This is a report on what happened  Friday.  This is not intended to be criticism or a rant. This is just a true story.   I went to see my good friend who is a 90 year old woman who lives alone.   She had fallen about 12 hours prior and now was able to walk, but with some pain in her knee and MUCH pain in her foot.   She knew it was not broken  because her daughter in law had told her because if she could move it, etc-----  However, I know the Ottawa rules.     She had 4/5 pain base of 5th metatarsal otherwise only 1/5 edema and eccymosis.       The Podiatrist I know   is not in his office on Friday so I took her to her/ and my own MD Family Practice Clinic.  She was seen immediately and with good humor, but much confusion about records.   The x ray tech took an accurate history of the injury and took excellent quality lateral, foot AP, and oblique views which clearly showed avulsion of styloid process of fifth metatarsal.     The FP MD wrote Rx for cam boot with vague instructions about where to obtain it.   We went to well known  medical aid store.  They had a correct size boot, BUT they knew NOTHING about sizing, proper fitting, or warnings.  The MD spent a good amount of time with her, but after an initial and customary embrace of greeting  he did not touch her.

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  • Medicine is riddled with stories like this one.  We've all seen similar stories.  At least we are in a position to speak to and with other medical professionals when the opportunity arises to improve the level of patient care.  Most patients don't have the luxury of a friend or family member in the medical community who can speak on their behalf.  I know that with my own family, doctors generally discuss issues and answer my questions more completely when they know my profession.  Sometimes we can even assist our own patients with a call to a provider who is otherwise unresponsive to the patient's needs.  Even the best of providers have bad days.  As long as we work with each other an openly discuss issues that affect patient care, outcomes will continue to improve.  Be the voice that makes the difference.

  • Quote"Life would be better if there were more podiatrists in this town".


    Now can someone explain to me how we need more DPM's and yet we have 80 recent graduates who cannot get licenses to practice podiatry at a non surgical level in those towns?


  • To my surprise, I have witnessed cam, 3D, and whatnot fracture boots donned every kind of wrong way by most every type of provider, even Pods, and techs alike over the years.  I continue to be chagrined when I see someone walk out of a clinic with their heel up over the back INSTEAD OF DOWN SNUGLY INSIDE AND TO THE BACK -or- the leading edge is too short (toes sticking out)... that is just not right. People, fit the right size; carry the straight leading edge (i.e., DonJoy) for those in between sized feet; and train the staff that a W lg is the same as a M med, for example... just in case they failed to keep up with stockage, and decide to tell you we're out of that one size we need on Friday at 5pm.

    Same thing goes for fitting postop/fracture/healing shoes:  seat the heel snugly into the heel counter, bring straps down firnly (adjusting the velcro catches properly into position), and cut off the excess strap (so they don't trip over them, and not look ridiculous).

    On the issue of poor fitting of fracture boots and healing shoes:  This can only be the result of poor training, not reading the instructions that come with them, not being properly detailed (demo'd) by the rep, and these days -not viewing the web video, not to mention- just plain don't care enough to pay attention to detail, don't care enough to get it right, and my two favorites- don't care enough about your patient much less that cast care is near the top of the list for malpractice liabilities.

    The fact is: it is just not that difficult to fully seat the heel properly, make sure the toes do not stick out past the leading edge, and to snug the straps down firmly but not too tight; then remove the velcro protectors seating it all properly so that the velcro along the sides can catch in place, and voila! You have fitted a cam/3-D/postop/frature boot properly!

  • Dr. Kass,     This is the same Doctor   named in my Advance  Directives and DNR.

  • Dr. Kass,    He did not know he did not know.

  • Dr. Bates if it was also your MD clinic, and the MD knew you are a podiatrist, I wonder why he did not "consult" with you, or defer when you mentioned the stocking......
  • My friend, the 90 y/o patient, was asking my opinion since she knew I had seen the x ray before the MD physician had seen either her or the xray.  I told her I was only her chauffeur, and that the MD was her doctor for this.  I agreed with his DX but his instructions about the boot were very vague.  I asked about a stocking and he did not agree.  I fitted the cam boot at the store but her dau- in- law later took it off and had reapplied it incorrectly so that the Velcro  was  now chaffing the skin  causing pain.  I knew this lady was not neuropathic.   I reapplied the boot after I applied a ' foot sleeve' because stockings were forbidden.    Life would be better if there were more podiatrists in this town.