06/14/2023    Steven, Kravitz, DPM

What is the biggest existential threat to podiatry? (Rod Tomczak, DPM, MD, EdD)

Dr. Tomczak points to an age old question that
faces not just podiatry, but all fields of
medicine. There's too often a disconnect between
the pride of being in medical practice, the
economics that drive that practice, and the
realization that all of us have a limitation of
education. At the end of the day the primary focus
must be whatever is best for the patient.

I just had a paper accepted by the Journal of
Wound Care (due October 2023) that addresses this
very issue. It describes a simple vascular
procedure that went wrong, causing a major
complication and nearly a BK amputation. It
exemplifies the point Dr. Tomczak mentioned in his
post that a very simple screw removal can become a
major complication when it breaks.

Do you as a practitioner have all the skills
necessary to handle the complications that can
occur with simple (especially new) procedures. Is
there someone that you can refer to, better
trained or has performed the procedure multiple
times where you may have not. If the procedure is
new -- is there track record for it demonstrating
complications, healing rates, etc.? What's the
cost versus gain for your practice?

A review of literature indicates that for wound
healing 80% of the time Advanced expensive
modalities are used in the treatment of a patient
for healing. Yet Bill Marston 20 years ago
presented a very good paper on Venous ulcers
demonstrated that nearly 95% of the time healed
with simple compression therapy and quality wound
care - "going back to basics". The economic
factors, the pride of being in practice, etc.
drive physicians to sometimes get in over their
head and/or utilize new technologies that are
exciting, inventive, but at the end of the day do
not create better outcomes while simultaneously
increasing costs for the patient and/or the
system, and potential risk to the patient.

The question is huge and not only deals with scope
of practice but more importantly, the morals,
ethics, and the principles of knowing one's
educational limitation's and best available
opportunities for that patient. It's too easy to
lose that in our fast-paced world; we can barely
keep up with the changes.

I will be making presentations with open
discussion at upcoming conferences, "just because
you're able to do it, should you do it?"

Steven, Kravitz, DPM, Winston-Salem, NC

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