|
|
|
|
|
Search
05/27/2019
RESPONSES/COMMENTS (PM NEWS ARTICLES)
From: Allen Jacobs, DPM
The article on practice guidelines authored by Lawrence Kobak and featured in PM is interesting from a “legal perspective”. What is not discussed is the issue of practice guidelines utilized as manipulative efforts by corporate entities to gain market share and encourage irrational product use. As an example, some years ago, Advanced Biohealing paid for a panel of alleged thought leaders to develop “practice guidelines” for the treatment of DFUs. The panel of paid “experts” included the use of products such as Dermagraft (manufactured and distributed by ABH). Following this publication of this guideline, ABH paid attorneys to lecture at podiatric seminars. These lawyers suggest that not following these guidelines was equivalent to malpractice. On two separate occasions, I was asked (but declined) to testify against podiatrists who failed to utilize Dermagraft in the treatment of patients with less than optimal outcome in the treatment of DFUs.
In my opinion, we are witnessing the same evolving issue. Guidelines can be generated by quasi-authoritative bodies, such as the ambulatory surgery group to which the author of this article is a member. How many readers of PM would do an elective extensor halluces tenotomy for non-neurological hallux IPJ extension deformity causing a nail dystrophy? Yet this is a recommended procedure by certain “guidelines“.
Each patient represents an individual compilation of facts, findings, and circumstances. Best evidence guidelines are general recommendations to be modified as appropriate in each and every case. Most importantly, they are not "standard of care". We must remember that in science, today’s truth may be tomorrow’s fallacy.
Allen Jacobs, DPM, St. Louis, MO
Other messages in this thread:
06/12/2020
RESPONSES/COMMENTS (PM NEWS ARTICLES)
From: Rich Bouche, DPM
Concerning Kenneth Rehm’s response on 6/11/20 to my original Setting the Record Straight post, I would like to thank him for his post, though I have few comments concerning his post which may be helpful to Dr. Rehm and readers of PM News as we all move forward.
In the second paragraph of his email, Dr. Rehm lists five physicians (Drs. Sheehan, Gilbert, Pagliano, Barnes, and Subotnick), who he ultimately refers to as “forefathers” of podiatric sports medicine later in his email. He rationalizes the use of the term "forefathers” for all the physicians listed because...
Editor's note: Dr. Bouche's extended-length letter can be read here.
02/21/2020
RESPONSES/COMMENTS (PM NEWS ARTICLES) - PART 1
From: Alan Sherman, DPM
The always reasonable Elliot Udell asks, “Why has dentistry has been able to maintain clearly defined specialties and podiatry has not?” Podiatry as a profession does have de facto sub-specialties, carved out by the individual podiatrists and supported by some excellent specialty societies. Ones that come to mind are the American College of Foot and Ankle Pediatrics, spearheaded excellently by Louis DeCaro, DPM, the American Society of Podiatric Dermatology, so ably lead by Joel Morse, DPM, and the American Academy of Podiatric Sports Medicine. There are groups in podiatric forensics, MIS surgery, and other sub-specialty areas.
There are podiatric fellowships in advanced foot and ankle surgery, sports medicine, wound care, limb salvage, dermatology, and infectious disease. I have been strongly advocating for a greater tolerance and support of diversity for podiatrists, particularly in our residency training programs. Putting ALL podiatrists through intensive surgical training programs ignores the fact that the country needs ALL of these kinds of podiatrists to best meet our public health foot care needs. All the time that we are requiring podiatric residents to be focusing on surgery during their 3 years is taking time away from training that they could be having in these other sub-specialties. THAT, Dr. Udell, is part of the answer as to why we are different than dentists.
Alan Sherman, DPM, Boca Raton, FL
10/22/2019
RESPONSES/COMMENTS (PM NEWS ARTICLES)
From: Ira Baum, DPM
I agree with most of Dr. Sherman’s assessment regarding a single certifying board. Structurally, it’s a sound solution - a single certifying board and sub-specialty boards for our sub-specialties. However, will it solve the issue of recognition by the public that podiatrists with specialty training are differentiated from “podiatrists”? Dermatologists, vascular surgeons, gastroenterologists, etc. are identified by their specialties; their general medical degree is assumed.
I question whether the public will identify a podiatric foot and ankle surgeon as simply a foot and ankle specialist, or a podiatric dermatologist as simply a dermatologist of the lower extremities, particularly when there are orthopedic foot and ankle surgeons and MD/DO dermatologists. It seems to me the least confusing solution is a single certifying board... the allopathic or osteopathic certifying board with a sub-specialty for podiatric medicine (lower extremity medicine), if necessary.
Ira Baum, DPM, Naples, FL
09/28/2019
RESPONSES/COMMENTS (PM NEWS ARTICLES)
From: Howard Osterman, DPM
The recent article in PM News from Podiatry Management Magazine represents an inaccurate picture of the American Academy of Podiatric Sports Medicine (AAPSM) and the American Board of Multiple Specialties in Podiatry (ABMSP). The Academy has not been involved with their [certification] process. Dr. Rehm and his team have approached us on many occasions and have been rejected by our Academy. They have been undeterred and have opted to use the names of many of our esteemed Academy members and our Executive Director Rita Yates in their promotions.
I am current president of the Academy and resent the liberties taken. I have discussed this personally with Dr. Rehm. I explained that Fellow status in the AAPSM currently presents the highest level of education to promote our profession. I do not believe that the certification status at this time provides any tangible value, but people are free to make their own assessment. Anyone who attended our recent stand-alone meeting in Cambridge, MA, or any of the previous seven stand-alone meetings, knows that our Academy provides the best level of sports medicine education our profession has to offer.
Howard Osterman, DPM, AAPSM President
05/31/2019
RESPONSES/COMMENTS (PM NEWS ARTICLES) - PART 1B
From: Steven J. Kaniadakis, DPM
Clinical practice guidelines can also be used to determine what is considered appropriate covered services. In 2000, the federal government's expert referenced the "Practice Enhancement Manual for the Podiatric Physicians" in its case against me. Included with this was the so-called Global Surgical Task Force Report (1996-99), which was a report from the APMA. The expert did not directly refer to the AMA's CPT ® code book. I did not find this out until the trial against me.
Thus, the authoritative source was not the AMA's code book. Instead, it was opinions from these other resources that went back to the jury room. Despite the jury request for the AMA CPT code book, it did not go back to the jury room. In short, what the jury saw was a paid for (commercial) report, with advertising and sponsors, which was presented to the court and grand jury instead of the authoritative source, the AMA's code book.
Steven J. Kaniadakis, DPM, Saint Petersburg, FL
05/28/2019
RESPONSES/COMMENTS (PM NEWS ARTICLES)
From: Don Peacock DPM, MS
I agree with the post written by Dr. Allen Jacobs, DPM that some corporate entities can unduly influence where and how money is exchanged. However, he seems to be guilty of the same in his post. He is giving opinion and assessment not based on facts, but merely a flawed view.
He calls the “ambulatory group”, now known as the Academy of Minimally Invasive Foot and Ankle Surgery, a quasi-authoritative group. This is unfair. He degrades the use of EHL tenotomy for most uses. Patients with "spoon toe deformity" complain of pain in footgear. A percutaneous EHL tenotomy for extensus hallux toe deformity is used by many practitioners today. It’s effective and has research back-up. Here is the abstract of one such study. Dr. Monroe LaBorde’s many publications on soft tissue correction of foot and ankle deformities are a great resource.
The Academy is composed of many members including board certified ABFAS members like myself. I find many of the ideas taught by the “ambulatory society” to be very useful. The Academy strengthened me as a foot surgeon. I hope all examine their own biases based in proven research. Dr. Jacobs, I respect your position but strongly disagree with your opinion.
Don Peacock, DPM, MS, Whiteville, NC
|
| |
|
|
|
