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From: Ivar E. Roth DPM/MPH


I do not understand why this alcohol is so expensive, and what is so special about it? Can one of our colleagues explain this? Also, can’t we just find another source, say buy a big bottle and draw from that bottle?


Ivar E. Roth DPM/MPH, Newport Beach, CA

Other messages in this thread:



From: Michael Zapf, DPM, MPH


This is in response to Dr. Secord’s October 23 claim that COVID-19 is not more deadly than the flu virus and that masks are worthless. This view is not borne out by science and statistics. As of October 2, 2020, according to the CDD, there have been 299,028 more deaths than would be expected if we compared the death rates to the averages of the last 5 years. 300,000 more deaths? Dr. Secord, what one thing makes this year different from the other 5 years? And the rise did not start until about March or the number would be higher. For a 12-month period, the excess deaths will be well above 400,000 or one in less than every 1,000 people. Most years the number of flu deaths is less than 50,000. Clearly, without successful vaccinations available, Covid-19 is worse than the flu.


Yes, the COVID-19 virus is smaller than the holes in our surgical masks but most Covid virus particles ride in on aerosolized droplets that are bigger than the mask holes. The best advice is to wear a mask. 


Michael Zapf, DPM, MPH, Agoura Hills, CA



RE: An Open Letter to the Council on Podiatric Medical Education

From: Lee C. Rogers, DPM, et al.


It's Time to Finally Make Wound Care a Mandatory Part of Podiatric Medicine and Surgery Residency Training.


Dear Council on Podiatric Medical Education (CPME) Residency Ad Hoc Advisory Committee, As you are completing the arduous task of the required periodic review and revision of CPME Document 320,1 the Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies (PMSR), we wish to applaud your efforts on the advancement of podiatry residency training standards over the decades. Today’s podiatrist is well-trained in surgery because of your actions and those of other CPME committees to ensure the standards are being followed. However, there remains one glaring omission from the PMSR training in Document 320, last revised in 2018.


Where is wound care? Please note our preference would be to refer to the topic as “tissue repair and wound healing”, since we don’t just care for wounds; we use a combination of...


Editor's note: This extended-length letter can be read here. 



From: Robert Scott Steinberg, DPM, Brian Kiel, DPM


I reject Dr. Secord's assertions, or his referencing articles not in evidence, nor any links. I offer this article.


Robert Scott Steinberg, DPM, Schaumburg, IL


Dear Dr. Secord, please walk through a hospital E.R. maskless and laughing; then tell me how harmless COVID-19 is. Of course, a virus can pass through a mask, but it limits its dispersion. Denial of its virulence has killed thousands. The theory you espoused has been repeated by certain politicians but the opposite is stated by experts like Dr. Fauci. I think I will take his word for it.


Brian Kiel, DPM, Memphis, TN



RE: Jeffrey Toobin, Esq. “Clearly not a Foot”

From: Bret M. Ribotsky, DPM


I sit back today with the majority of our profession with a big smile,  It was a little over 10 years ago when the same Jeffrey Toobin from CNN and The New Yorker magazine published an article where he referred to podiatrists as “three steps below a dentist.” I took the opportunity to interview him on Meet the Masters in 2010.


During the 10 minute interview, he acknowledged that a podiatrist saved his mother's (a national CBS Reporter) life and was appreciative of our profession, but he was unwilling to retract or say he would do anything different if given the chance to do again. Thus, I was grinning from ear to ear at the news of him caught in the act of masturbation on a Zoom call. An anonymous source who was on the Zoom call said, “he clearly did not have a foot.” - Karma .


Bret M. Ribotsky, DPM, Boca Raton, FL



From: Ron Werter DPM


I fully agree with Dr. Kiel. A few years ago, I was having an excellent conversation with a salesman in a major shoe store here in New York City. I finally asked him his name. He proudly responded, "It's on the sign in front."


It’s the same with us; whose name is on the front door? It’s your office, you make the rules. If the non-compliant person doesn’t like it, probably don’t want them as a patient anyway.


Ron Werter, DPM, NY, NY



From: David Secord, DPM


I had no choice but to laugh when I read the part of the post from Dr. Kiel which stated: "This is a life or death situation." I have several peer-reviewed papers residing on my hard drive which has fully explored the topic of a cloth or OR-type mask being able to stop something the size of a virus. All of them conclude that they are ineffectual. That they don't do anything is right on the box! We know that the death rate for the COVID-19 virus is around 0.1%, which puts it in line with every other seasonal influenza. We also know that we really don't have good numbers on the death rate, as everything shy of diaper rash has been listed as a COVID-19 virus death. We also know that we don't have good numbers for the population who has the COVID-19 virus, as the PCR test (by admission from the guy who invented it) is churning out a 95% false positive rate.


Are there people dying from this contagion? Yes. Is it more deadly than any other coronavirus seen each fall with a new seasonal influenza? Not according to the data. Is the hysteria we are reading, especially the absurd "Everyone has to wear a mask or we all die" hysteria believable? Not if you are sane. Wear a mask. Don't wear a mask. They are ineffectual against something the size of a virus.


David Secord, DPM, McAllen, TX



RE: Mental Health Resources

From: Jean Chen-Vitulli, DPM


During this COVID-19 crisis, many families are suffering financial hardship. Isolation and stress can lead to depression. As a healthcare provider, we try to be empathetic to the trials and tribulations the patients are undergoing. However, if we can direct them to proper resources, it may ease some of the burden, stress, and worries. I would like to share some of the resources available with you to those in need.


Mental Health Resources


Please be aware of local food banks near you. Patients often choose between medications or paying for food. As such, potential future complications can arise. If you can provide a list of local food banks, there will be more financial resources for their medications to sustain their life. In New York state, offers a confidential emotional helpline to cope with stress brought on by COVID-19. For veterans and service members, there is a list of mental health resources from Don’t know where to start? Go to


Jean Chen-Vitulli, DPM, Fishkill, NY



From: Brian Lee, DPM


I guess I'm old school. In my opinion, Foredom cable drills are still the best. I still have 2 that I've been using for over 30 years! They have much better low-end torque than Osada, even with their stepdown handpiece. Not as compact, but definitely less expensive. 


Brian Lee, DPM, Mt. Vernon, IL



From: Connie Lee Bills, DPM   


I am shocked. I wouldn’t have actually touched the child, but definitely would have insisted that the mother deal with it immediately. I’ve had a similar situation during a procedure with a child. It was horrible.


Connie Lee Bills, DPM, Mt. Pleasant, MI 



From: Denis LeBlang, DPM, Nick Turner


There is a company in Los Angeles called Osada, Inc. They have the equipment that you need to drive the Shannon 44 burr. You will be happy with their equipment. 


Denis LeBlang, DPM, Congers, NY


Many physicians have opted to use the Osada Portable All-in-One PEDO-30W drill unit along with the Shannon for in-office MIS. DocShop Pro carries this unit and all other Osada units. Additional saw options are available as well to complement your Shannon.


Disclosure: I am the Vice President of DocShop Pro.


Nick Turner



From: George Jacobson, DPM


Drs. Jacobs' and Shea's comments go well with my recent posts about the “no show” new patient. There is a change as they both described which leads to the lack of keeping a new appointment as they are still just rude customers. Maybe they even order food and don't pick it up. Once these new customers are seen by us physicians, most of us naturally convert them to patients who do garner some respect for our care. 


Most value the physician-patient relationship that we develop and become lifelong patients that help build our practices. There was another old adage that says "like refers like." When I first started in practice, I saw everyone's worst patients. In some cases, I was their 4th podiatrist. A well-established colleague and friend, Henry Merritt, DPM, told me not worry that someday I'd be able to "weed the garden." Pull out those weeds (charts) that don't have you feeling better after they leave. Yes, our lives matter too! If there is no legal need for me to follow a patient, we just won't invite the rude customer back. I hope you noticed that I turned them from a patient to a customer.


George Jacobson, DPM, Hollywood, FL



RE: If Falsely Accused - What Would You Do?

From: Martin R. Taubman, DPM, MBA


Friday, August 17, 2012 ended the week-long ordeal of one of the most damaging series of San Diego County fires in local history. Clouds of ash blanketed the city leaving an oily, gray residue on our cars, lawns, and streets for most of the week. People were evacuated from their homes; some homes burned to the ground. In fact, one of our fellow podiatrist’s home was lost to the fire and had to be rebuilt. People died. Lake Cuyamaca and its surroundings were devastated.


Driving through its prior verdant scenery was heartbreaking—the trees stood like broken, blackened skeletons amidst a barren, burned earth. The canopy of trees which covered miles of Highway 79 leading to the lake from Route 8 was gone. It was estimated it would take 100 years for the area to return to its previous pristine grandeur. I’ll never forget it.


However, there was another event that occurred that fateful Friday, and it will remain etched into my memory with at least the same vivid horror (or worse) as...


Editor's note: Dr. Taubman's extended-length post can be read here.



From: Ivar E. Roth DPM, MPH 


I have found a simple way to solve this problem. When a problem occurs, I speak to both parties to get both sides and then and only then do I make a decision on how to handle the problem. I NEVER take either the patient’s word or my employee’s alone. Based on what I find out, I act accordingly. Surprisingly, it is about 50-50. My suggestion is never back the employee until you know for sure.


Ivar E. Roth DPM, MPH, Newport Beach, CA



From: Charles Morelli, DPM


Dear Mrs. _____:


This letter will serve as formal notice that we will no longer be able to provide foot care to you because of the following reasons: 

  • It has come to my attention that you berated a member of my staff  numerous times, after she had gone out of her way to assist you in attaining a copy of your previous MRI.

  •  After speaking with this staff member, she was both visibly and emotionally upset. She has worked here for close to 20 years and no one has ever spoken to her the way you had, especially when she was actively trying to help you attain another copy of your MRI images.

  • If you want the entire disc again, you will have to go to _______, pay $25.00 and they will be happy to give you another copy.         

It pains us to do this as we have known you for many years, but this behavior cannot be tolerated or condoned. As you have already chosen to see another practitioner to address your current condition, I will be happy to send him or her a copy of your medical records and upon receipt of your written request, I will forward a copy of those records to your new provider. As you have already attained the services of another doctor, I am under no legal obligation to continue providing you with treatment and wish you well.   


Charles Morelli, DPM, Mamaroneck, NY 



From: Jack Ressler, DPM


Dr. Dananberg brings up an excellent point with the experience he described. There are some very important points we can all learn from this encounter. First, and most important, is for the doctor to understand any underlying circumstances that could be involved in the patient’s life that may be causing their behavior. Understanding this can lead to a wonderful professional patient relationship that not only could last for years, but also lead to many referrals. I have had countless experiences as described by Dr. Dananberg. New patient protocol in my office involves having one of my assistants take the patient into a treatment room after they have been registered.


A brief history is done, followed by my assistant conferring with me before I go in the room. During our talk, my assistant will sometimes comment as to the patient’s condition, mood, or personality "quirks". This is of utmost importance because it is a signal to me that extra care or compassion is needed. I love to make patients laugh and feel comfortable. My goal is to have a patient leave the office feeling good both physically and mentally. Losing spouses or dealing with...


Editor's note: Dr. Ressler's extended-length post can be read here.



RE: When a Patient Sexually Harasses An Employee

From: Elliot Udell, DPM


This past week, the Nassau County Podiatric Medical Association sponsored a lecture on dealing with sexual harassment issues. The main thrust of the presentation dealt with potential problems between employees and employers in the workplace as well as potential problems between workers regarding various forms of sexual harassment and discrimination. It was an excellent presentation by Mathew Feldman, JD and the Long Island team.  


Two years ago, one of my employees told me that one of my long-time male patients made some unacceptable verbal remarks to her of a sexual nature. There were no witnesses. My gut feeling at the time was to permanently "show the patient the door." I did let my employee know that what he said was totally unacceptable; however, since there were no witnesses, if I confronted the patient, would I not be opening myself and even my employee to a lawsuit? The patient could say in court that I falsely accused him and damaged his reputation, and since I was not there, I caused him pain and  embarrassment based on hearsay. I am certain that I am not alone and this has happened in other offices. How have others handled this problem?


Elliot Udell, DPM, Hicksville, NY 



From: Allen Jacobs, DPM 


Customer is defined as an individual (or organization) purchasing goods or services. When doctors became “providers,” patients became customers. The enthusiastic utilization of urgent care centers by patients illustrates the declining value of the doctor-patient relationship in exchange for service convenience. How many new patients do you see because “you were on my list of providers”? How many patients do you not see because you are no longer a provider for a particular third-party payer? How many lectures or seminars do you attend about maximization of profit from your customers/patients? People have to a large extent changed. They demand convenience, are increasingly demanding, lacking courtesy, and social graces. Egocentricity has become the new normal.


No, the patient/customer is not always right. I have no hesitancy to discharge patients who are abusive to staff or office policy. My charge is to provide quality care and support. Neither I nor my office exist for any other purpose. Nor should yours. You have studied too much, sacrificed too much, worked too hard, and are bound by ethical charge to be treated with other than the respect which you have earned. Conversely, to paraphrase Sir William Osler, MD, once profit and business become your priority, you have lost the spirit for which you entered healthcare. Under those circumstances, you do indeed have customers not patients. You have a business not a medical practice. As such, the customer is always right.


Allen Jacobs, DPM, St. Louis, MO



From: Howard Dananberg, DPM


Many years ago, I had a new patient present for care. After my nurse's interview with him, she came out and said how angry and mean spirited this man was and wished me good luck. After our visit, we came out laughing and very friendly and she was shocked. It turned out that he only has a small interdigital corn, but his wife of more than 50 years who was recently deceased had exclusively cared for this.   


He was angry at her passing and that someone else was going to treat him. Once we both recognized the underlying cause of the anger, he turned into a long-term, wonderful patient for several years until he died. There are lots of reasons why patients are angry. Sometimes, finding the cause goes a long way towards resolving the basic issues.  


Howard Dananberg, DPM, Stowe, VT    



RE: Medicare Advantage Companies Attempt to Game System by Overbilling CMS $2B (Paul Kesselman, DPM)

From: Ron Freireich, DPM


Here is from a post of mine on this very topic over two years ago. I start out by saying, "What a crime!" In it's simplest terms, it's called fraud. When a provider commits fraud of this magnitude, they are fined and thrown out of the Medicare system for life. If you read the OIG's 45-page report, their recommendations are basically a slap on the wrist as Dr. Kesselman points out. These insurance companies are trying to make patients look sicker on paper solely for their financial gain. These audits do not benefit the patient, the physician, or the medical system in general but are a continuous burden on our practices. These insurance companies should be held accountable like anyone else that commits fraud. What advantage are these advantage plans anyway?


Ron Freireich, DPM, Cleveland, OH 



From: David E Gurvis, DPM


I find patients are rude to the staff for several reasons. Pain and anxiety are uppermost. Fear of what the doctor might do, especially if they are fearful that it might include a needle. Having stress at their workplace for having taken off to even see a doctor. Financial reasons. And many more. I agree with what Tim Shea, DPM has said as well. And I will always try to turn a “bad” patient into a “good” patient. However, some people are just naturally rude and feel superior to those they feel are working for them. This is how they interact with the world around them and they carry it into the office.


The older I get, the less I find I tolerate rudeness. Life, and the day at the office, is too short for that. I don’t work for patients. I work with patients. For those who cannot be “turned,” I find discharge is appropriate.


David E Gurvis, DPM, Avon, IN



From: Keith L. Gurnick, DPM


About 15 years ago, I had an issue with an adult female patient, a tough and very wealthy widow and locally well-known philanthropist who dropped in to my office one day without an appointment, requesting to be seen for a non-urgent visit. When we refused her request, she then demanded her medical records and prior foot x-rays on the spot. I am sure some of the readers have encountered this same or similar challenging situation once or twice in their careers.


When she was told that our policy was that we needed a couple of days’ notice to make copies of her chart and physical copies of her x-rays, and that we were not able to stop whatever we were doing to comply with her non-urgent requests, she made quite a scene in front of other patients and stormed out of the office, opening the reception room door so violently that it... 


Editor's note: Dr. Gurnick's extended-length post can be read here.



From: Tim Shea, DPM


In the spirit of collegial discussion, I would like to point out that Dr. Udell makes some very salient (as always) points in his response to Dr. Klirsfeld's post of rude patients and staff. After almost 50 years of teaching and private practice, I must graciously disagree with some of his points.


Dr. Udell refers to the phrase "the customer is always right" as sort of a basis for allowing rude patients to behave inappropriately. This concept dates back to the late 19th and early 20th century and is attributable to very successful retail businessmen such as Harry Gordon of Selfridge, England, etc. There are similar phrases also seen in Germany, Japan, and other countries. They suggest that when a...


Editor's note: Dr. Shea's extended-length post can be read here



RE: Medicare Advantage Companies Attempt to Game System by Overbilling CMS $2B

From: Paul Kesselman, DPM


Those wonderful letters you receive from Ciox and others are at the heart of what the principal deputy inspector of the HHS OIG divulged in a recent report. These companies are attempting to game the system by corrupting the data you supply and placing patients in a higher risk level in order to obtain increased reimbursement for themselves. Their report cites that some patients were never even seen by providers yet were placed in a higher risk category.


UHC was one of several Part C Medicare plans which was recently fined millions of dollars. Admittedly this is small potatoes to them and still worthwhile. So your office spends time and wastes money providing this data, obtaining pre-authorization, appealing claims which should have been paid in the first place (e.g. Humana). This begs the question: Who has the "Advantage" here? The Gov't, the patient, the provider? The answer is none of the above. It is the carrier. 


The gov't won't withdraw carriers out of the Medicare Part C business anytime soon. So what then are the alternative penalties? How about if we start with higher financial penalties and not something akin to a $5 traffic ticket and prison sentences for those executives who are behind this corruption. More information may be found here


Paul Kesselman, DPM, Oceanside, NY



From: Elliot Udell, DPM


Thank you Dr. Klirsfeld for starting a very interesting discussion. For starters, we all have to accept that many patients who come to our offices are in pain and are stressed out. People exhibit this in different ways and sometimes take it out on staff. It's important to meet with staff and let them know that unless the situation is extremely odious, approach all patients with the old adage: "the customer is always right." Sometimes just listening to a patient who is "ranting and raving" can calm things down. 


It is also important to determine if the staff member who is complaining about a rude patient has a "low boiling point" for patients who may have gotten up on the "wrong side of the bed" that day and may need an ounce of TLC. Such staff members may need to be trained on how to deal with difficult patients or need be have their jobs terminated. There are programs available online that can help train all of us with dealing with difficult people in trying situations. My staff and I are taking one such program right now. If anyone is interested in any of these courses, contact me personally and I will be happy to furnish you with leads. 


Elliot Udell, DPM, Hicksville, NY 



From: Jack Ressler, DPM


There is a fine line in dealing with a rude patient. On one hand, you do have to respect the patient’s opinions. Probably more importantly, you have to go to bat for your staff if they are right. I had a very interesting experience in my office where my staff member was both right and wrong on two different occasions. The first incident occurred when a patient did not get their way when making an appointment and ended up calling my receptionist an idiot. This patient did come back to the office after apologizing. It took all of two minutes for the patient to rehash this incident and again called my receptionist an idiot. I proceeded to tell the patient to leave and never come back. This was done before treatment. I must admit, dismissing a patient like this from my practice felt great, and was the first and only time I ever did that.


The second occasion occurred when the same staff member left a patient who was in severe pain in the waiting room because they were early for their appointment time. This patient did confront me in private while in the treatment room. I assured the patient that I will discuss this with the staff member. Although she was wrong, I made the mistake of asking her to come into the treatment room to discuss the incident in front of the patient. She had no explanation for her reasoning. Later in private, I diplomatically explained to her why she was wrong. She obviously was not in agreement because three weeks later, she quit citing this incident as her reason. In most cases, your staff is generally going to be right and they must be defended against unruly patients.


Jack Ressler, DPM, Delray Beach, FL
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