01/24/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3

RE: Hospital Requirements for Board Certification

From: Greg Caringi, DPM

 

I have been on my hospital bylaws committee for many years. I have always been proud of our work. Recently, administration asked that we change our board requirements from what was admittedly a long list of specific specialty boards (ABFAS for podiatry) to a statement that simply says, "The specialty or subspecialty certifying board must be commonly recognized nationwide in the United States." I objected to the change, and to the new wording, as being too vague and likely unable to be enforced or defended. I would appreciate any opinions on what wording would be fair and defensible.

 

Greg Caringi, DPM, Lansdale, PA

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08/11/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3

RE: Nail Avulsion Guidelines (Ivar Roth, DPM, MPH)

From: Robert D Teitelbaum, DPM

 

I was around in the mid-eighties when the nail avulsion guidelines were established. Right then, I knew there was a problem. The issue was one of enforced overtreatment. To get paid to relieve a potentially dangerous condition, especially in geriatric and diabetic patients, was to make one or more injections to a toe with local anesthesia, when freeze spray anesthesia was often adequate. Using freeze spray also cut the time to a fraction of the other procedure. And when you are dealing with an anxious patient, time is trauma.

 

Also, strange requirements were made to incise eponychial tissue that seemed to be 'make work' type of actions that were not clearly correlated to the issue that was causing the pain and incipient infection. In other words, I was on the razor's edge of 'assault and battery'. All that was required was removal of 'the offending spicule" and...

 

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