01/27/2025    Rod Tomczak, DPM, MD, EdD

The Ethics of Obfuscation

I was starting on a crossword puzzle and the clue
for three across was a ten-letter word for “foot
doctor.” The answer was far too obvious, so I
started thinking about other terms for a minute or
two. After completing all that I could this
morning I decided to look at the other terms we
now use to replace the term podiatrist. I cross
matched “podiatrist” with cities in the United
States to see what they had to offer. After a half
dozen or so cities I quit the hunt. I found the
following portrayals:

Lower extremity orthopedics; foot and ankle
surgeon; reconstructive rearfoot surgeon; minimal
incision bunion surgeon; lower extremity surgeon;
ankle surgeon; foot and ankle trauma surgeon;
biomechanical surgeon; board certified lower
extremity surgeon; cosmetic foot and ankle
surgeon; toe shortening surgeon; cosmetic toe
shortening; aesthetic toe shortening; flat-foot
surgeon; sports medicine foot surgeon; orthopedic
foot surgery; diabetic foot surgery; board
certified Charcot foot surgery; advanced
intervention for high arched feet; beyond podiatry
with advanced tools; renowned bunion specialist;
peripheral nerve specialist; trusted hammertoe
specialist; diplomat of the American College of
Foot and Ankle Surgeons; foot dermatology
specialist; toenail fungus and onychomycosis
specialist.

I thought about all the un-edifying information I
had just gleaned and wondered why the word
podiatry had to be really hunted to find it on
these websites. Is it to one up the next guy and
make a dollar? I’ve come to believe the bottom
line of all conflicts is economic, that’s just my
thoughts. But why delete the word “podiatric” from
the descriptions of the specialized services?

Could it be the word “podiatry?” Do we think
seeing that word alienates the patient or somehow
makes them think less of us? Are they critical of
our in-classroom curriculum? I’m willing to bet
they have no idea of what our curriculum entails,
how we are evaluated for didactic classes,
clinical rotations, and what the national exams
are all about, or the rigors required to
successfully navigate board certification.

Or much worse, are we, ourselves, reviled by the
term “podiatry?” Are we ashamed to use the word
podiatry as a self-descriptor? Would we be ashamed
to tell a friend that our son or daughter is
marrying a podiatrist? Are we tempted to “white-
out” the word podiatric on our diploma? Were we
secretly overjoyed to find out we were no longer
board certified by ABPS but finally by the ABFAS?
Do we drop the DPM initials whenever feasible and
insert “Dr” as the prefix of preference? When
asked our specialty do we quickly invoke the foot
and ankle surgeon mantra before anyone else can
pre-empt us with podiatrist?

Do we quickly answer “I went to medical school at
Kent State hoping no one knows they have neither a
medical school nor a decent football team? Of
course there are podiatrists out here who will
write in to respond how damned proud they are to
be podiatrists. I’m not talking about those folks
who have done everything to grow this profession
as podiatrists.

Simone de Beauvoir was a famous French
existentialist and partner of Jean Paul Sartre.
She penned a book titled Ethics of Ambiguity.
She, like other existentialists, believed we are
born with no essence. Conscience is part of our
essence. We have existence and with that existence
we create our own essence. To put it simply,
everything we think and do creates who we are, and
we are always condemned to choose what we do. To
say we have no choice, that we must perform a
single act and only that is wrong. We always have
a choice of options and to not choose to act is
still a choice and an act. To obscure who we are
as a professional is a choice we make. If it is an
attempt to obscure who we are it is acting in bad
faith and is not authentic.

De Beauvoir feels that how we think about
something heavily influences how we eventually
act. If our thoughts about what we call ourselves
focus on how we can confuse potential patients
into thinking we are not what we are, for whatever
reason, those thoughts are not authentic and in
bad faith. All of us are obliged to form a correct
conscience, but that is not always the reality. We
feel there is some overriding excuse to choose a
less honorable option for a personal reason. The
key words are “personal reason.”

Joseph Fletcher popularized this thinking in the
1960s with his book called Situation Ethics. No
one understands my personal need to act this way,
only me, but if you were in the same situation,
you would think and act like I do. Situational
ethics are not authentic but are commonly invoked
if we are trying to mislead a potential patient
into thinking we are something other than what we
are.
By the way, that ten letter word for footdoctor is
podiatrist; and a ten-letter word for podiatrist
is footdoctor. No obfuscation here.

Rod Tomczak, DPM, MD, EdD, Columbus, OH)

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