Future of Podiatry might be changing vastly

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aphistis said:
This entire post, and all its links, are focused completely on managing foot & ankle problems in the diabetic, which is something I never disputed in the first place. Once again, instead of trying to bait me into defending a position I never took, how about somebody actually responds to my original posts?

Now that you have actually admitted a point on a position in a concrete manner, I can prove my point. Last posts have been based on the fallacy of vaqueness.

You stated :
I'd like to meet some of these people. Failing that, I'd like to see some citations. I'm sure an assortment of nephrologists, endocrinologists, ophthalmologists, and others would all be quite interested in your thoughts on diabetes management.

I gave you examples of health professionals that do ask DPMs for their thoughts on management. Why would they need advice on the foot since they are trained to treat the whole body? Obviously they had studied it in their lifetime and are aware that the diabetic can have serious problems with the foot. I bet many of the mentioned also know a little bit about the other professions area of expertise also. Interprofessional healthcare is designed to utilize the knowledge of the entire team of health professionals but it is truly effective when all Doctors have a basic understanding of the disease process on the body. How can it affect the kidneys, pancreas, eyes, heart, skin, and other parts of the body.

If each doctor is fully observing and treating the patient as one control volume, then there will most likely be greater success in compliance. Podiatric Medical Students and Residents are trained to think of the patient as a person with a problem.

As I have stated in my past posts, there are many signs that can suggest autonomic neuropathy. This can be a very detrimental scenario for diabetics. Everyone should be looking and evaluating the patient for these signs.

N minds are better than n minds.

Now, quit making Vague comments to support your arguments. It is obvious that you do this so that you can try to shake off any rebuttals.


Podiatrist should be able to use the

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PM2 said:
Now that you have actually admitted a point on a position in a concrete manner, I can prove my point. Last posts have been based on the fallacy of vaqueness.

You stated :


I gave you examples of health professionals that do ask DPMs for their thoughts on management. Why would they need advice on the foot since they are trained to treat the whole body? Obviously they had studied it in their lifetime and are aware that the diabetic can have serious problems with the foot. I bet many of the mentioned also know a little bit about the other professions area of expertise also. Interprofessional healthcare is designed to utilize the knowledge of the entire team of health professionals but it is truly effective when all Doctors have a basic understanding of the disease process on the body. How can it affect the kidneys, pancreas, eyes, heart, skin, and other parts of the body.

If each doctor is fully observing and treating the patient as one control volume, then there will most likely be greater success in compliance. Podiatric Medical Students and Residents are trained to think of the patient as a person with a problem.

As I have stated in my past posts, there are many signs that can suggest autonomic neuropathy. This can be a very detrimental scenario for diabetics. Everyone should be looking and evaluating the patient for these signs.

N minds are better than n minds.

Now, quit making Vague comments to support your arguments. It is obvious that you do this so that you can try to shake off any rebuttals.


Podiatrist should be able to use the
...Once again, I'm glad to hear we're in agreement that podiatrists are the experts in foot & ankle problems, since I've never argued otherwise.
 
aphistis said:
Yeah, that must be it. :rolleyes:

Of course, as long as everyone here stays too afraid to engage it, there'll be no way to know.

aphistis said:
don't want to put words in anyone's mouth, but to an outsider, the (very elegantly presented) logic of this post seems to progress as follows:

1. Podiatrists are currently recognized as foot & ankle surgeons.
2. The foot & ankle contain bone, muscle, tendons & ligaments, soft tissue, nerves, vasculature, etc.
3. These same tissues are found all over the body, not just the foot & ankle.
4. Therefore, podiatrists are adequately trained to operate all over the body, & should be so recognized by the medical community.

Amphiboly

Only one word really needed but how about another

Division

A terrible fallacy.

You may call it a Fallacy of Relevance. Yet the structure doesn't even allow that conclusion.

Still, it has nothing to do with the original topic. As I mentioned in my 1st response you were "extreme" in your wording. I WAS trying to be friendly :) and not a A**. Fact is, you attempted to contruct a logical argument that was based on a fallacy. It didn't work. Then you attempted to use ambiquity to defend yourself.

Now, I agree with R.P.Feynmann about phil. Your argument is about as accurate as stating that the Heisenberg Uncertainty Principle is proven wrong by the fact that two photons emitted at 180 degrees to each other are independent of each other.
 
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tkim6599 said:
The reposting of PM's is considered rude and violates SDN's Terms of Service unless permission from the sender is granted. Please edit any posts which contain such private converstations, or I or another mod will edit them.

If someone sends you a PM which you deem offensive, respond by asking them not to send you any further PMs, or report the PM to any mod.

Now, I just discussed this with tkim6599 and he admitted that checked the rules today and could find nothing, in the rules, that mentions posting of private messages. Later, after he talked to another, he said it is covered under the member names and personal info rule.

"Please refrain from using offensive names and never post a message under another person's name or pretending to be another person. When posting a message to a Student Doctor Network forum, your member name, username and email address will be displayed publicly unless you select otherwise during the registration process or in your user profile. You should always exercise judgment when revealing personal information about yourself when you post messages in public forums. Additionally, users who are aware of another user's personal information (including name and location) must respect that user's privacy and not reveal his or her personal information on the boards. For more information, please read the Student Doctor Network Privacy Policy."

Quite a stretch of the rules.
 
PM2 said:
Now, I just discussed this with tkim6599 and he admitted that checked the rules today and could find nothing, in the rules, that mentions posting of private messages. Later, after he talked to another, he said it is covered under the member names and personal info rule.

"Please refrain from using offensive names and never post a message under another person's name or pretending to be another person. When posting a message to a Student Doctor Network forum, your member name, username and email address will be displayed publicly unless you select otherwise during the registration process or in your user profile. You should always exercise judgment when revealing personal information about yourself when you post messages in public forums. Additionally, users who are aware of another user's personal information (including name and location) must respect that user's privacy and not reveal his or her personal information on the boards. For more information, please read the Student Doctor Network Privacy Policy."

Quite a stretch of the rules.

Hmmm, this is not the part of the TOS that I quoted - this is:

Other General Rules of Conduct
You shall not post on these forums any Content which (a) is libelous, defamatory, obscene, pornographic, abusive, harassing or threatening, (b) contains viruses or other contaminating or destructive features, (c) violates the rights of others, such as Content which infringes any copyright, trademark, patent, trade secret or violates any right of privacy or publicity, or (d) otherwise violates any applicable law. You may not post on these forums any links to any external Internet sites that are obscene or pornographic. You shall not use the main forums for any commercial purpose, to distribute any advertising or solicitation of funds or goods and services or to solicit users to join competitive online services.

People who send Private Messages should retain the right *not* to have their contents revealed to the public without permission. In any event, as per our PM discussion, contacting Lee for clarification is the next step.
 
tkim6599 said:
Hmmm, this is not the part of the TOS that I quoted - this is:



People who send Private Messages should retain the right *not* to have their contents revealed to the public without permission. In any event, as per our PM discussion, contacting Lee for clarification is the next step.

Interesting....

Which is more logical? :)

Sorry if I misrepresented you tkim6599. I should have checked my copying and pasting.
 
For what must be the fifth or sixth time now, my original post (congratulations on finally finding it) was descriptive, not argumentative. I absolutely agree that the logic I posted was seriously flawed, but what you keep doggedly refusing to realize is that I was summarizing efs' argument, not submitting one of my own.


PM2 said:
Amphiboly

Only one word really needed but how about another

Division

A terrible fallacy.

You may call it a Fallacy of Relevance. Yet the structure doesn't even allow that conclusion.

Still, it has nothing to do with the original topic. As I mentioned in my 1st response you were "extreme" in your wording. I WAS trying to be friendly :) and not a A**. Fact is, you attempted to contruct a logical argument that was based on a fallacy. It didn't work. Then you attempted to use ambiquity to defend yourself.

Now, I agree with R.P.Feynmann about phil. Your argument is about as accurate as stating that the Heisenberg Uncertainty Principle is proven wrong by the fact that two photons emitted at 180 degrees to each other are independent of each other.
 
On a complete different note to turn away from the hostility...

I'm sitting here in clinic browsing SDN over lunch, and it occurred to me to wonder: how do podiatry students spend their third & fourth years of school? I spend it treating patients, I know opto students do the same; but that's why residencies are optional for those professions. My understanding is that pod residencies are required, so do you spend your P3 & P4 years on ward rotations like med students, or doing supervised patient care like dents & optos?

Chest-beaters, save your energy; I'm asking an earnest question, not soliciting a propaganda flyer.
 
diabeticfootdr said:
Furthermore, dentists all over the country are attempting to change their scope of practice to allow them to do facial plastics --- I could pose the same question to you . . . aren't you satisfied just being a dentist?

Please post some references for your broad comment that "dentists all over the country are...".

In my opinion that's a broad brush with no evidence to back it up.

From a financial standpoint, it really isn't worth our time to do most facial plastics procedures. More money is to be made by doing routinue dental procedures along with hygiene running at full load in our operatories.
 
diabeticfootdr said:
and technically an MD/DO can provide services in the oral cavity -- they just don't want to.

Actually, no, they can't provide services in something they haven't been trained in. Where would they receive the training? It's impossible, as you know, to provide services if you've never seen them performed, even once.

MD/DOs have no background in any dental treatments, other than being the patient in the chair themselves. They wouldn't even know where to begin with our instruments or materials.

In most states physicians can only extract teeth in an emergency (which requires no expertise at all), not "provide services" as you state.
 
Our dental and podiatry friends,

I was reading through the posts and this back-and-forth arguments and honestly all i'm going to do is add my 2 cents...

practically anyone will need to see a dentist at some point or another and i don't think MD's/DO's can perform the full scope of dentistry on their patients. All I know is that when I have cavity problems and feel extreme tooth ache, I go see a dentist not a family physician...even if the bill is hefty...which is always the case....but i need to see one AT any COST nevertheless...

with podiatry, i noticed that many of the services can be performed by different medical specialties including Family physicians, NPs, dermatologists, etc. and yes, even orthos. But out of thie variety that i have given, there isn't a single one of them who can perform ALL of the lower extemeties problems at once and with the same proficiency of the podiatrist.

This argument about how MD's/DO's can do the podiatrist's work has been really over used and is getting old...allow me when i say..."so what?" I know a family physician MD or DO can remove an ingrown toe-nail, and at the same time if I break my ankle, I can go to an orth. surgeon, and if i needed casting, I know some Physical therapists can do this service....again none of those points are new....however, as a patient, isn't it MUCH more convenient to go see ONE lower extremity specialist who is trained to perform ALL those services. In other words, when I have a foot problem, I go see a podiatrist....just like how when I have tooth and cavity problems, I go see my dentist.

So instead of one group of "professionals" bashing the other, why not accept that we are all members of the healthcare team, we all provide important services to our patients, and provide the best services possible.

My 2 cents.
 
Excellent post drbeesh. I think pride for ones profession has gotton in the way of the original topic. Its weird, cause the more I look into and talk to various doctors about their profession, the more respect I have for them and their degree. SDN has been great to me and soo many others, but "why does my profession is better than yours" mentality soo predominant? Lets keep this thread going and focused on podiatry. I have learned a lot by reading some of these posts. ;)
 
Thank god for dentists, Podiatrists, MD, DCs, and everyone else that helps fight disease and pain. :)
 
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cg2a93 said:
Thank god for dentists, Podiatrists, MD, DCs, and everyone else that helps fight disease and pain. :)


How dare you not capitalize the word "dentists," while capitalizing the professions of podiatrists, medical doctors, and chiropractors.

Please provide no less than 5 scientific articles outlining your reason for doing so. I eagerly await your response.

Sorry...couldn't resist.
 
Is it possible we are all taking ourselves a little too seriously?
 
aphistis said:
On a complete different note to turn away from the hostility...

I'm sitting here in clinic browsing SDN over lunch, and it occurred to me to wonder: how do podiatry students spend their third & fourth years of school? I spend it treating patients, I know opto students do the same; but that's why residencies are optional for those professions. My understanding is that pod residencies are required, so do you spend your P3 & P4 years on ward rotations like med students, or doing supervised patient care like dents & optos?

Chest-beaters, save your energy; I'm asking an earnest question, not soliciting a propaganda flyer.

I know that Scholl students begin clinic 2nd year which is mainly palliative care. This continues through the summer after 2nd year into PM3 and also includes clinical duties for the underinsured & underserved. It may have changed since I was there. The fall semester of PM3 includes didactic coursework as well as a clinical surgery component in addition to regular clinic. Spring semester of PM3 through PM4 is on the wards with other med students including medicine, gen surg, ortho, emergency med, radiology, as well as the podiatry clerkships.
 
PM2 said:
Anasazi23,

Congrats wrt Psych.

I Cannot speak for podiatry schools that haven’t merged with medical schools; I can partially speak for schools that have merged with medical school (partially because I am just starting my 2nd year.)

In our program, podiatry students take several classes with medical students and the first two years is almost identical to medical students. One of those classes is clinical, and podiatry students take the same test as medical students. I have met a director of an east coast pediatrics department, a couple of other pediatricians, EM physicians and several family practice physicians who have stated something very similar to the following: The first 2 years of podiatry is almost exactly the same as medical school. The have gone on to comment about the proficiency of podiatric residents. As far as radiology, podiatrist are already considered specialist in techniques of the lower extremity. Appropriate angles of different anatomical locations... etc. Our program has a great radiology department. From what I have heard, 1-3 podiatry students are chosen each year to rotate through the University of Chicago's radiology program. Therefore,it would make since that our prof's are on good standing with UofC's profs.

As for the training in all fields of medicine, I think we both know that a class or even a rotation does not make one proficient in an area such as emergency medicine. Graduating internal medicine residents don't have the knowledge of a graduating EM resident. This is the reason, a practicing IM doc is required to complete a residency in EM if they want to cross over.

Even though a class or rotation will not provide podiatry and medical students with knowledge to become proficient, it does allow the student to gain some understanding of the various responsibilities.

In current podiatric residencies, podiatric students do rotate through general surgery, EM, IM, etc....

Podiatric physicians are the most qualified to perform foot and ankle surgery. Our knowledge of lower extremity anatomy (Hip down) far exceeds the knowledge obtained by medical students. I realize this alone does not make one more qualified but it is a good start for one who is interested in rearfoot reconstructive surgery and becomes board certified.

Although I have great respect for psychiatrist, I think we can both agree that psychiatrist are not competent enough to perform any surgeries. Furthermore, I will also suggest that a psychiatrist would not be competent in performing the normal duties of an EM physician while in an EM department. Yet, rightfully so, the psychiatrist is still called an MD. I am not asking that DPMs be called MDs; I am asking that the medical establishment realize the advances that have occurred in podiatric education, recognize podiatric medicine as the specialty that it is and assist podiatric physicians with creating a “scope of practice” that truly fits the profession of podiatric medicine. In the age of interprofessional healthcare, we need the best medicine available to help patients heal while saving money. Instead of wasting the knowledge that a podiatric physician obtains during per’s education, allow the podiatric physician to practice medicine in a scope that is practical and deserving.

Have a nice day! ;)

I'm sorry, but I have to disagree with you on this one. In order to be a psychiatrist, an MD or DO must complete four years of medical school, including one year of clerkships/internships where we rotate through all of the appropriate medical areas (peds, cardiology, neuro, etc.). I completed an IM residency and then a psychiatric residency. While I'm not qualified to perform open heart surgery or a laminectomy with fusion, I feel my training is much more comprehensive than a podiatrists.

I have no doubt a DPM is well qualified to provide comprehensive foot care, and with a residency, is qualified to perform complex foot/ankle surgeries. However, a DPM is not a physician and should not be allowed to exceed his/her scope of practice. An OMFS is not qualified to perform brain surgery. Likewise, a DPM is not qualified to perform surgeries above the ankles. If you want to exceed your scope of practice, I suggest going back to school and getting an MD or DO.
 
ProZackMI said:
However, a DPM is not a physician

Uh-oh! someone opened up the "physician/not physician can of worms", may be we can refer to ourselves as po-sicians, would that make everyone happy.
 
AFVET said:
Uh-oh! someone opened up the "physician/not physician can of worms", may be we can refer to ourselves as po-sicians, would that make everyone happy.

LOL...well i don know why there's problem to begin with because PM2 clearly stated "podiatric physicians" and as far as the medical community is concerned....podiatric physicians is the term used to describe podiatrists so i dont see the problem.....and if po-sicians will make ppl happy and go to sleep at night then why not lol
 
ProZackMI said:
However, a DPM is not a physician and should not be allowed to exceed his/her scope of practice. .

ProZack,

You should petition to have a new condition added to the DSM-IV (or the DSM-V when it comes out) . . . . called podo/dento-physician-ophobia.

It would be as follows:

Diagnostic Criteria

A. Must be an MD
B. Criteria for podo/dento-physician-ophobia
____1. fear of dentists and podiatrists referring to themselves as physicians
____2. incident sparks fear of self-worth, then anger, causing MD to write paragraphs degrading the other health professional
C. Criteria have never been met for other forms of generalized insecurity disorders
D. The disturbance is not due to the physiologic effects of a substance (e.g. drugs of abuse) or general medical condition

And furthermore, being a physician (besides being a legal definition that both DPM and DDS meet - aren't you an attorney?) is a state of mind. A DPM may practice in their scope of practice, but I may prescribe a TCA for painful diabetic neuropathy and doing so, I must consider recent MI, somnolence, other psychotropic drugs the patient may take, h/o suicidal ideation. That is being a physician.

LCR
 
If I call myself a physician or a Podiatrist will it change the way I treat my patient?
BTW I agree a Pod should not exceed his or her scope of practice nor should a MD, DDS ect. Bottom line do what you are trained to do.
 
cg2a93 said:
If I call myself a physician or a Podiatrist will it change the way I treat my patient?
BTW I agree a Pod should not exceed his or her scope of practice nor should a MD, DDS ect. Bottom line do what you are trained to do.

Bottom line do what you are trained to do.

That is one of the key points being argued. Podiatrists are not always able to do that.

If a patient has a venous stasis ulcer at the ankle a podiatrist can treat that. Easy to do and well within the scope of training and practice of most podiatrists. If that same patient develops a similar ulcer a couple inches higher on the leg, it may not be within their scope of practice, depending on the state. It still remains well within their scope of training.

A podiatrist may also do a residency in one state and subsequently practice in another. If the first included ankles in their scope of practice, they likely trained that way and are competent to perform surgery on ankle fractures, arthroscopy, fusions, lateral ankle stabilizations, etc. But in their new state, this may not be included in the scope of practice. That would not allow them to use the full extent of their training.

Paronychias, warts, subungual exostosis, and many other common and simple entities affect both the toes and the fingers. These things are well within the scope of training and expertise of the podiatrist, yet based solely on anatomical location may be out of the scope of practice for a podiatrist. Depending on the state. (There are 5 states that specifically allow podiatrists to treat the hand in addition to the foot.)

The people that bear the brunt of this problem are the patients. Access to care is an issue in our current system. While they might easily have their current podiatrist treat a problem, they may have to find someone else simply because it is outside of a certain anatomical region, and therefore out of the scope of practice, while it may be easily treated within the scope of that persons training.

No easy answers, but maybe this can give everyone something to think about.

Eric
 
diabeticfootdr said:
ProZack,

You should petition to have a new condition added to the DSM-IV (or the DSM-V when it comes out) . . . . called podo/dento-physician-ophobia.

It would be as follows:

Diagnostic Criteria

A. Must be an MD
B. Criteria for podo/dento-physician-ophobia
____1. fear of dentists and podiatrists referring to themselves as physicians
____2. incident sparks fear of self-worth, then anger, causing MD to write paragraphs degrading the other health professional
C. Criteria have never been met for other forms of generalized insecurity disorders
D. The disturbance is not due to the physiologic effects of a substance (e.g. drugs of abuse) or general medical condition

And furthermore, being a physician (besides being a legal definition that both DPM and DDS meet - aren't you an attorney?) is a state of mind. A DPM may practice in their scope of practice, but I may prescribe a TCA for painful diabetic neuropathy and doing so, I must consider recent MI, somnolence, other psychotropic drugs the patient may take, h/o suicidal ideation. That is being a physician.

LCR
For what it's worth, I've never heard a dentist refer to him/herself as a "dental physician." ;)
 
aphistis said:
For what it's worth, I've never heard a dentist refer to him/herself as a "dental physician." ;)

Perhaps because you're only a DS-3 you've never heard this.

Google "dental physician" and you come up with numerous hits, including the first match . . . .
http://www.johnsdental.com/articles/product/books/bkfonder.htm

Which refers to a book titled "The Dental Physician".

See, you learn new things everyday as a student.

LCR
 
diabeticfootdr said:
Perhaps because you're only a DS-3 you've never heard this.

Google "dental physician" and you come up with numerous hits, including the first match . . . .
http://www.johnsdental.com/articles/product/books/bkfonder.htm

Which refers to a book titled "The Dental Physician".

See, you learn new things everyday as a student.

LCR
Thanks for the link, Lee. Make sure to keep using the word "only" to describe other people. Your professionalism is really something.
 
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