On a recent trip, while waiting for a delayed flight, I started up a conversation with a woman on the same flight who told me she had had a difficult experience with a podiatrist in Boston many years ago. She had been referred to him for a painful "bunionette" and "he spent  only 10 minutes with me before he booked me for surgery," she said.

She said he never tried conservative care, did the surgery after the first visit and was left with a lengthy, painful scar. She said that the birth of her four children was far less painful than the tailor's bunion surgery and post-op period. I told her that I imagined she had a pretty bad feeling about podiatrists now and she admitted that she had said some "awful things about your specialty."

I took the time to explain to her what our education and training are now (she was startled to learn the length of it.)
I apologized as a representative of our profession for what that doctor had done to her and explained that he should have done a conservative work-up first.

I simply said "I am so sorry that someone in my specialty did this to you. This was not right."  I felt like the fellow probably had a boat payment due.

What would you do in this case?

I tell the unhappy patient that I am sorry for the bad feelings and outcome.  I much prefer strangers telling me their good experiences with Podiatry.   The latter case is more common in my experience.

I would do exactly what you did, Kathy.  You can't, nor should you apologize for what another podiatrist did, but you can make sure that the next experience that this person has with a podiatrist (that being meeting you) is a good one.  You showed compassion and empathy...2 essential characteristic of any physician, and let her know that her experience was an outlier.

Yea....this is a bad situation. I tend to take issue with apologizing on behalf of any physician's previous attempt at a treatment. That responsibility or "act of contrition" should rest with the practitioner who rendered that care. However, this does not preclude me from being empathetic for any complication that the patient may have sustained or experienced. In a situation such as this, I would probably be inclined to allow the patient to "vent" but then explain that surgical complications or poor outcomes can come about in "any specialty of medicine." In regard to her ongoing situation, I would advise that she get alternative opinions to mitigate or correct the problem. Without knowing who the practitioner is, his/her level of training, more importantly his/her side of the story (for eg. was the patient non-compliant, walking to excess post-operatively), you tread on dangeous ground subjecting yourself to being interjected into a possible litigenous issue. Here's an idea...how about referring her to a practioner your trust or if you are unaware of one having her call your office with a few names of such individuals in her geographic region that you may be able to secure for her at a later date.

Excellent points all, and I did do some of those....

I considered how long ago it was and if the statute of limitations was probably past (15+ yrs. - probably.)

I offered to give her the name of a qualified, well-trained practitioner in her current area. (She passed. I understand.)

I remember something Dr. Leonard Levy told me on the first day of class in Iowa. He said to us that as a minority profession, if one of us did something wrong ALL of us would be branded with that wrong-doing. Now I understand exactly what he was saying.

This is a perfect example of that.

I would not appologize for the bad outcome, nor would i comment on it directly at all -- I make it a rule never to comment upon a case unless i was physically in the room during the surgery.  Instead i would express my concern that the patient had had an overall negative experience with a member of the  profession and would try to encourage the patient toward a qualified, well-trained practitioner, should further intervention be required. 

As has been described previously, we are all ambassadors of our profession, and it is incumbent upon each of us to strive to educate (and in some instances RE-educate) members of the community, even if that means in some instances having to over come patient's previous negative experiences.

A example of this that I can share is a patient that i recently treated for osteomyelitis of the left hallux distal phalanx.  She is a diabetic who is relatively poorly controlled who has a concomittant ezcema-type skin lesion on her left 1st and 2nd digit.  She, apparently, had been bounced around a series of dermatologists in an attempt to diagnose this lesion, while at the same time her hallux would swell and drain occasionally.  Ultimatley she was having significant enough toe pain that she presented to my office for evaluation.

I took an xray and found cortical erosions consistant with OM, which was confirmed with a bone biopy.  I was able to obtain deep cultures to guide antibiotic therapy and i obtained an Infectious disease consult to manage the ABX component of her care.  Her hallux swelling has quickly resolved and she is doing well now.

She presented in my office the other day in follow-up and i was asking how her home infusion was going and if things were working out with the local ID doc (i'm relatively new in town so i'm still learning about the other local practitioners.  She responded that he was very nice....but related that  he (the ID doc) thought i was a "podiatrist"  [I work in with an orthopedic office, and i suppose she just assumed i was a foot and ankle ortho...].

I smiled and said, "well, i AM a podiatrist..."  and to which she replied....."Oh, i didn't realize you were JUST a podiatrist....."

Now..... In my head i found myself thinking that i was JUST the podiatrist who'd saved her foot because i was the ONLY physician among the six she'd previously seen who recognized the risk due to her diabetes and took xrays which led to a diagosis and treatment  of her osteo with a coordinated, interdisciplinary approach to provide her care........

She didn't get it....even as I was saving her.  It is up to each of us to go out every day and change those perceptions about what it is what we do.  The good news is that this is a war we can win.  Each day we have the opportunity to earn the respect of our colleagues and patients by going out and being the best, well-trained physcians and surgeons we can be.  People notice,and things change.

That's the time, Ryan, to say "Yes, and aren't you glad that you finally were seen by a podiatrist because I am the only one who got you onto the correct regimen of medications andtreatment protocol to start your healing process. You were very fortunate to finally be referred TO a podiatrist."

Make the EXCEPTION the EXCELLENCE.

At least that will make the patient start realizing that the physicians on the shining hilltop are lacking something. That initial doubt will start to grow and that patient's voice will grow and grow.

Oh, and by the way, you can be darn sure that I bought that woman a drink while we were waiting for that plane to take off for DCA. As my good friend would saying, "I'm just saying...."

She presented in my office the other day in follow-up and i was asking how her home infusion was going and if things were working out with the local ID doc (i'm relatively new in town so i'm still learning about the other local practitioners.  She responded that he was very nice....but related that  he (the ID doc) thought i was a "podiatrist"  [I work in with an orthopedic office, and i suppose she just assumed i was a foot and ankle ortho...].

I smiled and said, "well, i AM a podiatrist..."  and to which she replied....."Oh, i didn't realize you were JUST a podiatrist....."

Now..... In my head i found myself thinking that i was JUST the podiatrist who'd saved her foot because i was the ONLY physician among the six she'd previously seen who recognized the risk due to her diabetes and took xrays which led to a diagosis and treatment  of her osteo with a coordinated, interdisciplinary approach to provide her care........

Ryan, she gave you the best complement in the world.  We are a young profession.  And what do young professions do, they continue to grow.  Perceptions can always be stronger than reality and deceive us when patients we care for seem to shrug off your ability to accurately diagnose and treat their condition.  But when it is our professional counterparts (I will leave out the initials to be P.C.) that make a mistake, patients think it is acceptable that they are the experts, right? The fact that you surprised her with your identity, shows that her perception of a podiatrist is on new ground.  Don't let that comment punch you in the ego breadbasket.  You just started and there are plenty more punches where that came from.  You are doing good work and you will do it every day.  In that process, you will be changing peoples minds, teaching them not to judge a book by its cover but by the contents within them. 

Ryan, she gave you the best complement in the world.  We are a young profession.  And what do young professions do, they continue to grow.  Perceptions can always be stronger than reality and deceive us when patients we care for seem to shrug off your ability to accurately diagnose and treat their condition.  But when it is our professional counterparts (I will leave out the initials to be P.C.) that make a mistake, patients think it is acceptable that they are the experts, right? The fact that you surprised her with your identity, shows that her perception of a podiatrist is on new ground.  Don't let that comment punch you in the ego breadbasket.  You just started and there are plenty more punches where that came from.  You are doing good work and you will do it every day.  In that process, you will be changing peoples minds, teaching them not to judge a book by its cover but by the contents within them.

George makes a good point. That would be a good time to comment "and yes, I guess it was good that you were referred TO a podiatrist, wasn't it?"

Suddenly you aren't JUST a podiatrist but THE podiatrist. Your diagnostic acumen and expertise puts you into a completely different category once the patient starts to reflect upon the fact that the MDs did not successfully diagnosis and treat her problem but the "just a podiatrist" DID!!

You just gave our profession the best advertising possible. Thanks, Ryan!!

Kathy