.

The number of e-prescriptions nearly tripled last year to 191 million from the previous year's 68 million, representing about 12% of the 1.63 billion original prescriptions, excluding refills, according to Surescripts LLC, whose online network handles the bulk of the electronic communications. The growth has accelerated. For the first three months of this year, nearly one in five prescriptions was filed electronically, Surescripts says. About 25% of all office-based doctors currently have the technology to e-prescribe, more than twice as many as at the end of 2008, Surescripts says.

Source; Timothy W. Martin, Wall St. Journal [4/20/10]

Alleged Unnecessary Surgery and Failure to Arrange for Covering Doctor (IN)

FACTS: In the early months of 1999, Andrea Vedope was suffering from a bunion on her right foot. She consulted on the matter with the defendant. On 5-27-99, Defendant performed surgery to remove the bunion. He used the McBride procedure, which realigned the toe after the bunion was removed. The surgery on Vedope appeared to be successful, and shortly thereafter defendant left his office to take a vacation of several weeks. He did not arrange for another podiatrist to be on-call during his vacation.

While defendant was on vacation, Vedope returned to his office and received follow-up care and an x-ray from an assistant who was neither a doctor nor a nurse. The assistant also changed Vedope's bandages. When Defendant returned from his vacation, he realized that during his absence Vedope had developed a "hallux varus" deformity.

Defendant promptly arranged for a second surgery to attempt to correct the hallux varus. The record does not describe the outcome of the second surgery. Vedope, however, was unhappy at having to undergo a second surgery at all. Vedope presented the matter to a medical review panel comprised of three podiatrists. They were Dr. Michael Helms of Indianapolis, Dr. Sandra Cho of South Bend, and Dr. Nelson Worden of Mishawaka.

According to Vedope, Defendant had breached the podiatrist standard of care by performing unnecessary surgery to remove her bunion in the first place and then by failing to make arrangements for follow-up care during his vacation. The panel's unanimous opinion was that the  defendant had not breached the applicable standard of care.

Vedope filed suit against Defendant and criticized his treatment of her as outlined above. Her identified experts included Dr. Lowell Weil, Sr., Des Plaines, IL. Interestingly, Dr. Weil was of the opinion that Defendant had not breached the standard of care in using the McBride procedure. However, Dr. Weil went on to say that it was a breach of the standard of care for Defendant not to have arranged for another podiatrist to be on call during his vacation.

Defendant defended the case and denied having committed any breach of the standard of care. His identified experts included Dr. Harold Schoenhaus of Philadelphia, PA.

Result: Defendant's verdict

Source: Indiana Jury Verdict Reporter  

Two Questions to Motivate Employees

Encourage others to reach their full potential when you ask them these two questions:

1) “Are you in the best position to make the greatest contribution to this practice?” 

2) “What do you need to learn so you can fully realize your capabilities?”

Source: Adapted from The Practice of Management, Peter Drucker, HarperBusiness, via Communication Briefings

Query: H&P Referral Requirement

One year ago, the only hospital in town started requiring a pre-op H&P on every patient scheduled for surgery. Prior to this change, the anesthesiologist performed these H&Ps in the ASC, while my H&P was accepted in the hospital itself.  Now the H&Ps are required to be performed by an MD. I am required to send every patient, no matter how healthy, back to an MD for this H&P. It’s not only frustrating and inconvenient, but costly and time-consuming for the patient. A subsequent by-law change allowed nurse practitioners to do H&Ps. Talking to the hospital is useless. Any suggestions?

Glenn McClendon , DPM, Conway, AR, gmcclendon@conwaycorp.net

RE: A Gratifying Day in My Office (Bryan C. Markinson, DPM)
From: Elliot Udell, DPM

Dr. Markinson raised an important issue with regard to examining a lesion out of the anatomic scope of practice of podiatry. In the original case presented, the patient had already had two opinions given by two doctors for which a belly lesion was clearly within their scope of practice. When I examined it, I clearly told the patient that this is not within my scope, and the opinion should not be taken as an official one.  Dr. Markinson's concern is quite valid. We have had past discussions in PM News about podiatrists who choose to do their own pre-op complete histories and physicals.
 
If a podiatrist palpates a belly or puts a stethoscope up to a person's chest, and misses cardiac or pulmonary pathology, could that podiatrist be accused of practicing out of scope? Would that podiatrist be held to the same standard in picking up systemic pathology as an internist or family practitioner? How would Dr. Markinson's concerns impact on a podiatrist doing a pre-op history and physical who chooses to include a full body skin examination with or without a dermatoscope? Perhaps some of our legal authorities could comment on these questions.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Editor’s comment: PM News does not provide legal advice. Dr. Udell’s questions again bring up the issues of scope of practice, degree, and licensure. We believe that podiatrists should operate under the same guidelines of all other allopathic specialties, that is with an unrestricted scope of practice, which is only limited by our education and training. This is one of the primary reasons we believe that podiatrists must someday be licensed as DOs or MDs. This necessary paradigm shift would also saves millions of dollars of APMA funds used to fight the never-ending battle to achieve parity.  

Until the colleges along with the leadership of this profession relinquish the concept of podiatry existing autonomously from these degrees, the answer to Dr. Udell’s life-saving question will remain legally problematic, as will Dr. McClendon’s H&P dilemma.

RE: Radiology Lab Performing Neuroma Injections (Alan Kalker, DPM)
From: Paul Kesselman, DPM

A recent article in Arthritis Rheum. (March 10, 2010) describes a randomized, controlled, double-blinded study of ultrasound guided corticosteroid joint injection in patients with inflammatory arthritis. This study revealed that ultrasonic guidance of needle placement for joint injections does improve the accuracy of needle placement. However, this does not translate into any significant improvements in patient outcome. The only lower extremity joints studied appropriate to podiatrists was the ankle. Other rear foot or forefoot joints were not addressed in this small study.  The small scope of this study and the lack of more extensive anatomical sites limits the reliability of this study.

There have also been some other articles in some radiology journals illustrating the efficacy of high dose dehydrated alcohol for neuroma injections.

The bottom line is that podiatrists need to publish more studies showing both improved accuracy of needle placement along with increased clinical efficacy for the smaller joints and soft tissue structures of the foot. The statement that these techniques improve needle placement are simply only one part of the equation. To not comment and/or react to this limited study does not bode well for future reimbursement of either fluoroscopic or ultrasonic guidance of joints and soft tissue structures (plantar fascia).

Paul Kesselman, DPM, Woodside, NY,  pkesselman@pol.net

RE: TN Podiatrist Supports Ban on Fish Pedicures (Leonard A. Levy, DPM, MPH)
From: Kathy Satterfield, DPM

I agree with Dr. Levy. I don't want to volunteer for any fish-nibbling on human studies either. But interestingly enough I did have a patient at a wound care clinic in Iowa who spent half the year in Tonga. He recalled (fondly, no less) resting his ulcerated foot in a pool to allow these small fish to debride away the ulcers. He recounted that they did "an excellent job," taking away only the necrotic and callused tissue. If there was any infected tissue they would take that as well.
 
I couldn't resist asking if anyone fished from those waters. Unfortunately, the answer was yes. He was quick to add though that he passed on those fish for his table. Thank goodness for some small favors. I swore off seafood for a long time.

Kathy Satterfield, DPM, Boerne, TX, vksatterfielddpm@aol.com

RE: Want to Join the Barefoot Running Club? (Ray McClanahan, DPM)
From: Ben Pearl, DPM

I have spoken to Chris McDougall regarding his book, and he is quite enthusiastic and translates his enthusiasm to the sport. There has not been a running book to hit the NYT best seller list since the days of Jim Fixx in the late 1970's, so good for him, and so good for running. There are no good controlled  studies on barefoot running - period. I have talked with runners who have gotten relief from various running injuries with the Vibram Five Finger Shoes. It is very difficult to tease out conclusions when comparing various running shoes.  I was disappointed that some recent work in the press by a Harvard PhD was not more substantive, but as Dr. Benno Nigg astutely puts it, “sometimes you catch attention with nice packaging.”

Ben Pearl, DPM, Arlington, VA, abenpearl@netscape.net

Editor's note: This topic is closed. No more letters will be accepted on this topic.

ASSOCIATE POSITION – GEORGIA

Immediate opening for a surgically-trained individual for associate position in northern suburb of Atlanta. Hospital privileges available. Position could lead to partnership or purchase of practice. Send resume and CV to pd751@hotmail.com

PRACTICE FOR SALE - MAINE

SEEKING ASSOCIATE POSITION – WESTERN STATES

PSR-36 trained podiatrist seeking position in western states esp. CA, WA, or UT (Current licenses in these states). Finishing a sports medicine fellowship in July. Patient-oriented and ethical podiatrist. Ideal situation would be mutually beneficial relationship with a diverse practice. Please contact me at sportsmedpod@gmail.com

PRACTICE & BUILDING FOR SALE - MIDDLE TENNESSEE

Two locations each with 3 exam rooms, x-ray room, large waiting room, and ample parking. Excellent locations and growth potential. All equipment and furniture included. Website and marketing material included. Seller happy to assist with transition. Priced to sell with financing available 250k. Call 931-446-5724.

ASSOCIATE POSITION – NEW YORK

Podiatrist Needed Immediately - RFC only. $45/hr working for the state prison system. Clean and safe. Easy money to help pay the bills. Several shifts available. If interested, E-Mail hansfeet@aol.com

ASSOCIATE POSITION - TUCSON ARIZONA 
 
Full-time position which involves all phases of podiatry.  Compensation based on training and experience. Must have current Arizona podiatry license. Send Resume to Transcription697@aol.com

ASSOCIATE POSITION – MICHIGAN

Well established practice in Southeast Michigan suburbs seeking full time associate. Must be ethical, personable and professional. This is a solid opportunity for a PSR-36 graduate or experienced practitioner. Must be able to diagnose and treat everything from general podiatry to reconstruction of severe deformities of the foot and ankle. The practice is currently maintained by two board certified surgeons. This practice is residency affiliated. Please forward current location and availability with C. V. to HKANEDPM@gmail.com

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

ASSOCIATE POSITION - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com Texas Podiatry License Required.

ASSOCIATE POSITION - SOUTHWESTERN PA

Suburban Pittsburgh. To work in an established practice and also a new office scheduled to open in August 2010. Future partnership buy-in possibilities. Rearfoot credentials needed to expand the established practice, and to maximize the potential in the new practice. Competitive salary, benefits. 724-337-4433.

FULL-TIME PODIATRY OPPORTUNITY - BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.com

HOME FOOT CARE PHYSICIAN NEEDED-LOS ANGELES, CALIFORNIA

Honest, caring, hard-working podiatrist needed to make visits to homebound patients, facilities, etc. for Home Foot Care, Inc. Part-time position, flexible hours, independence and excellent compensation. If interested email CV to homefootcare@hotmail.com or call Terri at 323-353-8103.

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