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From: Paul T Slowik, DPM


All this talk about parity with MDs/DOs and now comparing our training with NPs and PAs is baffling. Maybe it’s because I practiced in a progressive city of Oceanside, CA, but we were considered physicians by patients, hospitals, physicians, and other sub-specialties in every way. In my opinion, we are not limited by our license, but only ourselves and our own self-perception. I acted like a physician and was treated as such. We are not primary care providers nor were we trained to be them. Do you think a hand orthopedic surgeon wonders if he is a physician or “real doctor” because he/she knows they are not PCPs?


Most of podiatrists’ problems originate in their own head. If you believe in yourself, others will too.


Paul T Slowik, DPM, Oceanside, CA

Other messages in this thread:



RE: "My Feet Are Killing Me"

FFrom: Joel Lang, DPM


I think the program "My Feet Are Killing Me" (The Learning Channel) is a great public relations entity for the profession. However, am I the only one who thinks that the doctor taking off the shoes and socks of an able-bodied patient is "weird"? My doctor does not help me undress. For one thing, the touching of shoes, which are inherently dirty, with or without gloves, contaminates anything else that might be touched.


When I was in practice, upon entering a room, the patient had already shed his/her footwear, but the feet were covered with a towel, so that the feet were not the first thing I met when entering the room. I was able to first focus on....


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



From: Steven Finer, DPM


Given that formaldehyde is a known carcinogenic product, it is very effective as a drying agent for mosaic type warts. A pharmacist can make up a 10% solution to be used as a soak. 


Steven Finer, DPM, Philadelphia, PA



RE: Letter from Ben Walner of APMA

From: Jeffrey Kass, DPM


Point of reference: in the event anyone gets an email from Ben Wallner, FYI, he is the Director of Legislative Action for the APMA. The email contains links to call your Congress people to help pass the HELLPP act which is included in the reconciliation package. This is important as it would help recognize us as physicians under Medicaid.


I don’t know Mr. Wallner but I think it would be prudent that the email come indicating in the subject line that it is from APMA. I think colleagues who don’t recognize his name might not open the mail. I think the message is important and it is more likely the email would be opened from APMA vs. Ben Wallner. Having said that, I applaud both Mr. Wallner and the APMA on this advocacy.


Jeffrey Kass, DPM, Forest Hills, NY 



From: Jack Ressler, DPM


I have purchased new MTI and Midmark chairs. Both are very good but Midmark is the best. I also purchased a used Midmark 417 chair and must say that it is still giving me maintenance-free operation. A good rule of thumb would be to purchase a good used, top brand chair. If you look at Midmark, DO NOT purchase an hydraulic model. There are still some out there but the maintenance is very costly, not to mention difficulty in getting parts. Stay away from other models.


Again, there are several available at good prices but in the long run, you will be dumping hard earned money into a poor functioning chair. If purchasing used equipment, try to deal with a company with a good reputation. Remember, as the saying goes, "you get what you pay for." 


Jack Ressler, DPM, Delray Beach, FL



RE: Slip and Fall Prevention

From: Keith L. Gurnick, DPM


Podiatry has taken such an interest in slip and fall prevention for our patients and the public, with the implementation of gait training, physical therapy, muscle strengthening, shoes, orthotics, and AFOs, when indicated and medically necessary. Every one of our patients who sustains falls does not suffer from pre-existing conditions such as drop foot, peripheral neuropathy, or flexible forefoot valgus.


Here is a link to a site that includes other ideas we should incorporate into our discussions with patients and family members to help prevent slips and falls. This is even more relevant, especially for otherwise healthy elderly patients, but also for our patients who are suffering or recovering from strokes, hip or knee replacements, or have conditions that affect stability and gait issues like ALS, MS, and more.   


Disclosure: I have no affiliation with EMC Insurance Company.


Keith L. Gurnick, DPM,  Los Angeles, CA



From: Charles Morelli, DPM


As no one else has commented, I guess it is I who has a problem with this ad. It is yet one more thing that I shake my head at as to how our profession is portrayed in the media.


Here we have a podiatrist (an actor) who is not only examining a patient’s foot and he still has his socks on, but then quips “have you read any good books lately?" I would have preferred the doctor/patient interaction to have been different as this could have been done so much better. 


Charles Morelli, DPM, Mamaroneck, NY



From: David Secord, DPM


I have a brother-in-law who did a dental residency in Richmond, VA to specialize in endodontics. During an interesting conversation with him some years back, he explained that if you are trained in endodontics, you are not allowed to do general dentistry and could be disciplined if caught doing so.


I don't know how this is legal, as it seems like restriction of trade to me, as someone who does a root canal can certainly fill a cavity or make braces. As such, if his claim is true, that is NOT the model we want for our profession.


The humorist Will Rogers had a quip he would share, which goes as follows: "The World of medicine has become absurdly specialized. I went into the office of an eye doctor and told him 'doctor, I have something in my right eye. You have to help me'. The doctor responded 'I'm sorry, but I'm a left-eye doctor.'"


David Secord, DPM, McAllen, TX 



RE: Zocdoc’s Portrayal of Podiatry 

From: Alan Sherman, DPM


It’s always interesting to see how popular culture is portraying your medical specialty. Podiatry has, for the last two decades, been the specialty that people are at ease talking about. Is that because they find it funny or just, accessible? Imagine this Zocdoc commercial with general surgery, oncology, or ENT as the consumer focus.


Click on photo to watch Zocdoc ad


BTW, Zocdoc also has ads targeting conditions like migraines and back pain, without mentioning the specialty that you need to treat them. Should we be pleased that they mentioned us by name? You bet we should!


Alan Sherman, DPM, Boca Raton, FL



From: Pete Harvey, DPM


About ten years ago, I had a similar incident. The crooks got about 8K from my account which Chase immediately reimbursed. Since then, I write zero paper checks by hand or by computer and printer. I sign in to my bank account on my office PC, cell phone, iPad, etc. I bring up a Payee Tab, select the payee, fill in the amount and invoice number, and click PAY THIS ACCOUNT.


The bank then either sends the amount to the payee by electronic means if possible or the bank sends its own paper check. Their check cannot be duplicated. This also allows me to reconcile the accounts online each day. No system is foolproof, however I have no further encroachments on my accounts.


Pete Harvey, DPM, Wichita Falls, TX



RE: Be Aware of the Cancelled Check Scam 

From: Elliot Udell, DPM


Recently,  I reviewed my checking account and lo and behold, the check I used to pay my rent had been fraudulently stolen. What the crooks did was gain access to the check by raiding a mailbox and then writing their name over the name of the rent company and then cashing it via a cell phone. Even though the forgery was obvious, the bank did not catch it.


I had to spend hours filling out forms at the bank and then had to do the same at the police station. A friend of mine had the same thing happen to her a month ago. She paid a bill and the thieves took the check and added on their names to the person she was paying and then cashed her check. Bottom line - check your cancelled checks carefully, this racket is spreading. 


Elliot Udell, DPM, Hicksville, NY



From: W. David Herbert, DPM, JD


Over two hundred years ago, Thomas Jefferson predicted that judges would become little dictators. If we are talking about the standard of care in a medical malpractice case, one of these little dictators will be the one who will be in charge of who will be allowed to testify regarding the standard of care in any malpractice case. In some states, a non-doctor can testify about the standard of care of a doctor.


You also must remember that becoming a judge really depends on your politics and has nothing to do with your knowledge of science or medicine. Just something to consider when discussing standard of care.


W. David Herbert, DPM, JD, Billings, MT



From: Dennis Shavelson, DPM, CPed


Resistance Training (RT) is one area where there has been a dirth of reviewable evidence for the “Standard of Care” (SOC) for decades. This has led to the ability of those producing and marketing their equipment and methodology to claim “SOC” in the marketplace. Company websites and blogs claim that their free weights, machines, weighted wearables, and resistance bands are the best to own without justification.


Some years ago, I published a 21 page meta-analysis of RT: which reviewed the current evidence for all forms of resistance training. There have been 1,300+ readings of that article on ResearchGate alone to date. I have advocated for change in the misrepresentation of resistance training standard of care exactly as Dr. Jacobs suggests, with some level of success.


Dennis Shavelson, DPM, CPed, Tampa, FL



From: Carl Solomon, DPM


This goes beyond commercial entities and advertising. Several years ago, I attended a presentation at one of our seminars. The speaker was a nationally recognized colleague and I believe the topic was infections. He posed a question to the audience (I don't remember specifically) was either "Do you ALWAYS order antibiotics for infected ingrown nails?"...or "Do you ALWAYS get a C&S before ordering any antibiotics?"...or  "Do you ALWAYS get x-rays for an infected ingrown nail?"...or "Do you ALWAYS administer Abx prophylaxis prior to bone surgery?" The specific question isn't the issue. He asked for a show of hands indicating who does. Of an audience of probably 150 attendees, very few raised their hands. He then scolded us, saying that the "standard of care" was that we should ALWAYS do that. 


Excuse me...didn't the response of that audience (assuming it's a fair representation for this locale) just define that the standard of care is that we do NOT always have to do whatever it was? How can someone who comes from a couple thousand miles away define what OUR standard of care is? When we let these things go unchallenged, there can be scary ramifications.


Carl Solomon, DPM, Dallas, TX



RE: Include Podiatric Medical Students in Bill to Vaccinate During Public Health Emergencies 

From: Leonard A. Levy, DPM, MPH


To extend existing emergency provisions and make permanent the ability of qualified health professions students to vaccinate during federally declared public health emergencies, Senator Mark Kelly (D-AZ) and Senator Susan Collins (R-ME) introduced S. 2114, the Student Assisted Vaccination Effort (SAVE) Act. S. 2114; this ensures that more than one million qualified health professions students are able to administer vaccines with supervision at the outset of a federally declared public health emergency. This bill also enables schools to put in place procedures for rapid deployment. It is important that podiatric medical students be included in this initiative. 


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL 



From: Lawrence Rubin, DPM


Once again, Dr. Jacobs hits the nail on the head. No corporate entity, especially with special interest, or CME seminar should dictate what is the “Standard of Care." This would be an extremely dangerous precedent leading not only to easy misinterpretation, but misinformation. Remember, we are dealing with a "Forensic" definition that can carry a lot of consequence.


Gary Dorfman, DPM  Dana Point, CA



From: Lawrence Rubin, DPM


I agree with Dr. Allen Jacobs who objects to advertising and CME programs suggesting a product or service is a "standard of care" without backing up that claim with statistical or other valid evidence. The claim implies that those podiatrists not using or prescribing the product or service for a particular condition are providing substandard care. Obviously, this advertising could have serious legal repercussions.


Lawrence Rubin, DPM, Las Vegas, NV



From: Jim Rief


Gill Podiatry has sodium hydroxide in stock.


Disclosure: Jim Rief works for Gill Podiatry. 


Jim Rief, Strongville, OH



RE: Advertising “Standard of Care”

From: Allen Jacobs, DPM


Increasingly, corporations are advertising the utilization of their products or services as “standard of care.” I believe this to be an inappropriate, even dangerous behavior. The concept of standard of care in not defined by corporations nor their spokespeople. It is defined by podiatry healthcare providers. It is the degree of knowledge and skill expected of the average practitioner, not the use of a particular product or diagnostic service.


Corporations seeking increased podiatry utilization must discontinue suggesting that they have the authority to define the standard of care. Standard of care varies from state to state, and varies from the particulars of each individual patient. Standard of care changes over time.


Advertising and CME programs suggesting “standard of care” should, in my opinion, be prohibited. We are seeing this claim of “standard of care “with increasing frequency. This is a potentially dangerous road upon which to travel.


Allen Jacobs, DPM, St. Louis, MO



From: W. David Herbert DPM, JD


Because I am close to 80 years old, I would personally not be interested in a degree change. Because I have a wife who has taught in several college level nursing programs and two cousins who have practiced dentistry for decades, I have a little different perspective about what is going on in medicine. We must look at the whole picture and must look at the whole forest and not be caught up with looking at just a few trees or maybe a few large bushes.


The big issue is that NP equals DO and MD. I can guarantee you that NPs will never be required to pass any tests that DO and MD students have to pass. Yet, legislatively at least in a number of states, they are considered equivalent to MDs and DOs. I have heard several well-known politicians state that robots and computers will replace physicians. Our students have been dumbed down by our school systems for decades! 1984 came about just 30 or so years late.


W. David Herbert DPM, JD, Billings, MT



From: Avi Kornbluth


Henry Schein has 10% sodium hydroxide in stock.


Disclosure: Mr. Kornbluth is a field sales and podiatry specialist at Henry Schein.


Avi Kornbluth, Spring Valley, NY



From: Ivar E. Roth, DPM, MPH


Dr. Slowik is correct concerning perception by our peers. If you act like a physician and think like one, than you are one. If you walk the walk and talk the talk, others will see you as you want to be seen. I personally have carved out a niche in my community as a concierge podiatrist and it is working wonderfully. You are what you believe you are. Think positive and the results will follow.


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



From: Todd O'Brien, DPM


I agree that our biomechanics training differentiates podiatrists from most if not all of our allopathic colleagues. I also believe that this training can provide a foundation for entrepreneurship and engineering-related pursuits. I actually wrote a short book about this topic (Caesar’s Guide for Innovators). My early experiences with biomechanics while in school and then under the mentorship of Dr. Tom Sgarlato more than prepared me for my secondary career developing medical devices. I am often asked if I have an engineering background by contacts in the medical and business worlds. I tell them that although I have no formal engineering degree, I did have a solid education in lower extremity biomechanics. 


Todd O'Brien, DPM, Orono, ME 



RE: Biomechanics Expands Podiatrists’ Skill Set

From: Bret Ribotsky, DPM


I find it exciting when an interesting human story pops up on PM News about a fellow podiatrist who has left clinical practice and has pursued a different career. I recall seeing attorneys, financial planners, hospital administrators, high-school teachers, CEOs, and this week an executive in the plumbing industry. It makes me think how diversified our education must really be.


I attribute many deep conversations with Drs. Bill Sanner and Harold Schoenhaus who were the chairman of the biomechanics department at PCPM in the mid 80s. They shared with me that if you can learn and understand biomechanics and pathomechanics, you will have the foundation to logically understand and define processes that offer so much more than just how the foot works. To me, it has been the harbinger of many great entrepreneurial endeavors that I have undertaken. What do others think? And should podiatrists lose the functional training of biomechanics, will that be a greater loss that will affect all aspects of what being a DPM really is? I could not imagine being any good at surgery without this understanding.


Most MDs and all PAs/NPs have not been taught these engineering principles with applied biomechanics. This makes us great problem solvers, so that our unique skill set can be useful in many, many industries. Comments?


Bret Ribotsky, DPM, Boca Raton, FL



From: Paul Kesselman, DPM


Having shared an office with a PCP for over thirty five years and practicing podiatry for just a tad longer than that and being a patient of a PCP and a myriad of medical/specialists, I feel not only qualified but obligated to respond to this thread. There is no way that I, as a practicing podiatrist, whether I had an MD/DO or DPM degree want to be compared to an NP, nor can I state that I am as qualified as they are to provide primary care. I have seen not only what the PCP does but what the NP does in the primary setting as both patient and provider. I have also been to four different specialists for a variety of routine issues (nothing serious fortunately) in the last two months.


When they ask me about or I state certain things which are related to primary care, the MD/DO specialists immediately state that's not their area of expertise. The same is true for the NP in...


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



RE: The Practice of Medicine vs. Podiatry

From: W. David Herbert, DPM, JD


My perspective regarding the practice of medicine and the practice of podiatry began being formed in the fall of 1972. Dr. Abe Rubin, the then president of OCPM, told us that many MDs did not consider us real doctors because we had never delivered a baby. In the fall of 1975, I spent six weeks at an osteopathic hospital in Texas assisting in OB deliveries (27 exactly) and assisting in all podiatric surgeries that were performed there. Did this make me a better podiatrist? 40 years later, I still do not think so. 


As foot specialists, we are as competent as any physician who treats foot problems and more competent than most doing it! We must remember to limit our practice to what we know we are trained and able to do at any particular time. 


W. David Herbert DPM, JD, Billings, MT

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