The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 16, 2009 #3,728 Publisher-Barry Block, DPM, JD

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MO Podiatrist Prefers Conservative Approach to Foot Problems in Seniors

We may focus more on our bodies above the ankles while we’re young, but as time goes on, our feet become a lot more important. There’s nothing worse than walking around on sore feet, and seniors are just naturally prone to foot ailments. “I find that seniors’ most common complaints are bunions or hammertoes that have been untreated for some time,” says Dr. John Holtzman, a podiatrist with Missouri Foot and Ankle at St. John’s Mercy Medical Center. Fungal infections of the nails, dry skin, and arthritis also appear more in older patients.

Dr. John Holtzman

Holtzman takes a conservative approach in treating these common complaints. “Shoes should have wide toe boxes and be made of soft leather. A soft, over-the-counter orthotic also may help with some types of deformities. And it’s important to go to a shoe store where knowledgeable staff properly measure the feet.”

Source: Ladue News

VA Podiatrist Organizes Shoe Drive for the Needy

Charlottesville foot doctors are collecting shoes for those in need this winter. The Let Someone Fill Your Shoes campaign will be in full force through January. It's an annual event where podiatrists collect usable shoes. Organizers hope to collect 4,000 to 5,000 pairs of shoes.

Dr. Samuel Schustek

Dr. Samuel Schustek, a shoe drive organizer, says, "All year round, we see people who are in need of proper fitting shoes and then through the work of the Salvation Army, we have identified individuals that need proper shoe gear to prevent things like frost bite, infections, sores."  To date, more than 80,000 pairs of shoes have been collected.

Source: WVIR-TV [12/14/09]

Facebook Privacy Revisions ‘Sign Post' for Healthcare

Facebook, the global phenomenon in Web-based social media, rolled out a massive overhaul of its privacy protection policies and technology this week—and in so doing, may have drawn up a playbook for healthcare as well, industry experts say.

The Facebook privacy upgrade gives its 350 million worldwide users increased control over who has access to some of, but not all, the information on their personal pages. These new, so-called “granular” controls—specifically those embedded in the site's “publisher” function, which enables a user to post new material to his or her Facebook pages—reach down to the level of discrete data elements. The new controls, for example, allow a user to restrict who gets to see each newly posted photo or typed comment.

The new Facebook standards, healthcare experts say, reflect a growing, cross-industry cultural norm toward more individualized control of electronic personal information that likely will be upheld by healthcare IT policies and systems. The Facebook revisions, they say, also demonstrate to the healthcare industry that personalized controls can be deployed on a massive scale.

Source: Joseph Conn,  Health IT Strategist [12/11/09]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What dermatologic tools should every podiatrist have? 

Dr. Bryan Markinson

Bryan Markinson: For non-cancer skin issues, everyone should have a magnifying glass. You would be shocked by what a simple 10X lens can show you as opposed to the naked eye. Practitioners should be comfortable doing a skin scraping, certainly a punch biopsy or shave biopsy. They should be able to take photographs, not only for documentation purposes, but for comparative purposes from one visit to the next, or to determine if complete resolution of a lesion has occurred. It is really not expensive to do dermatology in the office.
 

Dr. David Novicki

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's show features podiatric surgeon, Dr. David Novicki. You can register for this event  by clicking here

Query: Collections of Small Balances
 
I was wondering what others were doing to collect small balances that were outstanding (co-pay, co-insurance, etc.). The collection agency I've been using will no longer handle any accounts with balances less than $100. I have shopped around and I can't seem to find anyone who will handle small balances. I've been told that small balances can be handled by office staff through small claims court, but that seems like it wouldn't be worth the effort.
 
Anas Khoury, DPM, Passaic, NJ
 

Query: Disgruntled Employee

We had to let an employee go a few months ago for poor job performance, and possible patient endangerment. She is now asking for her personnel file and a copy of our office policies and procedures (which she already has).

Are we obligated to provide her with a copy of her personnel file? I have had others tell me that this is something we only need to do if it is requested by an attorney. Any advice would be appreciated.

Name Withheld by Moderator

Response: Employment issues are generally covered under state law, so the first step is to check with an attorney in your state as to your legal responsibilities. In general, when you get a request like this, it is usually best to send the requested the material. This is especially true when none of the records you have would be damaging or incriminating to you.

If you refuse to send these records, you may inadvertantly create a situation where you force the employee to contact an attorney, who can then sue you to force you to turn over the records anyway. Again, in a matter like this, consulting with an attorney in your state is the prudent action to take.

Barry Block, DPM, JD, Forest Hills, NY

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RE: The Prescribing of Uric Acid Lowering Drugs (Elliot Udell, DPM)
From:  Multiple Respondents

I don't know a lot about the practice and referral patterns across the country, but I do know that the vast, vast, number of patients that I get in my practice with gout are referrals from primary care. "Looks like gout, go see Dr. Sullivan." Many of those referrals come from what I call "doc-in-the-box" practices, but many of my older private practice referring docs send me acute gout. They know that podiatrists are the best at treating "foot" problems and I believe they, like many podiatrists, do not always look into the depth and breadth of the issue.

I basically do as has been suggested: make sure that I am happy with the diagnosis. If I feel like there is any debate, I will do the diagnostic tests, give them immediate relief (limp in-leap out) via intra-articular injection (which after reading previous comments I may change to phosphated form), make sure that they are trying to stick to their diet, and send a note to the primary care physician that may or may not recommend long-term uric acid management.

Patients are very pleased with the relief. They see me as their savior. Every acute attack that I treat comes back to me. I evaluate their management and send them back to primary care with very humble suggestions.

On another sub-issue of podiatrists treating systemic diseases, I have had several complaints about podiatrists in my area treating obesity with medication and diets and the claims that they are doing it as a method of treating foot complaints. Has anyone heard of this before?
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net
 
In the past, I had always referred patients back to their PCP once I got the acute attack under control. Lately, I've had several patients who were not properly managed by their PCP and I felt I had to take over. Several patients who were given 100mg/d. allopurinol with no other treatment, continued to have problems until I took over.  Others are given 300mg allopurinol right off the bat and either stopped from side-effects or needed more than 300mg/d. Some never even had their uric acid tested! 

After baseline uric acid testing, I start with 100mg/d x 1 wk, then 200mg/d x 1 wk, then 300mg/d x 1 wk.  After 3 wks, the uric acid is checked again to adjust the dose to keep UA equal or less than 6. If there are any questions or problems, I send them right over to the rheumatologist. 

It is a good question whether we should be managing gout as podiatrists, but what can we do when they are not being properly managed by their PCPs?

Tom Silver, DPM, Minneapolis, MN, tsilver01@juno.com

The issue of whether or not we, as podiatrists, should be prescribing these agents has nothing to do with scope of practice. It has to do with good medicine. Many patients with gouty arthritis have or will have co-morbidities. We should get them through an acute attack and treat that pedal manifestation. If we manage them subsequently with uric acid lowering agents, are we prepared to treat the renal manifestations that might evolve? The management of their steady state uric acid levels is best left in the hands of their primary physician. He/she will appreciate your efforts and respect your medical judgment.

Thomas A. Graziano, DPM, MD, Clifton, NJ, tgrazi6236@aol.com

RE: Strengthening the Feet Will Not Correct Biomechanical Problems (Bruce Williams, DPM, Stephen Pribut, DPM)
From: Ray McClanahan, DPM

I had a look at the link provided by Dr. Williams, and it appears as if the principal investigator in the study I referenced is in the development process of a barefoot mimicking shoe called BOGS. Good for him! If Dr. Williams had read the 60 articles that the investigator referenced, which helped him decide to go into the development process of his new shoe, Dr. Williams probably would ...

Editor's note: Dr McClanahan's extended-length letter can be read at: http://www.podiatrym.com/letters2.cfm?id=31214&start=1

RE: WV Podiatrist Arrested on Drug Charges
From: Bhavin Mehta, DPM

I am not sure what purpose PM News serves by posting a picture of a man being arraigned on drug charges. This listserv should strive for and maintain a higher level/quality of disseminating medical information/education. I don't know this fellow, and I am certainly not condoning what heallegedly did because it is WRONG. But, I would like to think that most other PM News readers read  this newsletter to learn from fellow practicioners on how best to take care of patients and advance our field. Posting a picture of a podiatrist being arraigned just adds fuel to the argument that podiatrists love to see other podiatrists fail,we  and is simply embarassing.

Bhavin Mehta, DPM, Warm Springs, GA, tarheel72@hotmail.com

Editor's comment: We understand Dr. Mehta's point and are always anguished to see a fellow podiatrist in trouble. We don't think that most other podiatrists love to see such photographs.   PM News is a newsletter, and thus one of our primary functions is to disseminate news to let the podiatric community know what is happening. This is what every major newspaper, television, or radio station news program in America does. We obviously prefer to publish positive news stories about podiatrists, and if you check the last 3,727 issues, you'll find that over 99 percent of our stories fall into that category.

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

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

ASSOCIATE POSITION - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. Fax cover letter & CV to (843) 208-3348 or E-mail to melissafoot@pol.net

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

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 Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

PRACTICE WANTED- NYC/LI AREA

I am an ABPS board certified podiatrist seeking to purchase a well established practice. I am looking for the current practitioner to help with the transition. All offers will be considered. Complete confidentiality will be upheld. Please contact poddr45@yahoo.com for more information. This advertisement is not affiliated with a broker.

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 f-massuda@footexperts.com

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.

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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