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The Society of Chiropodists and Podiatrists insists the complaints about podiatrists are being orchestrated by orthopaedic surgeons anxious to protect their territory.
Re: The bunion surgeons who are maiming their patients
Saw it - if you excuse the pun. The issue according to the Orthopaedic representative, is one of training and he is quite correct. It is different. Doctors study medicine then go on to do surgery - proper - post graduation. But there are substantial sections of the medical degree that are not relevent to foot and ankle surgery, whilst it could be argued that there are substantial parts of the undergraduate podiatey degree that are relevent to foot and ankle surgery.
I would like to think that part of the success of podiatric surgery is because of the knowledge and skills the clinicians gained as an undergrad and post grad general podiatric practitioner. It takes five years to gain a medical degree as opposed to three or four to gain a podiatry degree but considering the latter is devoted to the study of the foot in health, disease and dysfunction whereas the former covers all ills (literally)and cures othe body from cradle to grave. On that basis I would say that it is the podiatrist who has a better grounding pre-surgical training for the discipline.
So if the issue is surgical training - and it may be given the nature of the article - citing the various ?malpractice? cases, surely the route to go down would be a joint programme with podiatry and medical degree clinicians embarking on the same pathway. I would have thought that this would be the best option especially as everyone gains from shared knowledge.
However, the derogatory tone of the article - with the ascertion that podiatric surgery is a danger to the public is quite defamatory. How many orthopaedic cock-ups have we all seen over the years and that are still rife? I would hope the Faculty can get some air time to challenge this view.
The Society of Chiropodists and Podiatrists insists the complaints about podiatrists are being orchestrated by orthopaedic surgeons anxious to protect their territory.
Re: The bunion surgeons who are maiming their patients
Think there will be much hand wringing at Fellmongers over whether to send a mildly worded letter to the Brixham Advertiser or whether to capitulate totally, bend over and assume the position and hope the shafting ain't too painful. Whatever happened to the Podiatry Association?
Here's a suggestion for the Society: take Podiatry out of the NHS completely - including the training schools - keep it entirely in the private sector with a dedicated podiatry insurance scheme. Come out of the HPC. And set up a podiatric regulatory body that encompasses the whole profession - and tell the government, Dept of Health and the aforementioned orthopaedic surgeons to go fcuk themselves.
What? Sorry? Haven't got the balls? What a surprise.
Re: The bunion surgeons who are maiming their patients
Quote:
Originally Posted by davidh
I liked the lie "The qualification involves a one-year postgraduate course in surgery after a chiropody or podiatry degree." .
Ah but in the very finest traditions of journalistic brinksmanship, its not a lie. The qualification INVOLVES a one year post graduate course. A medical degree INVOLVES learning to use a sphyg without throttling a patient. The reader is left to draw their own incorrect conclusion that this is ALL it involves.
The interesting question for me is whether this sort of hatchet job would continue if / when Pod surgeons drop the title and become surgical podiatrists. That seems to be whats getting everyones backs up.
[FONT="Garamond"]
Jealousy is a sad quality and the group of orthopods that continue to peddle this disinformation do themselves no favours, they are unworthy of an otherwise commendable profession[/font]
Re: The bunion surgeons who are maiming their patients
Foot Health Surgeons now Rob. Some interesting symmetry in all this - the HPC foists grand parenting and inadequate regulation on the profession and the Society recommends the profession to drop its breeks - and after three decades of establishing podiatric surgery, the Society is lobbying for a name change to placate the Dept of Health and some of the minority groups in orthopaedics.
Maybe the Brixham Advertiser has too much circulation after all....
Re: The bunion surgeons who are maiming their patients
Quote:
Originally Posted by Robertisaacs
Ah but in the very finest traditions of journalistic brinksmanship, its not a lie. The qualification INVOLVES a one year post graduate course. A medical degree INVOLVES learning to use a sphyg without throttling a patient. The reader is left to draw their own incorrect conclusion that this is ALL it involves.
The interesting question for me is whether this sort of hatchet job would continue if / when Pod surgeons drop the title and become surgical podiatrists. That seems to be whats getting everyones backs up.
Re: The bunion surgeons who are maiming their patients
Quote:
Originally Posted by Robertisaacs
The interesting question for me is whether this sort of hatchet job would continue if / when Pod surgeons drop the title and become surgical podiatrists. That seems to be whats getting everyones backs up.
I'm not so sure Robert. Perhaps 'Consultant Podiatric Surgeons' could change their title to 'Consultant Red Herrings' and everyone would live together side by side on pianos in perfect harmony? The issue of title is a blatant method of diverting attention away from the real issue under the guise that certain orthopods are protecting the public. It's also a great way of taking up time and scant resources within the Faculty of Podiatric Surgery. The title 'surgical podiatrist' doesn't even make sense and I feel it is poor use of our language. No title will satisfy the originators of these sentiments - these people are bullies who are resorting to name-calling. Kowtowing to bullies on issues such as this in the proposed manner will not stop them being bullies.
The real issue here is that orthopods don't like podiatric surgeons taking any of 'their' private practice away. Well boo hoo guys - if you are misguided enough to believe that patients are not walking through your door because a local podiatrist is operating on all these patients then you need to take a good look at yourself. There seems to be some sort of misguided view that there are about 12 bunions in every town and we've got to fight to the death for the privilege of operating on them. If people spent less time coming up with similar articles to this steaming pile of misinformation (as they do about once a year) and actually worked together for the good of patients then perhaps foot and ankle surgery outcomes might improve? Possibly, the experience of trainees and practitioners in each discipline would also improve? Along with this, the hit rate of dire publications such as the Daily Mail would go down a little bit (which can only be a good thing in my opinion).
Training in podiatric surgery takes approx 10-11 years on average. This includes the 3 year BSc which I also feel is a huge advantage to clinicians treating the foot and ankle surgically. Not just the theoretical training in management of foot and ankle pathology and anatomy, physiology, pathology, pharmacology, etc... but also the physical skills/ manual dexterity in use of a scalpel. By the time any medical doctor gets hold of a scalpel, he or she is many years into their training. I have witnessed first hand the often terrible scalpel work of junior orthopaedic surgeons and helped and advised in those cases that I was party to. How long do orthopaedic 'foot and ankle specialists' train in surgery of the foot and ankle? Checking the BOFAS website, it appears that the longest fellowship is 12 months. 12 months training in forefoot, midfoot and rearfoot surgery? Impressive stuff. Not. Compare that to 6 years for a podiatric surgery trainee/ registrar.
Aside from this, podiatric surgery in the UK has a national audit system. I am aware of the criticisms of it as well as its benefits, but if someone can show me the equivalent or improved orthopaedic version I would be very grateful. How can anyone hope to say that either one is better or worse than the other without a meaningful attempt at comparing apples with apples?
Articles such as this allow orthopods to use individual case studies of poor outcomes to attempt to damn podiatric surgery. I could have come up with 3 similar case studies showing very poor results following orthopaedic surgery based on my outpatient clinic today alone. I realise that the Daily Mail and the initiators of this article are not stupid enough to really believe the rubbish contained therein, but it does make for a good story and gets us all talking. Loving Mark Russell's contributions to this thread by the way. Why hasn't my profession adopted a similar approach? This is a question that I can not answer. Personally, I do not want to engage in a fight when I could be making patients better and I am not generally an aggressive person, but I am aware that some of my colleagues are less placid. What happened to the PA? They got old. The new breed seem to handle situations in a 'different' way. I can not really criticise as I am not a political animal and as such, not party to the inevitable background bumf.
How much difference will this article make to my day/ week/ month? Not much. I had a few laughs today at it with my happy patients and after that it will no doubt go the way of the other similar articles. In 30 years time, somebody could do a systematic review of these articles and come up with a conclusion that newspapers print whatever sells papers and orthopaedic surgeons do not like 'surgical podiatrists' (whoever they are). Yawn!
Bob the Consultant Podiatric Surgeon
ps. ner ner na ner ner!
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Biggest load of rubbish I ever read, but then not surprised its coming from the Daily Mail - home of quality journalism! I can only hope people treat it with the contempt it deserves and realise that all surgery carries a risk.
Hello Bob - it's more than just mischief making. One of my colleagues has had a real nightmare recently with loss of priviliges and theatre rights at a local private hospital despite having a very successful surgical practice. Seems the orthopods do not share the enthusiasm for his skills and appear to have pressurised the hospital management into suspending all podiatric surgery - to the clear detriment of many patients who are part-way through their surgical programme. I am having to send some hypocure patients to the other end of the country to have the second implant done, which is altogether unsatisfactory.
I'm not sure what the Society or Faculty have planned in their response but would hope it is robust and broad enough to make this group of orthopods think again before venturing forth with this particular brand of behaviour.
To be fair, I learned a great deal about bunions from the article. I always thought that footwear was a factor in their aetiology but apparently not - all down to genetics and inhereted factors. You're never too late old to learn, eh
Hello Bob - it's more than just mischief making. One of my colleagues has had a real nightmare recently with loss of priviliges and theatre rights at a local private hospital despite having a very successful surgical practice. Seems the orthopods do not share the enthusiasm for his skills and appear to have pressurised the hospital management into suspending all podiatric surgery - to the clear detriment of many patients who are part-way through their surgical programme. I am having to send some hypocure patients to the other end of the country to have the second implant done, which is altogether unsatisfactory.
I'm not sure what the Society or Faculty have planned in their response but would hope it is robust and broad enough to make this group of orthopods think again before venturing forth with this particular brand of behaviour.
Hi Mark,
I heard a similar story not so long ago myself about a colleague. I hope for podiatry's sake that it was the same person. Private hospitals (and NHS Trusts) need to be kept well informed of outcome measures in podiatric surgery and the individual's results for assurance and to safeguard against situations like these. It seems sad that people can lose their livelihoods based on the whisperings of troublemaking anti-competitive orthopods and I am hopeful that cold hard data can be used to pro-actively ward off these evil spirits.
All quiet on the western front today. None of my patients cancelled their surgery and they were all happy as they left hopping to their lift home safe in the knowledge that I am not a doctor and that their foot operation was conducted by someone with greater than 1 year of training in management of foot and ankle pathology.
It seems sad that people can lose their livelihoods based on the whisperings of troublemaking anti-competitive orthopods and I am hopeful that cold hard data can be used to pro-actively ward off these evil spirits.
If only that were so. If you look at satisfaction studies, then there is ample evidence that patients and referring agencies are satisfied with podiatric surgical intervention - it has enhanced my practice greatly to the benefit of many of my patients. As a clinician, it's a two way street in more ways than one. I can refer my patients with observations and recommendations to clinicians who have an inkling to what I am saying - they speak the same language in other words. So an active middle aged patient with hallux rigidus might expect a TJR or chielectomy rather than a fusion when I refer on - or I might expect to be referred a post op scarf-Atkin for HAV where fthe patient has a grossly mediated STJ axis for orthotic management.
Yet, although I can see an improvement in patient management - as well as the patient and whoever else is involved in their case - the sad fact is that there has been no corresponding increase in podiatric surgical posts in the NHS (or private practice) which reflects this satisfactory outcome. For me, the interesting question is, why? Especially when there has been a substantial increase in dedicated foot and ankle surgeons in orthopaedic departments. This, for me, represents the greatest failure of our profession body in establishing our practice base in the UK.
I agree with everything you say; I think we are best placed to deal with foot problems - in their entirety - through all of our specialisms, for that is the 'sole' subject of our studies, but we must be prepared to adapt and change our environment when conditions dictate if we are to preserve the high standards of care we desire for those who seek our help. Sadly the current health market - NHS and private consortiums primarily - are not serving our profession and patients well.
If this had anything to do with investigating the current situation then I'm sure they would have turned that up. As it is it looks like a fairly blatant hatchet job driven by motives other than public interest.
Given it's the Daily Mail (who do not have the best record on balanced health stories) we should be glad that the headline wasn't "Podiatric surgeons cause cancer".
With the strength of audit and satisfaction data for podiatric surgery it would be a good opportunity for another publication to have a dig at the Daily Mail for publishing such a poor piece by actually running a researched, balanced article.
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I was just wondering, is this all part of a recent surge in anti pod sentiment by the orthopod community?
I saw on the BOFAS and the BOTA websites that they and other ortho groups have just successfully lobbied to prevent the Royal College of surgeons from setting up a training program for podiatric surgeons. I imagine RCS involvement in podiatric surgery would lend a whole heap of credibility, so its clear why they stepped in to prevent this.
Are orthopods stepping up their campaign? Could they even block independent prescribing?!
I don't think I'll want to go into pod surgery after my undergrad, but I really love the fact its there, it definitely lends strength to the professions public image (if publicised for the right reasons!). Also, for the sake of the public, surely dedicated foot and ankle surgeons can only be a good thing - as the evidence suggests.
So what can the profession do in response? Does the SCP have a plan? Is the future of pod surgery in question?
Looks like the natural growing pains of the UK Podiatric/orthopedic communities.
Check out the history of Podiatric Surgery in the USA...this is most likely where you in the UK are headed.
As UK Podiatrists become more surgically oriented and infringe more and more into the orthopedic surgeons territory, they naturally will begin pushing back.
Better get some thicker skin...it will get worse before it gets better.
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
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Given it's the Daily Mail (who do not have the best record on balanced health stories) we should be glad that the headline wasn't "Podiatric surgeons cause cancer".
Well we waited for 6 months for this and its a joke really. I feel really sorry for the patients who have had a bad outcome and ever more for the way they are treated as pawns in a political game.
I am just coming up to 1000 patients at 6month follow up on PASCOM-10 with a lost to followup<10%, I have 41 patients who are worse off following surgery since June 2010. OMG does that mean i am a Bad Podiatric Surgeon- what would the Mail make of that- No I am an honest Podiatric Surgeon who has discussed risk and benefits with every single one and have exhausted conservative care.
But in reallity seeing as there are 1000 patient there, there is aroud a 4% chance of making a patient worse with surgery or a 96% chance of making them better!
Guess what- I always tell patients there is around a 4% chance of being worse off as part of the informed consent! Yes thats INFORMED consent not that bull**** I have seen from the gen medics which usually does not involve any advice leaflets!
Also as we qualify using local anaesthesia we are 50% better than ortho as they can't do either. My anaesthetist was beside himself when he read that bit!
As for the future, well if you look back we are stronger than ever. We now have annotation, we will get IP, and we will continue to grow and if we are not pissing them off we are not doing enough surgery!
Not a single patient has mentioned it to me and I am busy, busy, busy. So to all those undergrads worrying-DON'T, just go for it because if you want it you can have it
Tony Wilkinson
Former Dean FOS
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A week ago marked 27 years of being in private practice. During that whole time, I have been in practice with orthopedic surgeons. Initially, for the first 17 years of practice, I shared an office with 3-4 orthopedic surgeons. For the past 10 years, I now have my own practice that I share with an orthopedic surgeon.
Initially, when I began to practice with the group of orthopedic surgeons in July 1985, they definitely were very skeptical of my abilities, and mostly were concerned whether my surgical skills were acceptable to them. I even remember the main orthopedic surgeon asking me some anatomy questions of the foot and ankle during one of our early surgeries together, which I had no problems with....he didn't ask me any more anatomy questions after that.
However, when our back office assistant began to notice that my patients always did better post-operatively than did the surgeries from the orthopedic surgeons, and then asked me to surgically correct her hallux varus deformity within a year of me arriving at the orthopedic practice, I knew that I had finally proved my worth surgically to the orthopedic surgeons.
Now, after 27 years of practicing with orthopedic surgeons, I still work and see these orthopedic surgeons on a regular basis and we are all very friendly. They ask me things about how I do certain surgeries and I ask them about certain things I see that I know they are more knowledgeable on. This is the way things should be. We each have our strengths and weaknesses in our knowledge and we all want to learn better techniques from each other to improve the care of our patients.
Having a podiatrist work for years in a private practice with orthopedic surgeons is not common here in Sacramento, but it can work and work quite well. I am very pleased that I ended up in an orthopedic surgery practice after all these years. However, I am even more happy that I did not start working with a group of podiatrists since, for me personally, I believe I learned far more from working with orthopedic surgeons than I ever could have learned by working with a group of podiatrists.
Therefore, please don't label all orthopedic surgeons as being "podiatry-haters" since, if you are well-trained and knowledgeable, they will probably find you to be a valuable member of their "medical team". However, as Steve said, this may take years of work in each of your respective countries to get to this point...but it can happen and it can be a very good situation for all those involved.
__________________
Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Thats very true Kevin. I work with the Orthos here and organise regular MDT meetings to discuss cases. This is not about individual practice its about national issues. In fact I am looking to set up chambers with 2 ortho surgeons. This comes from me proving myself over the last 15 years.
Pods need to realise that respect for their practice needs to be earned. Its tough if you do not like it, but thats the reality. You yourself have to earn a reputation locally just like me and Kevin have.
Good luck my friends
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Hmm, yes. Makes me wonder what SCP are doing with my annual subscription - where is the positive PR for podiatric surgery? What is my profession doing to educate and inform the public about what podiatric surgery is and what it has to offer?
Bad podiatric surgeons
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