05/29/2019    Richard M. Cowin, DPM

What Are Clinical Practice Guidelines? (Don Peacock, DPM)

Back in the 1980s, the federal government
announced that they were seeking Preferred
Practice Guidelines (PPGs) (aka Clinical Practice
Guidelines) for all medical specialties for their
National Guidelines Clearinghouse. In this
announcement, they went one step further and
stated that if the various medical specialties
groups didn’t produce these on their own, the
government would produce these documents for
them. Doctors were rightfully concerned about how
these untrained and informed bureaucrats might
draft these documents and to their credit, many
medical specialty groups went on to produce such
guidelines.

The first podiatry organization to research,
draft, and submit their PPGs to the National
Guidelines Clearinghouse and to have such
guidelines approved was the American College of
Foot & Ankle Surgeons. However, the Board of
Trustees for the Academy of Ambulatory Foot
Surgery (now the Academy of Minimally Invasive
Foot and Ankle Surgery) under the leadership of
their then president, now prominent healthcare
attorney, Lawrence Kobak, DPM, JD, felt that the
ACFAS guidelines did not fairly represent the
proven, successful techniques of minimally
invasive foot and ankle surgery (which I have
personally heard Dr. Jacobs call “minimal
precision surgery” from the podium, thus showing
clear bias in this regard).

As such, Dr. Kobak appointed a group of some of
the Academy’s most well-respected members
(several of whom who were double boarded in
traditional and MIS foot surgery) to research and
draft its own set of Preferred Practice
Guidelines which were also accepted for
publication by the National Guidelines
Clearinghouse. These two sets of guidelines stood
in separate, but equal status by the National
Guidelines Clearinghouse for many years.

As one of the double board-certified podiatric
surgeons that served on that Academy committee
having been appointed by Dr. Kobak and having
served as a member of the short-lived MIS
committee of the ACFAS, having been appointed by
then-president Lowell Scott Weil, Sr., DPM, it
remains my opinion that both organizations, the
ACFAS and the AAFAS (now AMIFAS) did excellent
jobs in fairly representing the preferred
practice methods of their respective
organizations with their respective Preferred
Practice Guidelines.
As such, may I respectfully suggest that every
podiatric surgeon continue to practice utilizing
the methods that he/she believes to be in the
best interest of his/her patients, while being
familiar with and following the clinical practice
guidelines that best correspond to the
procedure(s) being performed (traditional or
MIS)? May I also respectfully urge all podiatric
practitioners to do what democratic and
republican congressmen is Washington can’t seem
to be able to do—to have some respect and
consideration for opinions of others whether or
not they agree or disagree with them?

As Friedrich Wilhelm Nietzsche so eloquently
stated, “You have your way. I have my way. As for
the right way, the correct way, and the only way,
it does not exist.”

Richard M. Cowin, DPM, Orlando, FL

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