This is what's wrong with medicine...

[347932]

I get a consult on a Friday at 4AM to see a diabetic who might have an abscess. I don't think he does, but because the Hospitalist writes R/O deep space abscess, my hands are tied and I have to order an MRI. Of course, I write the order at 7AM and the patient gets the MRI at 7PM Friday night. No one is around to read the MRI until Monday morning, so the patient sits in the hospital all weekend, only to be told that there is no abscess, and they can be discharged that night. 3 days wasted in the hospital and tens of thousands of dollars of needless care out the window.

I had three cases today. TOTAL cut time for all three cases combined is 70 minutes. I was in the hospital from Noon to 4:30PM for those three cases. How is anyone supposed to make any money this way? Huge waste of my time and the hospitals. Yes surgery centers are the way to go, but they need to make money and won't let me use the equipment I need because it costs too much.

Just venting. Sorry.

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[PADPM]

Ah Grasshopper......now after all those visits to our offices, doesn't this sound familiar? Remember me preaching to you that although surgery is academically rewarding and an ego boost, it 'ain't always the most profitable.

I know exactly how you feel, but you already know that fact. On one of my surgical days last week I had 4 cases including a soft tissue mass excision, midfoot exostectomy, amputation and bunionectomy with osteotomy. My total OR time for the cases was 12 minutes for the soft tissue mass, 18 minutes for the exostectomy, 38 minutes for the bunion/osteotomy with 2 screws and 14 minutes for the amputation, but I was at the hospital for over 4 hours.

Yes, surgical centers are superb at turn around time and getting you started on time, they are even better if you are an owner. However, most surgical centers receive a set price for a procedure and can not get additional fees for expensive hardware, therefore are relatively strict when it comes to bringing in certain products that could kill their profit.

On the other hand, hospitals generally receive payments for the actual products. Due to the surgical volume of our group, I was recently approached by a surgical center that wants to cater to us. At surgery centers you don't get "bumped" for emergencies, they start on time and room turnover is quick. But I often need or want hardware not available, so I'm going to have to talk about them regarding our needs. If it works out, I will be happy to do less hospital work.

I hope you're right about your hospital consult, otherwise you may have made a big stink over nothing!! If there IS an abscess, don't tell anyone you were annoyed with the MRI!

I presume the hospital consult is at a smaller community hospital if no MRI read is available. To me that's crazy, so you'll have to read the MRI yourself if you REALLY want that patient out of there.

 

[347932]

You are absolutely right PADPM.

I know about it, but it still never ceases to amaze me how hospitals complain about not making any money when they let these things take so long.

Maybe you and I should collaborate on a hospital project and show everyone how to make some REAL money, huh?

Who's going to put up the capital for that one???

 

[hematosis]

I get a consult on a Friday at 4AM to see a diabetic who might have an abscess. I don't think he does, but because the Hospitalist writes R/O deep space abscess, my hands are tied and I have to order an MRI. Of course, I write the order at 7AM and the patient gets the MRI at 7PM Friday night. No one is around to read the MRI until Monday morning, so the patient sits in the hospital all weekend, only to be told that there is no abscess, and they can be discharged that night. 3 days wasted in the hospital and tens of thousands of dollars of needless care out the window.

I had three cases today. TOTAL cut time for all three cases combined is 70 minutes. I was in the hospital from Noon to 4:30PM for those three cases. How is anyone supposed to make any money this way? Huge waste of my time and the hospitals. Yes surgery centers are the way to go, but they need to make money and won't let me use the equipment I need because it costs too much.

Just venting. Sorry.

forgive my ignorance but i thought we can read our own MRI's? no?

 

[347932]

forgive my ignorance but i thought we can read our own MRI's? no?

Sure you can read it. You can't provide a definitive diagnosis, however. We are not radiologists, and our review of the MRI would not stand up medicolegally.

In this situation, if a radiologist misreads the MRI and says there is no abscess, and you let the patient go home, they then go septic and lose their leg, you are covered, because you based your clinical picture on a misread MRI.

However, if a radiologists reads it as an abscess and you ignore it for whatever reason, you are now on the hook. See?

That's somewhat of a simplification, but the basics hold. Interestingly, I tried to get involved in a radiology clinic where I was the one reading ALL F&A films (Radiographs, CT, MRI). It was almost a done deal until I contacted my malpractice carriers who wanted to see my Radiology License, which I, of course, don't have, since I'm not a radiologist. They told me that if I wanted to read radiographs, I would not be covered by my malpractice policy as a Podiatric Surgeon. See?

 

[streetsweeper]

I get a consult on a Friday at 4AM to see a diabetic who might have an abscess. I don't think he does, but because the Hospitalist writes R/O deep space abscess, my hands are tied and I have to order an MRI. Of course, I write the order at 7AM and the patient gets the MRI at 7PM Friday night. No one is around to read the MRI until Monday morning, so the patient sits in the hospital all weekend, only to be told that there is no abscess, and they can be discharged that night. 3 days wasted in the hospital and tens of thousands of dollars of needless care out the window.

I had three cases today. TOTAL cut time for all three cases combined is 70 minutes. I was in the hospital from Noon to 4:30PM for those three cases. How is anyone supposed to make any money this way? Huge waste of my time and the hospitals. Yes surgery centers are the way to go, but they need to make money and won't let me use the equipment I need because it costs too much.

Just venting. Sorry.

Isnt there an on-call radiologist at the very least? Or is it different with every hospital? I'm currently floor whoring off service right now and we have urgent/emergent MRIs that needs to be done/read on a daily basis and all it takes is a phone call to get it done... sometimes u gotta be annoying/persistent and call them up to 3 times to get things done around here. It also helps if you know them as well.

 

[347932]

Isnt there an on-call radiologist at the very least? Or is it different with every hospital? I'm currently floor whoring off service right now and we have urgent/emergent MRIs that needs to be done/read on a daily basis and all it takes is a phone call to get it done... sometimes u gotta be annoying/persistent and call them up to 3 times to get things done around here. It also helps if you know them as well.

In a small community hospital, not so much. And if you ask for a read from the university hospital, they have other "more important" films to look at.

I'm new to the area, so granted I don't know all the people I probably should, and being persistent and annoying in a new place is not the kind of reputation I want.

 

[PADPM]

Sure you can read it. You can't provide a definitive diagnosis, however. We are not radiologists, and our review of the MRI would not stand up medicolegally.

In this situation, if a radiologist misreads the MRI and says there is no abscess, and you let the patient go home, they then go septic and lose their leg, you are covered, because you based your clinical picture on a misread MRI.

However, if a radiologists reads it as an abscess and you ignore it for whatever reason, you are now on the hook. See?

That's somewhat of a simplification, but the basics hold. Interestingly, I tried to get involved in a radiology clinic where I was the one reading ALL F&A films (Radiographs, CT, MRI). It was almost a done deal until I contacted my malpractice carriers who wanted to see my Radiology License, which I, of course, don't have, since I'm not a radiologist. They told me that if I wanted to read radiographs, I would not be covered by my malpractice policy as a Podiatric Surgeon. See?

I'm not sure I agree with your assessment. This is especially true if you or one of your partners/associates ordered the study. It is certainly reasonable if you WANT to wait for the radiologist to read the films prior to making a clinical decision, but it is not mandatory.

If you believe you see pathology on the MRI and are confident in your abilities, I do not see any reason why you can't proceed. How many times in your career have you picked up a fracture that was missed by the "expert" radiologist???? Does that mean the radiologist's opinion is the "final decision" or definitive? Does that mean you won't treat the fracture because the radiologist said no fracture but you clearly see a fracture?

It's no different with the MRI. If you see pathology, treat it as long as you are confident with your abilities. You're not getting paid as the radiologist, but that doesn't mean your experience and professional expertise doesn't count.

 

[streetsweeper]

In a small community hospital, not so much. And if you ask for a read from the university hospital, they have other "more important" films to look at.

I'm new to the area, so granted I don't know all the people I probably should, and being persistent and annoying in a new place is not the kind of reputation I want.

So what? You rather be the nice guy than have people do their jobs?? I think in your case, it's justifiable to be persistent. You can even make a case for "hey, this guy might lose a foot..important enough?"

Sometimes, I think we are too nice..to our own detriment. I even see OR techs and schedulers taking advantage of us.. The B.S. ends with me i'll tell u that.

 

[347932]

So what? You rather be the nice guy than have people do their jobs??

No, I'd rather not burn bridges. These people don't work for me and with a long career ahead of me, I'd prefer to make friends than be overly demanding and potential have a situation that can be easily avoided.

That being said, if you read my example carefully, that wasn't the example I gave. Believe me I am a huge patient advocate, but the situation presents were I'm not the only one on board. If I order the MRI, whether I think there is nothing going on or not, the Hospitalist WILL wait for the official read before discharging this patient. I'm not the admitting physician.

Yes, maybe my example for the malpractice thing may have been lousy in THIS case, but again, that wasn't the initial example I gave. Also, as PADPM pointed out, if I really think something is going seriously wrong based on my clinical judgment, that patient is going to the OR. If I can justify the procedure clinically, I think I'm okay.

If I recommend discharge, and call the radiologist saying "Hey, can you just read the MRI so this cat can go home...", do you think they will move to do anything? It's not an emergency, so why should they? Bet you they won't. In fact, I know for certain they won't.

 

[streetsweeper]

If I recommend discharge, and call the radiologist saying "Hey, can you just read the MRI so this cat can go home...", do you think they will move to do anything? It's not an emergency, so why should they? Bet you they won't. In fact, I know for certain they won't.

Actually, I think this is a great reason to give them a call. Even a "preliminary read" is all we need sometimes. When I was on medicine, one of my attendings told me to "follow up on the CXR so we can get the patient the hell out of here." So as you can see, they'd be happy to take people off their census which = less to round on.

Do you guys not communicate face-to-face? Back on podiatry, when we have consults, medicine usually listens to our recommendations, not radiology's. So if we disagree with what medicine wrote and think a patient is good to go home, we relay the message to medicine personally or page them...they're usually good about doing what WE want. Unless of course, the patient was initially admitted for a heart attack or something and just happens to be diabetic with a questionable foot abscess. You didn't provide us the full story so we can't fully lament on the system yet.

Bottom line, being able to communicate won't burn any bridges. I think you're a tad too self conscious about that.

 

[347932]

Do you guys not communicate face-to-face? Back on podiatry, when we have consults, medicine usually listens to our recommendations, not radiology's. So if we disagree with what medicine wrote and think a patient is good to go home, we relay the message to medicine personally or page them...they're usually good about doing what WE want...

Face to face? Seriously? I work out of two offices a day and cover 2-3 hospitals depending on my inhouse/case load. My days star at 6AM and I'm rarely home before 7PM. As a resident you have the luxury, it seems, to hang out and hunt these people down to talk to them personally. I certainly try to communicate as much as I can with all my referral sources, but rarely ever see any of these people face to face. None of us have that kind of time.

When your malpractice kicks in after residency, you may not be so hot to make these blanket recommendations without backup. Especially if you're out of a small community hospital. Also, as I mentioned, over the weekend there is no one at this hospital to read any films and emergent cases are sent out to the University hospital for the weekend.

 

[PADPM]

So what? You rather be the nice guy than have people do their jobs?? I think in your case, it's justifiable to be persistent. You can even make a case for "hey, this guy might lose a foot..important enough?"

Sometimes, I think we are too nice..to our own detriment. I even see OR techs and schedulers taking advantage of us.. The B.S. ends with me i'll tell u that.

I understand your point(s), but you may want to lighten up a little. I can ASSURE you that when you're finished your residency and obtain privileges at some hospital where you've never worked before, the OR techs, schedulers, nurses, custodians, etc., are ALL important to your future success.

Understand that OR personnel are generally not impressed by doctors and won't necessarily put you high on a pedestal. These people work with surgeons of all specialties on a daily basis, and no one has larger egos than surgeons. So these people have "been there, done that", and aren't going to take much crap from a young new doctor.

Before you know it the scheduler will make it difficult for you to obtain OR time. The custodial staff will take forever to turn a room, the OR techs will make sure you don't have the equipment requested, the nurses will make sure YOU have to take care of all the little details.........they will make sure you have to come BACK to the hospital to write that order you forgot and they won't take your verbal order.

Once again, I fully understand your frustrations, but you must also understand where these people are coming from. They deal with demanding, spoiled, egotistical surgeons all day long.

I treat every member of the OR staff like gold and thank everyone for their help before, during and after a case. As a result, the rooms get flipped quicker, the OR techs make sure that they "put away" the power equipment I request even though another doc needs that for his case, the scheduler squeezes in emergency cases for me and the recovery room nurses bend over backwards for my patients without calling me for every little question. They will call me if I forgot something and then just do it without me having to return.

Cross ANY of those people and your time at that facility will be miserable.

Simply treat them with respect, let them know they are appreciated, let them know what you need and you'll get it. Start making demands and you're in for a lonely ride.

 

[347932]

Bottom line, being able to communicate won't burn any bridges. I think you're a tad too self conscious about that.

One of the huge obstacles to overcome with the transition from residency to private practice is exactly what you are saying. Being so non-chalant about this in a new environment as one of the new kids on the block can land you in some serious trouble. I've seen it and it's ugly. "I bet you JUST got out of residency, didn't you? You're new around here too, huh? Who do you work with, again? I see. Thanks for the information and I'd be a little more careful if I was you." There goes THAT referral. Next phone calls is from your boss or the partners in the practice.

Yes, being able to communicate shouldn't burn any bridges. It can and does, regardless of how carefully you think it is being done.

 

[streetsweeper]

I understand your point(s), but you may want to lighten up a little.

I can see how the tone of my post can show frustration... in my head, it didn't seem that way. So, apologies if I offended anyone. I absolutely agree about giving respect. I pretty much give it to everybody but I also refuse to be stepped on.

Once again, appreciate all insights from you and kidsfeet

 

[PADPM]

I can see how the tone of my post can show frustration... in my head, it didn't seem that way. So, apologies if I offended anyone. I absolutely agree about giving respect. I pretty much give it to everybody but I also refuse to be stepped on.

Once again, appreciate all insights from you and kidsfeet

 

[skiz knot]

I get a consult on a Friday at 4AM to see a diabetic who might have an abscess. I don't think he does, but because the Hospitalist writes R/O deep space abscess, my hands are tied and I have to order an MRI. Of course, I write the order at 7AM and the patient gets the MRI at 7PM Friday night. No one is around to read the MRI until Monday morning, so the patient sits in the hospital all weekend

If you are not capable of determining if a foot has a fluid collection in it that is large enough to necessitate surgical intervention, there might be a problem in your skills. You ARE expected to be able to independently read radiographic studies in your field of expertise. You have seen and evaluated the patient and viewed the appropriate studies. YOU are the reason the patient stayed in the hospital "all weekend" unnecessarily.

 

[347932]

If you are not capable of determining if a foot has a fluid collection in it that is large enough to necessitate surgical intervention, there might be a problem in your skills. You ARE expected to be able to independently read radiographic studies in your field of expertise. You have seen and evaluated the patient and viewed the appropriate studies. YOU are the reason the patient stayed in the hospital "all weekend" unnecessarily.

Sorry man. I gave my opinion about what the problem was, but the admitting physician wanted to see an MRI. I'm not the admitting physician. At this hospital podiatry does not have admitting privileges, due to some horrible mistakes made there by one of our colleagues. You need to READ what I wrote. I am able to read these studies but when push comes to shove on this potentially sticky cases, medicollegally, I'm SOL, and you know it..

You have now attacked me twice. Are you ready to tone it down a bit, and actually read what I post before flinging insults about?

 

[Traum]

That is really sad that the actions of one pod or a few, they are relegated to 2nd and 3rd tier status and cannot admit patients.

It is 2012 already, and still the parity is abundantly clear. DPMs regardless of training, breadth, rigor, residency, a pod is a pod is a pod, and they cannot admit at this hospital. Pathetic, sad, and akin to sitting in the back of the plane.

Where are the foot clubs, foot associations, and societies? Pay hundreds of thousands to deal with this?


Res ipsa loquitor.

 

[347932]

That is really sad that the actions of one pod or a few, they are relegated to 2nd and 3rd tier status and cannot admit patients.

It is 2012 already, and still the parity is abundantly clear. DPMs regardless of training, breadth, rigor, residency, a pod is a pod is a pod, and they cannot admit at this hospital. Pathetic, sad, and akin to sitting in the back of the plane.

Where are the foot clubs, foot associations, and societies? Pay hundreds of thousands to deal with this?


Res ipsa loquitor.

If you knew what this one guy did at this hospital, you would understand completely. Believe me. It's the stuff of legends AND presented a huge liability for that hospital. Once burned, twice shy, as they say.

 

[Ferocity]

If you knew what this one guy did at this hospital, you would understand completely. Believe me. It's the stuff of legends AND presented a huge liability for that hospital. Once burned, twice shy, as they say.

Just out of curiosity... did it involve money, greed, incompetence, or incontinence?

 

[skiz knot]

Sorry man. I gave my opinion about what the problem was, but the admitting physician wanted to see an MRI. I'm not the admitting physician. At this hospital podiatry does not have admitting privileges, due to some horrible mistakes made there by one of our colleagues. You need to READ what I wrote. I am able to read these studies but when push comes to shove on this potentially sticky cases, medicollegally, I'm SOL, and you know it..

You have now attacked me twice. Are you ready to tone it down a bit, and actually read what I post before flinging insults about?

Quite a bit melodramatic, don't you think. I read what you wrote, and I still assess the situation the same. By your logic, if you saw a huge abscess in the foot that needed to be drained, you would not operate on it until the radiologist read the study (3 days later).
If you were concerned that patient had some some early infection, but not an abscess, it would be prudent to start oral antibiotics and reevaluate the patient as an outpatient in a few days. How many times have you seen a normal MRI (by your well educated read, you probably have looked at more foot MRIs than whatever random non-musculoskeletal radiologist on call over the weekend) that some how turned into a limb and life threatening condition over the course of a few days, especially if they were on some sort of antibiotic?

 

[347932]

Quite a bit melodramatic, don't you think. I read what you wrote, and I still assess the situation the same. By your logic, if you saw a huge abscess in the foot that needed to be drained, you would not operate on it until the radiologist read the study (3 days later).

You are clearly not getting the gist of this whole thread. CLEARLY if there is a clinical reason to take a patient to the OR, it happens. FAST. Diagnosing an abscess that needs immediate drainage is not rocket science, and I rarely even order an MRI in those situations. OR I order a stat MRI with a wet read, which somehow never seems to happen on the weekend, so it gets done FAST (within an hour).

If there is no doubt in my mind that there are ZERO issues, my hands are tied about discharging the patient while a Hospitalist is waiting to get the validation they need to discharge the patient via a negative MRI. THAT is the problem.

If you were concerned that patient had some some early infection, but not an abscess, it would be prudent to start oral antibiotics and reevaluate the patient as an outpatient in a few days. How many times have you seen a normal MRI (by your well educated read, you probably have looked at more foot MRIs than whatever random non-musculoskeletal radiologist on call over the weekend) that some how turned into a limb and life threatening condition over the course of a few days, especially if they were on some sort of antibiotic?

I can count on one hand how many times in my ten years this has happened. Clinically, maybe, but why would I even consider an MRI if everything looks good. THAT is the other problem. I think nothing's wrong but the Hospitalist, once again, needs the validation that everything is hunky dory, so insists on an MRI (which is a useless expense to begin with), and has this patient sit the hospital over the weekend for NOTHING.

You sound like you have a whole lot of experience with this. What kind of resident are you, or are you in private practice already?

Melodramatic or not, an attack is an attack and it's not appreciated. Good luck with that attitude in practice.

 

[janV88]

Geez people.

Kidsfeet is talking about discharging a patient that he himself did not admit. He isn't talking about taking a sick patient to the OR. It's always up to the admitting physician to discharge the patient, right?

 

[streetsweeper]

It is 2012 already, and still the parity is abundantly clear. DPMs regardless of training, breadth, rigor, residency, a pod is a pod is a pod, and they cannot admit at this hospital. Pathetic, sad, and akin to sitting in the back of the plane.

You don't see that as a blessing? Admitting a patient, medically managing, and discharging a patient is a really big headache.. and one of the most dangerous things you can do if you don't know your stuff. The vascular surgeons I work with right now become very happy when medicine decides to manage their patients. Some of the post op patients who are clear to go home cannot b/c they become obstructed (OSA), then once that is resolved, they get orthostatic changes..so the BP medications have to be manipulated...but once that is resolved, their INR is supra therapeutic...... all of this management yet they only came in for a leg debridement..originally planned for same day. Which reminds me, I have to do the d/c summary on that person.

There is still disparity in the training of medical management as well. I've worked with a young attending during my externship year, great surgeon..does total ankles.. charcot recons..you name it...but when i asked him about insulin sliding scales, he just scratched his head.

 

[347932]

I am perfectly comfortable managing my patients medical HOWEVER, should I really be doing that? It has nothing to do with my training, but everything to do with licensing, scope of practice and malpractice insurance.

When I do admit primarily at other hospitals, the first consult I write for is Medicine to manage these patients medically. Then ID, Vasc, Nephro...etc, based on the individual patient. You do not want to be on the hook for these issues, as some of these patients have so many underlying medical issues, one simple, seemingly small mistake can snowball to catastrophe.

We are the foot and ankle experts, and trying to be the everyman/woman can lead to disaster. I am a specialist consultant in the hospital setting in my view. I can admit in most places, but am hardly the one to run the show medically. One I again, I a can do it, but the real question is should I.

 

[347932]

There is still disparity in the training of medical management as well. I've worked with a young attending during my externship year, great surgeon..does total ankles.. charcot recons..you name it...but when i asked him about insulin sliding scales, he just scratched his head.

This is frightening to me, truthfully. This should be addressed in the residency hunt imo. Everyone always asks "How many Ankle Fusions do you see as a resident?", but I don't think I've ever once seen someone ask about medicine rotations, ID rotations and the myriad of other potential medical rotations needed. We ARE physicians, remember?

One young attending is not representative I hope. This is also a case in point. Doing all that sexy surgery does not a true practicing physician make.

 

[347932]

It's always up to the admitting physician to discharge the patient, right?

Yep.

 

[streetsweeper]

Don't you find this disturbing? I guess my biggest complaint about my education in podiatry school is that I feel I am nowhere near as prepared as the medical students when it comes to knowing general medical knowledge. Yes, at SCPM, we do take some of the same courses w/ the medical students but there are other times where we take similar biomedical courses as the medical students but with our own faculty. I feel the information presented in those classes are like 90% of what the M1/M2s learn.

Streetsweeper, I remember recalling you graduated from one of the newer podiatry schools associated with a DO school. Do you think your education has prepared you to medically manage your pts as well as your fellow medical residents?

Hell naw. Initially, I felt the same as you. Once I had my medical rotations in my 3rd/4th year.. I realize i was graduating without the base knowledge as my MD peers. But once I became an intern on medicine and surgery in residency, I am glad I won't have to do these things when I get out. We are surgical consultants, let's focus on what we do best. The orthos I work with will not medically manage their own patients either, not sure if it's a privilege thing or choice.

FYI, i graduated from the Cali school. Answer is no. If I do have to admit a patient, I'm gonna have to consult medicine for medical management..which Is what I see podiatrists doing nationwide. I've been at programs that boast medical management in their training but the moment the pt has A. Fib history, they consult medicine anyway. I've also worked with TOP DMU students, co-residents with top AZPOD students and OCPM... they will tell you the same. However, I know there are residencies out there that will train you to be comfortable with medical management. Not my program though .. not my interest either.

 

[347932]

I realize i was graduating without the base knowledge as my MD peers.

Whoa what? You should be graduating with the same tools any physician out there graduates with (potentially with the exception of OB and Psych). Why do you feel you are not on the same ground?

Not my program though .. not my interest either.

It should be your interest. You will be conversing with many physicians and the hope is that you can, at least at a basic level, guide your patient's medical care and be adept at understanding the various medical issues that can ultimately impact your patient and the care you provide. We want parity? Sorry, but not with that attitude.

Thoughts?

 

[dtrack22]

Whoa what? You should be graduating with the same tools any physician out there graduates with (potentially with the exception of OB and Psych). Why do you feel you are not on the same ground?

That's nearly impossible with the way our clinical curriculum is set up. How many months do we spend in our 3rd and 4th year doing podiatry specific rotations? The answer is well over 50% at every podiatry school in the country.

So how do you propose we learn in 8 months what MD/DO students have 24 months of experience in?

If we flipped your statement around: "MD/DO students should be graduating with the same abilities to diagnose and treat podiatry-specific pathologies as DPM students." You think they could do that? Or would even care?

I'm not saying that we are way below the curve, I can't comment on that. But I don't see how you could think any DPM graduate is at the same level as a student who has had over double the amount of experience in "general medicine"

 

[347932]

That's nearly impossible with the way our clinical curriculum is set up. How many months do we spend in our 3rd and 4th year doing podiatry specific rotations? The answer is well over 50% at every podiatry school in the country.

So how do you propose we learn in 8 months what MD/DO students have 24 months of experience in?

If we flipped your statement around: "MD/DO students should be graduating with the same abilities to diagnose and treat podiatry-specific pathologies as DPM students." You think they could do that? Or would even care?

I'm not saying that we are way below the curve, I can't comment on that. But I don't see how you could think any DPM graduate is at the same level as a student who has had over double the amount of experience in "general medicine"

They are not the ones screaming parity, we are.

When you start your residency and you are on the IM service you are expected to be equal in capability as a medical intern.

 

[dtrack22]

They are not the ones screaming parity, we are.

When you start your residency and you are on the IM service you are expected to be equal in capability as a medical intern.

I expect to get an A on every exam. Doesn't mean it happens. But I'm still here...

 

[bobdolerson]

Who wants parity?

Parity means DPM=MD. I don't want to be an MD, or I would have applied to those programs.

I've yet to understand this obsession with trying to be the same as an MD/DO...why can't people just be happy with their position in the team, and understand that it's a valid one?

 

[shenanigans327]

Who wants parity?

Parity means DPM=MD. I don't want to be an MD, or I would have applied to those programs.

I've yet to understand this obsession with trying to be the same as an MD/DO...why can't people just be happy with their position in the team, and understand that it's a valid one?

this

 

[dtrack22]

Who wants parity?

Parity means DPM=MD. I don't want to be an MD, or I would have applied to those programs.

I've yet to understand this obsession with trying to be the same as an MD/DO...why can't people just be happy with their position in the team, and understand that it's a valid one?

This is a pretty ignorant comment. It's not that all the DPM want to be MD's (although I'm sure it is the case for some). Rather, we want to be able to practice medicine just like any other medical sub-specialty would. We want to be a "part of the team", when in many cases politics and semantics don't allow it.

One one hand, our education/training has outgrown our scope in most states and under many hospital bylaws. On the other, we still do not have the same admission and graduation requirements that MD programs do. So the APMA, AACPM, etc. throw around the word "parity" in order to push through changes in our education so that it more closely resembles MD/DO's. Essentially, we are trying to eliminate any argument that we should NOT be treated as physicians. Of course, we have a long way to go.

 

[bobdolerson]

Sometimes I can't help but laugh, your comments are so blunt.

I see what you mean, and I suppose if I'd taken into account posts in other threads from the posters in this thread, that would have been more clear.

The cases in California and some of the other things being said by pod students have apparently given me a definition of "parity" that I shouldn't apply so broadly.

Also, your mother is a very ignorant comment.

 

[streetsweeper]

Thoughts?

Totally agree. We want parity and I'm all for it except I went to podiatry school, not medical school. Dtrack pretty much summed it up.

 

[Creflo]

I get a consult on a Friday at 4AM to see a diabetic who might have an abscess. I don't think he does, but because the Hospitalist writes R/O deep space abscess, my hands are tied and I have to order an MRI. Of course, I write the order at 7AM and the patient gets the MRI at 7PM Friday night. No one is around to read the MRI until Monday morning, so the patient sits in the hospital all weekend, only to be told that there is no abscess, and they can be discharged that night. 3 days wasted in the hospital and tens of thousands of dollars of needless care out the window.

I had three cases today. TOTAL cut time for all three cases combined is 70 minutes. I was in the hospital from Noon to 4:30PM for those three cases. How is anyone supposed to make any money this way? Huge waste of my time and the hospitals. Yes surgery centers are the way to go, but they need to make money and won't let me use the equipment I need because it costs too much.

Just venting. Sorry.

As a first year resident, I have noticed similar situations that seem very inefficient. Patients often stay in the hospital for days, especially over the weekend, waiting on radiology studies (ABI, bone scans, MRI, etc.) After hearing so much talk in the media about the healthcare crisis, it astonishes me how long people sometimes end up in the hospital, at a high cost per day, just waiting on these studies. Not to judge radiology, because I don't claim to know the struggles they face, but if the radiological studies were done more timely, at my hospital we could get patients out much faster, at much lower cost. The same goes for procedures, for example, say a patient needs a vascular procedure or podiatry procedure, and they sit in the hospital for 2-3 days waiting on the doctor to be available to do the procedure. Not saying there aren't reasons for this or that there is an easy solution, just an observation as a first time resident.

 

[PADPM]

If you are not capable of determining if a foot has a fluid collection in it that is large enough to necessitate surgical intervention, there might be a problem in your skills. You ARE expected to be able to independently read radiographic studies in your field of expertise. You have seen and evaluated the patient and viewed the appropriate studies. YOU are the reason the patient stayed in the hospital "all weekend" unnecessarily.

Interesting comment. Ironically, last week our group was consulted on a patient with a "hot foot", which was erythematous, edematous and painful. The official MRI "read" was no abscess or fluid collection, but there was some apparent necrosis and liquefaction of the intrinsic muscles along the plantar-medial aspect of the foot.

I looked at the films and felt there WAS an abscess and the patient went to the OR for I/D. When I made the first part of the incision plantarly, pus came exploding out of the foot. I had to basically filet the foot open, because the more I cut the more pus came out.

I'm not sure I've ever seen that much pus before, despite an MRI (by the radiologist) who stated no abscess.

However, even though Kidsfeet may not have made his point very clear on this particular matter, I'm fully aware of what he's saying. Kidsfeet has actually spoken with me in private regarding this type of matter, and the main point is that despite HIS recommendations, it is often the admitting physician/hospitalist who is the captain of the ship.

I'm also aware of the actual incident(s) that resulted in the chief of staff and executive staff taking admitting privileges away from DPMs at that hospital. It was due to an obnoxious, big mouthed, young DPM who crossed the line on several occasions and insulted other medical professionals while at the same time exposing the hospital to litigation. He was actually very talented and bright, with no social skills.

However, one of my friends is actually very involved at that hospital and I believe that decision has been reversed.

As far as parity and medical knowledge.......I'm not sure that's realistic with our profession or any specialty including MD's. With the plethora of information today, it's very difficult to be a "jack of all trades" and know everything. Even the orthopedic surgeons, general surgeons, vascular surgeons, etc., will be quick to tell you how much true medicine that don't know or don't remember.

Yes, it's nice to be well versed in all phases of medicine and to have the ability to interact intelligently with other specialists. But I'm not an internist and will never know as much as they do regarding medicine, and similarly, they have even less knowledge regarding surgical care.

I can converse with almost every specialist, but if they REALLY want to corner me with information I don't know, I'm sure they have that ability. And I don't expect them to know as much about the foot/ankle as me, and they don't.

But more often than not, I know more about their specialty than they do about the foot and ankle, so I don't think we're really in the backseat.

 

[skiz knot]

Geez people.

Kidsfeet is talking about discharging a patient that he himself did not admit. He isn't talking about taking a sick patient to the OR. It's always up to the admitting physician to discharge the patient, right?

I admit that I was unclear as to why the patient was not discharged until the final read of the MRI was available and that it was the admitting doctor holding up the discharge. You were not explicit in your statements, and I missed the inference.

I get a consult on a Friday at 4AM to see a diabetic who might have an abscess. I don't think he does, but because the Hospitalist writes R/O deep space abscess, my hands are tied and I have to order an MRI. Of course, I write the order at 7AM and the patient gets the MRI at 7PM Friday night. No one is around to read the MRI until Monday morning, so the patient sits in the hospital all weekend, only to be told that there is no abscess, and they can be discharged that night. 3 days wasted in the hospital and tens of thousands of dollars of needless care out the window.

I apologize for "attacking" you undeservedly. I thought you were complaining that there was no radiologist to read the study, therefore necessitating the extra stay, when in fact you were complaining that the admitting physician would not listen to the specialist recommendations, necessitating the extra stay. If it were the former, I would still feel you were at fault. Being the latter, I wholeheartedly agree with your initial conclusion.

 

[that1guyfromFL]

Yes, it's nice to be well versed in all phases of medicine and to have the ability to interact intelligently with other specialists. But I'm not an internist and will never know as much as they do regarding medicine, and similarly, they have even less knowledge regarding surgical care.

I can converse with almost every specialist, but if they REALLY want to corner me with information I don't know, I'm sure they have that ability.

But more often than not, I know more about their specialty than they do about the foot and ankle, so I don't think we're really in the backseat.

These 3 statements sum things up very nicely IMHO.

Also, in my experience, the first two also hold true for almost all medical specialists, especially those in surgical fields.