03/20/2025    Rod Tomczak, DPM, MD, EdD

RE: "Nuclear" Malpractice Awards (Allen M. Jacobs, DPM)

I think the "pre-op clearance" is to "stratisfy"
(sic) the patient, similar to the ASA
classification of patients and to satisfy the
internist or GP when surgery was done in earlier
times when the family doctor knew the patient and
the podiatrist was not able to act like an
independent contractor and take over the patient's
care without notifying the family doc.

Historically, and by that I mean everyone before
you and I, and most podiatrists before the 3-year
residency programs who do not recognize a subtly
sick patient and the pre-op anesthesia visit was
not much more than a discussion of a golf handicap
or how the grandkids were doing. I was perfectly
happy knowing that my conversations and
examinations of patients revealed a sick patient.
I was pleased to know I could call the family
doctor and talk physician speak explaining my
concerns, and not the night before a 7:30 am case.

I have a friend who is an Italian orthopedic
surgeon with a sister who is a PM+R physician and
a brother who is an internist. Their mid-80s year
old father had a hammertoe that needed correcting.
The family figured that as long as the father
needed an H and P he should have a full court
press work-up a few days prior to the surgery. The
father passed with flying colors, including a
Thallium stress test.

The next day the wife found her husband and the
father slumped over his last supper/lunch of an
Italian sausage sub with peppers and onions. What
did he die of? A cousin was a pathologist who
performed an autopsy. He found a thrombus in the
LAD coronary artery. He listed that as the cause
of death. The old fellow passed away from TMB. Too
many birthdays. Sometimes there’s no one to blame
for catastrophes. This old fellow passed enjoying
his last meal. Likely he would have died soon
whether he was going to have a hammertoe
correction or not. We live in a society where we
feel the need to impugn somebody every time there
is an untoward outcome.

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

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