It has become a touchy subject, with DPMs not wanting "to admit" that they still do nail debridements for fear of being accused of being TFP's, typical f'ing podiatrists - a very unprofessional, derogatory term that supposedly separates the surgical podiatrists from the "typical" chip and clip podiatrists.

I beg to differ. While I could never have survived without our valuable office staff members who did much of the debridement of nails for our podiatric physicians, I have never felt that it was "beneath me" to pick up a pair of nail nippers and do the job myself. That was a period of time when I could interview the patient, gather their past medical history and question them about their current complaint. It seemed to put them at ease.

Other podiatrists don't agree and believe that it is definitely beneath them and wouldn't be caught dead with a pair of nail nippers. But on the other hand, they won't hesitate to collect the fee for the service, even though their MA performs it.

How do you feel about it? Take the poll and let me know.

Who debrides nails in your office? The doctor or the nurse/assistant?
Doctor
77%
(10 votes)
Nurse/Assistant
23%
(3 votes)
  • Comments (4)
  • I debride tons of nails every day. use code 11721 if they are significantly thick, dystrophic etc. No problem getting paid. I would never have my nurse, an RN, do this service. I also don't have her cast for orthotics. She was not trained to do that. She does my diabetic shoe fitting/dispensal.

    I have absolutely no problem doing nails. I also do other routine podiatry stuff every day in the office, and also do rounds at the hospital every day and also do amputations every week for limb salvage on diabetics. Nails is just another facet of my practice which includes the usual stuff....heel pain, neuromas etc. My practice is about 70% diabetics with a high inpatient population which is mostly diabetic, so of course I'm going to be seeing them every 3 months for their nails too.  It's just good business sense and part of what I was trained to do. 

  • Thank you, Ryan and Kazu, for being brave enough to answer this question.

    I believe that some lecturers have given DPMs the impression that they are inferior practitioners if they debride nails and you have illustrated two important reasons why doing so actually makes you a superior practitioner.

    Being the best at anything often means that you have to "pick up a lot of pebbles," meaning that you have to do a lot of what might seem to be mundane work but that is often where the discovery occurs as you both mention. This is the time when a more detailed history can be done through multi-tasking or a potentially foot-threatening abscess can be discovered.

    I applaud both of you for seeing the bigger picture. You get it.

  • E. J. Boyko et al published a study in a dermatology literature (I think it was 1993... I will look for the exact reference) that the presence of onychomycosis triples the incidence of foot ulceration in diabetic patients. This is the rationale why I believe in treating onychomycosis aggressively in DM patients, with manual debridement and either Lamisil or Sporanox therapy.

    I have also discovered numerous cases of subungual abscesses while debriding the nails, as well as finding ulcerations under (pre-ulcerative) callouses. I just don't see anything demeaning about doing these treatments.

    FYI, I don't specifically bill for these services. I consider them to be E&M services, as a part of on-going care of my wound care patients.

  • Throughout residency training, I've noted a both extremes in terms of nail debridement, from the doctor doing all of it, to the docter having the staff take care of it all.  In my practice, particularly because I am new to the community, I do it myself.  I find that it gives me the opportunity to talk with my patients, while I am performing the nail debridement, and to get to know them better --as well as to talk about any other problems they may be having.

     

    Furthermore, I don't feel that providing these types of services demeans or lessens me somehow as a physician and surgeon.  It is my job to provide the service that my patients need from me --whether it be a triple arthrodesis or a nail debridement.  Just because a procedure may be less technical [i.e nail debridement, callus paring, etc], does not make it any less valuable.  If some basic foot care is all that a patient needs, and I can perform that service and have them walking out of my office satisfied and pain free,  then I've done my job.