The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 21, 2009 #3,654 Publisher-Barry Block, DPM, JD

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Diabetics Need to Check Feet Daily: MI Podiatrist

We tend to take our feet for granted, especially when they don't hurt. But for those with diabetes, a minor scratch or bruise can become a real issue. That is why Battle Creek Health System took part of a state-wide foot screening program recently to bring public awareness to conditions of the feet.

Dr. C. William Wentworth, left, performs a foot inspection during statewide screening.

"Because people with diabetes often lose some feeling in their feet, what seems like a small problem like a blister or splinter can lead to serious complications," says Dr. C. William Wentworth, a member of the BCHS medical staff and a Battle Creek podiatrist who volunteered his time to do foot exams. "Everyone should check their feet periodically, but diabetics should do it every single day."

Source: Battle Creek Enquirer [9/17/09]

Shin Receives APMSA National Outstanding Podiatric Medical Student Award

Laura Shin, fourth-year student in the  Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, was selected as the 2009-2010 American Podiatric Medicine Students’ Association (APMSA) National Outstanding Podiatric Medical Student of the Year. In this first-time award, student body presidents at each of the eight podiatric medical schools across the nation selected Shin for her outstanding academic and research achievements.

Laura Shin

Shin, a native of Highland Park, IL, is also the current President of the Executive Student Council at Rosalind Franklin University. Previously, she was President of the Scholl College Chapter of American College of Foot and Ankle Surgery (ACFAS). “Laura Shin is an exceptional student who has distinguished herself in her studies, research and professional leadership,” said Terence Albright, DPM, Dean of the Dr. William M. Scholl College of Podiatric Medicine.

Shin is completing the first-ever DPM/PhD degree at Rosalind Franklin University, working on a research project that will study the possibility of using adult stem cells to treat the foot ulcers that often plague diabetes patients, putting them at risk of amputation. In pursuing that goal, Shin recently won the notable support of the American Diabetes Association. The ADA awarded Shin a three-year Clinical Scientist Training Award, funding her research in the field of podiatric medicine along with her tuition and research program costs.

Slow Down Your Listening

How many times do you find your mind wandering when someone is talking to you? No, you're not abnormal. And you don't have an attention deficit disorder. Most people speak at an average of 120 words per minute. But most people can listen about four times faster.

So, your mind fills in the gaps by thinking of other things. Be aware of this and slow down your listening. Force yourself to stay focused, so that you can really comprehend everything that the speaker is saying.

Source: Communications Solutions

Query: Alarming TENS Complication

I recently prescribed a TENS unit for a patient who is suffering from CRPS. She obtained relief from her pain, however, she suffered  from migraine headaches. This response was attributed to the fact that she used the device all day long initially. She stopped using the device for a few days and the headaches went away.

She resumed using the device three times daily for 30-45 minutes, and has encountered a new problem---whenever she enters or leaves a store that has an electronic wearing device for shoplifters, she sets off the alarms. She has left her handbag at home and was sure not to wear any metal on her clothing, yet she continues to set off the alarms. Has anyone heard of this type of response?

Frank DiPalma, DPM, Athens, GA

Query: Hearing-Impaired Patients

I had a patient call the office for an appointment.  We were informed the patient was deaf and that we were to arrange for an interpreter for the patient. The cost to me was $100.00 for the 1st hour. I understand that I am legally responsible to provide an interpreter but my question is am I legally obligated to see the patient as the patient has not been seen before. What if I had seen the patient once before 15 years ago? Do I have any right to not enter into a doctor-patient relationship with the patient or does the call/appointment constitute a relationship? My staff did offer the patient an appointment not knowing.

Alan Mauser, DPM, Louisville, KY

Editor’s comment: PM News does not provide legal advice. This topic has been discussed in this forum many times. The long and short of it is that legally and ethically, one cannot deny patient care on the basis of a patient’s disability or to any patient in a “protected class.” Under the Americans with Disabilities Act (ADA), a doctor must make reasonable accommodations for disabled patients. This is generally determined on a case-by-case basis, dependent on the degree of hearing loss of the patient. If the patient is profoundly deaf and insists on an interpreter, the doctor must pay for this.

RE: Burning Pain, Plantar (Robert Bijak, DPM)
From: Barry Mullen, DPM

Clearly, there is not information provided to make a definitive diagnosis. Dr. Bijak is spot-on with comments in his post. Burning pain descriptors generally signify vascular or neurogenic etiologies. From a vascular perspective, despite the presence of palpable pedal pulses, beta blockers create over alpha stimulation of the peripheral nervous system, causing vasoconstriction. The burning discomfort that is aggravated by activity, because of the increased blood flow required by the lower extremity muscles at those moments, during the presence of over alpha stimulation and concurrent vasoconstriction, could cause your patient's burning discomfort. It fits from the limited information Dr. Ross provided.

Empirically, I would discuss this possibility with the patient's cardiologist and see, for a short period of time, what substituting the beta blocker's effect has on your patient's symptoms. If there is no improvement, then move on to neurogenic etiologies and delve back into the patient's history...e.g., low back pain, ETOH abuse, lethargy (anemia), etc. If nothing is discovered, run the blood work needed to rule out the various causes of metabolic peripheral neuropathy.

Barry Mullen, DPM, Hackettstown, Nyazy630@aol.com

RE: Implant Data (April C. Borchardt, DPM)
From: Michael Turlik DPM

Cook, et al.'s meta-analysis (1) indeed is interesting and is undertaken with significant rigor in the design, research, article acquisition, abstraction and analysis of the quality of the articles. Unusually sophisticated for a podiatric publication, the authors should be commended for their scientific approach. The result is, of the 47 articles included in the meta-analysis, only one was a randomized controlled trial. The majority of the articles were observational studies and exhibited significant heterogeneity. Whether the data should be combined in a meta-analysis with this level of heterogeneity certainly is debatable. This is always the most interesting part of any systematic review.

The publication was assigned a level-1 clinical evidence rating by the Journal. I am not very familiar with levels of clinical evidence ratings (2), but more familiar with levels of evidence (3). Level-1 evidence for therapeutic interventions involves randomized controlled trials. Less rigorous study designs correlate with lesser levels of evidence. Regardless of how rigorous the systemic review is designed and executed, it is only as good as the underlying studies found.

With all due respect to the authors and the journal editors, it is my impression that the article is not a level-1 study, but something less; therefore, the inference drawn is not as strong. My conclusion after reading the article is that there does not exist sufficient level-1 evidence to make decisions about the efficacy of first metatarsophalangeal joint implants, and that more rigorous studies are needed to definitively answer the question.

1. Cook, et al. Meta-analysis of First Metatarsophalangeal Joint Implant Arthroplasty. JFAS 2009; 48(2): 180-190.
2. Malay S. Levels of Clinical Evidence. JFAS 46:63, 2007.
3. Levels of Evidence. http://www.cebm.net/index.aspx?o=1025. Accessed 9/19/2009.

Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Social Networking and Podiatry (Nicholas Pagano, DPM)
From: Multiple Respondents

Social media can be useful to maintain a connection with your patients, but I understand your dilemma and there are a few alternatives you may want to pursue. First of all, you can create a "Fan Page" for your practice. The fan pages have much of the functionality of the personal pages, but without your personal information being spread around. 

It's also a good idea to form your contacts on your personal page into groups. You can then designate which groups can see a certain post, and which to exclude. I do have patients as friends of my personal page on Facebook, but use this function if I need to. I also have a fan page, where anyone, patient or not, can become a fan.

Whatever you choose, I give you a lot of credit for considering social media as a way to maintain a relationship with your patients.

Andrew Schneider, DPM, Houston, TX, ajsdpm@aol.com

I would set up two Facebook accounts. Make the one you currently have with your name a  public podiatry one. Encourage your patients to “friend you” and you can share foot tips, etc. It is free publicity and will get you some patients. Set up your profile, saying you are a podiatrist and people in your town will find you.

Set up a private one that has a different name and use that privately - just give your friends the new name.
 
Al Musella, DPM, Hewlett, NY, musella@aol.com

I share Dr. Pagano's concerns about maintaining boundaries between my private and professional personas.  We are all entitled to privacy and should not feel bad about exercising those boundaries for our own comfort and protection. I know several doctors and other professionals who are meticulous about their web presence and will not join any such sites.  For my own comfort, I created a Google alert for my name.
 
However, social networking is here to stay, so I am certain successful practitioners will find a way to embrace it. My suggestion would to be to create a practice page. Explore the various formats by looking at restaurants, and other companies you do business with. Facebook offers personal pages and pages for organizations, event and businesses that allow members to become Fans, rather than friends. In this way, you can offer patients a way to connect to you professionally without opening the door to your personal life. I can see this as a very potent way to keep your name in front of your clients and spread the word - exponentially.
 
Another avenue I love is LinkedIn. I am amazed there are so few podiatrists using this powerful business networking and business development tool.
 
Peta Minerof, DPM,  Chicago, IL, Pminerof@aol.com

RE: LocalPodiatry.com (Kyle J. Kinmon, MS, DPM)
From: Steve M. Eng, DPM, Michael Nirenberg, DPM

I too had a similar exerience with LocalPodiatry.com. I did get a credit to my account since my balance was not that large. I did, however, end my relationship immediately. I too was charged for hang-ups and for calls that had no relationship to my practice. I practice with a multispecialty group, and they recorded a call for a patient's refill request for birth control...and charged me for it! Their technology is full of flaws, and I'm afraid that HIPAA violations may have been committed. For all those who use this service...beware!  
 
Steve M. Eng, DPM, Aliso Viejo, CA, smedpm@msn.com

I was sorry to read about Dr. Kinmon's horrible experience with LocalPodiatry.com.
 
I, too, had problems with this outfit and cancelled service. I hope other podiatrists do not go through the aggravation that I and Dr. Kinmon's experienced with LocalPodiatry.com. 
 
Michael Nirenberg, DPM, Crown Point, IN, michael.nirenberg@sbcglobal.net

RE: Obama’s Healthcare Plan (John Moglia, DPM)
From: Pat Caputo, DPM

Do not confuse the Medicare Program with paying $13,000/year in premiums for real insurance for a family plan. Medicare is not a real insurance plan, and only works because it is a giant pyramid or Ponzi scheme. The SEC has a website devoted to "pyramid" and "Ponzi schemes" {sec.gov/answers/pyramid.htm } {sec.gov/answers/ponzi.htm}.  Quoting the SEC website, "The Ponzi scheme continues to work on the "rob-Peter-to-pay-Paul" principle, as money from new investors (working people paying taxes) is used to pay off earlier investors (retired people) until the whole scheme collapses." (My additions parenthetical).
 
I try to tell my Medicare patients that the money that they paid into the system is essentially gone, and was used to pay their parents’ Medicare expenses. The money that is used to fund their care today is from today's working people. We are robbing Peter (the workers) to pay Paul (the retirees). If we enlarge the Medicare system beyond the retired people, this pyramid will undoubtedly collapse, and very possibly with it, our entire economy. If WE THE PEOPLE cannot afford healthcare, do not think that WE THE GOVERNMENT can! 
 
Pat Caputo, DPM, Holmdel, NJ, capstops@aol.com

ASSOCIATE POSITION (SURGICAL) – CONNECTICUT

Connecticut Surgical Group is seeking a Board-Certified podiatrist to add to our Surgical Podiatry division based in Central Connecticut. This podiatrist will provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. We require PSR-36 training and board certification or eligibility, excellent surgical and wound care skills, a strong focus on providing compassionate care to our patients, and the ability to work as part of a team in a group practice setting. To apply please visit our website . EOE

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

ASSOCIATE POSITION - CHICAGO AREA

Well-established, state of the art medical-surgical podiatry practice seeking well-trained motivated individual to work full-time with future partnership possible. Will start with full schedule. PSR-24 a minimum. Email resume to Howard4624@gmail.com

ASSOCIATE POSITION – NYC

Expanding Joint Commission Accredited Surgical and state of art medical podiatry practice seeks part-time ABPS Qualified/Certified podiatric surgeon on two weekdays in Flushing, Queens and on Saturday's in Midtown, Manhattan. Email CV and cover letter to EcksteinDPM@AOL.com

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

LOCUM TENENS POSITION – PHOENIX, AZ

Locum Tenens position available in West Valley Phoenix office beginning September 15th. Salary negotiable. One to two days a week in a friendly and casual office. Please direct all inquiries to drlaurel@cox.net

EQUIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $8k. OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - HAMPTON BAYS/LONG ISLAND, NEW YORK

Growing Suffolk County podiatric practice seeking a part-time associate that could lead to a future partnership opportunity. The ideal candidate must be highly motivated, have excellent communication skills, be flexible and have exceptional clinical abilities. We are a 15+ year well-respected established practice. If you are interested, please fax your current resume in confidence to: Wendy at (718) 723-5627 or via e-mail: Wendymakarowitz@aol.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION – CENTRAL FLORIDA

Growing practice east coast of central Florida looking for full or part-time associate willing to buy into practice. PSR 24/36 Please contact: pfk4@yahoo.com.

ASSOCIATE POSITION -  WASHINGTON, DC 

Interested in working in Washington D.C.? Our group is looking to add a highly motivated, hard working, well trained podiatrist to our practice. Must have surgical training. We have a very busy multi-office practice. We practice state of the art podiatry with EMR and digital radiography. Associate to partner on a fast track for the right person. E-mail CV and cover letter to Washingtonpod@aol.com

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