The Voice of Podiatrists

October 25, 2006 #2,723 Editor-Barry Block, DPM, JD

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35% of Diabetics Over 65 Have PAD: DE Podiatrist

Dr. Jason M. Bell, a Newark-based podiatrist, said diabetics who have not yet been diagnosed with PAD must be on the lookout for signs. In his experience, about 35 percent of diabetic patients over age 65 have PAD.

Dr. Jason Bell

Symptoms in the early stages of PAD include decreased temperature in the feet and loss of hair on the feet and toes. Leg pain is one of the clearest signs of PAD, but people sometimes mistake it for neuropathy. Neuropathy, however, is characterized only by a burning sensation, while PAD usually will involve pain with distinct muscle cramping.

"They'll wake up at night with cramping in their calves, and the only thing that will make them feel better is to hang their feet off the bed," he said. "That's how bad their circulation is."

Source: In-Sung Yoo, Delaware News Journal [10/24/06]

Screening Patient Calls May Be a Bad Idea

A new study casts doubt on the widespread practice of screening after-hours calls to physicians. Requiring patients to decide which problems are serious enough to deserve immediate attention and which can wait until morning is unrealistic and potentially dangerous, some experts say. It also may represent a little-recognized source of preventable medical errors, they add. The study was published in the current issue of the Journal of the American Board of Family Medicine.

Read the study http://www.jabfm.org/cgi/content/full/19/5/437

Source: Sandra G. Boodman, Washington Post [10/24/06]

The Uninsured: Many Believe Issue Should Serve As Top U.S. Priority

About 42% of U.S. adults believe the federal government should make the issue of the uninsured a top healthcare priority over the next two years, according to a new WSJ.com/Harris Interactive poll, the Wall Street Journal reports. The poll, conducted between Oct. 8 and Oct. 10, included responses from a nationally representative sample of 2,384 adults.

According to the poll, 42% of respondents cited "reducing the percentage of Americans without health insurance" as one of the top two health care issues, followed by Medicare reform (28%) and efforts to reduce out-of-pocket healthcare costs (26%).

Source: Wall Street Journal via American Health Line [10/24/06]

Query: Hookworm Parasite Infection

A 41 y.o. healthy female scraped her feet on the ocean floor in Cancun Mexico in June '06. After ~ 5 days incubation she had raised blistering lesions with itching and track marks in the arch and around the great toe L>R. She was treated by a dermatologist with one treatment of Stromectal (4 pills at one sitting). She then had a fever and full body rash. The episode resolved in ~1 week. She presents now, 3 months later with a faint non-raised outline of the hookworm on the left foot only and has no symptoms. She is concerned with nail discoloration. The distal 1/2 of all nails are yellow-brown with chalky texture and subungual debris similar to most dermatophyte infections of nails we see. There is no evidence of Tinea pedis and no other symptoms.

I'm curious about any known side- effects of Stromectal, if it comes in a topical or if there are any other anti-parasitic medicines that are available. Could the parasite, it's toxin or the Sromectal contribute to the nail changes or is it likely a secondary fungal change? I will be doing a nail scraping/culture next week.

Michael A. DeVito DPM, Oak Lawn, IL, devitodr2@sbcglobal.net

Query: Scanning X-Rays

I know there has been information about taking a picture of an x-ray with a digital camera and downloading it into the computer but is there any way to use a scanner to get the x-ray image into the computer. If anyone has had success doing this please say what equipment you use.

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

Query: E-Mailing Patients Bills/ Statements

A while ago I saw a posting or a discussion somewhere regarding the emailing of patient bills for unpaid visits or portion thereof, and monthly/weekly statements of their account.
Does anyone have any written information (citations, references) on the legality of this according to HIPAA?

Ken Katz, DPM, Oceanside, NY

Response: The HIPAA Security Rule provides, with relatively little explanation, that electronic transmissions over an open network (i.e., Internet email) of protected health information (PHI), which does include information in patient billing documents, must be done in a "secure" manner. Just sending an email is not considered secure per every expert I have read, heard speak, or worked with.

The following are 4 options I suggest, in order of preference:

1. Put the document containing PHI in Word or Excel format, password-protect the document (those programs have a feature that does this) and send it as an attachment to the email. The person on the receiving end can either have a standing password from you or you can call them with the password. They receive the emaiI and open the attachment with the pasword. Pretty low tech, but it works for many of my clients.

2. Where possible, remove identifiers (name, address etc.) from the email--if there are no identifiers, it is not PHI.

3. Create a secure website and require that all emails go in and out of that website (like your credit card company or bank). This is probably too high tech for most of us in smaller office settings.

4. Use encryption software. I don't see many folks doing this in the medical industry--too difficult to implement.

I guess the last option is not to use email, at least when such contain PHI.

J. Kevin West, Esq , Boise, ID

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RE: Hemochromatosis (Dr. Aronberg)
From: Bryan C. Markinson, DPM

Dr. Aronberg does not mention whether his patient is a child or and adult with established complications. This disease, manifested by very high iron deposition in body tissues, should be managed by a hematologist, gastroenterologist or hepatologist. The treatment is simple phlebotomy. How much blood letting must be done is individual to each patient, and is done for life. Podiatric manifestations would most probably be arthritis. If that occurs, even with treatment for the iron deposition, it is usually irreversible. Has anyone out there actually ever had a case with podiatric complications?

Bryan C. Markinson, DPM, New York, NY, Bryan.Markinson@msnyuhealth.org

MEDICAL EQUIPMENT WANTED

MinXray P-200 Exposure Hand Switch with Timer Control (circa 1977). jim.fractal@gmail.com

PRACTICE FOR SALE – FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice for sale. This one has everything. Surgery, Orthopedics, Pediatrics, Trauma, ER, General Podiatry. Participates in all local and national managed care plans. $850,000 but will discount depending on amount up front. Mature, serious inquires with business experience preferred. email response to podfootdocs@aol.com

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established podiatry practice in Mt. Airy, North Carolina that is either for sale or in need of an associate/partner to come on board to take over patient care. Dr. Hodges unexpectedly passed away in January 2006, leaving approximately 3,500 patients without a podiatrist to care for them. This is a unique opportunity to be able to begin work in an extremely busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

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