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UK podiatric surgery vs orthopaedic surgery

Discussion in 'Foot Surgery' started by bob, Dec 19, 2011.

  1. bob

    bob Active Member


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    It looks like BOFAS have a nice Christmas present wrapped very neatly in Daily Mail pages for podiatric surgery in the UK. There is some talk that this 'high quality daily newspaper and purveyor of truth' is due to publish information that is not entirely complementary of podiatric surgery in the UK. This follows a previous bbc program and an article in some other rag (I will not post the link here as I do not want to increase their website's hit rate).

    I am very bored of seeing these people attack my profession. I am equally bored of answering questions from the unfortunate patients that are manipulated by these inaccurate and biased articles. Currently, in the UK, if you type 'podiatric surgery' into google the first page is a link to the BBC's negative article about the profession.

    Have similar occurrences happened in the USA, Spain or Australasia to anyone's knowledge? Or anywhere else in the world where podiatric and orthopaedic surgeons compete? Are there any orthopods who read podiatry area that would care to comment? I understand that the negative pressure comes from orthopaedic surgeons who would rather spout negativity towards podiatric surgeons than raise their game. Their primary (and most likely only) motivation for this is money (some orthopaedic surgeons love to make money in private practice and they do not want podiatric surgeons 'stealing' their childrens' private school fees). They have previously attacked podiatric surgery claiming that their motivation was to preserve 'patient safety' - only to find that this is simply untrue based on audit data collected from podiatric surgery departments, legal cases and some research into differences between the two types of service.

    I wonder how organised orthopaedics are in their attack against our profession? It is interesting that this latest article comes in the period prior to Christmas when news is 'slow'. The bbc article on the internet also came at the beginning of December. I wonder if this will be an annual present from our orthopaedic friends? I assume they are quite upset that we have not given them a present in return.

    Of course, that is an option. It is possible for podiatric surgeons in the UK to provide data on all the orthopaedic surgery that they routinely revise. It would be possible to mount a media campaign using orthopaedic patients that have had very poor outcomes following their surgery. It would be possible to encourage all orthopaedic patients to sue their orthopod or to speak to the press about their terrible experiences in orthopaedics. Podiatric surgeons can provide information about their outcomes using the national audit scheme in the UK (of course the validity this can be questioned as can the validity of the national orthopaedic surgery audit - oh, wait, no we can not question the validity of the ortho audit because it does not exist).

    I wonder how many patients who have undergone podiatric surgery to correct orthopaedic surgery would come forward to speak up for our profession or how useful this would be? It is a shame that podiatric surgery and orthopaedic surgery do not have the same audit process so that we could more accurately compare the two disciplines. One of the motivating factors for the rise in podiatric surgery in the UK was the consistently terrible results of orthopaedic foot surgery many years ago. BOFAS or BOFSS was formed as a response to the growth of podiatric surgery and orthopods only got more serious about foot surgery as a protectionist response, so perhaps orthopods should be knocking on my door thanking me for indirectly and directly helping to protect all of our patients? I won't wait up.

    Rather than spend excessive time and effort fighting each other, it would be nice to think that the two professions could coexist in peace and harmony. The vast majority of humans have 2 feet, so there is plenty of work to go around. My clinics are far from empty and I am very busy doing what I was trained to do - make patients with foot problems better. I know that there are orthopaedic surgeons and podiatric surgeons out there who work very well together (I have in the past, but times and people change, staff leave, etc...) but this seems to be the exception in my experience. I would like to see an end to all the fighting, I find it boring and unnecessary. I am too busy helping other people and earning my wage to fight over my right to exist. I can only presume that the type of orthopaedic surgeon who has time to attack my profession has lots of time on their hands? Have they looked at why they have so much time? Perhaps they could attend a local podiatric surgery service for training in foot and ankle surgery to improve their skills?

    I honestly would like to see an end to it all. I recognise that there are many of you out there who are considerably more intelligent, experienced and academic than I am - I extend an open request to you for suggestions on how to bring an end to this situation that has existed for far too long in my opinion.

    From where I am sitting, it is very easy to fight negativity with negativity, but I am hopeful that we can have some positive ideas. Perhaps it might be an idea to group all the previous UK orthopaedic/ podiatric surgery threads together and include this one so that readers who are unfamiliar with the debate can gain a greater incite to some of the issues and previous allegations? I presume that moderator/ admin can decide of the need for this and combine relevant threads?

    Merry Christmas to you all and thank you for taking the time to read what is hopefully the longest forum post I will ever write. :santa:
     
  2. simonf

    simonf Active Member

    deleted post
     
  3. W J Liggins

    W J Liggins Well-Known Member

    Sadly, I don't think that the gist of your message 'peace on earth, goodwill to all men' will ever eventuate; not least amongst pods and orthopods. Why? Well it's largely territorial and as you point out, associated with money. What really fascinates me is why an orthopod would want to look at feet? Those of that profession that I get along with well - yes some even refer patients - are too busy dealing with hips, knees and shoulders which are far more lucrative.

    I suppose that it is an A type male versus an A type male situation (forgive me ladies) which is why I don't think that it will ever be resolved unless the orthopods achieve their aim which is control over podiatric surgery. If they do, then they will think it the best thing in the world!

    All the best for the festive season

    Bill
     
    Last edited: Dec 20, 2011
  4. Playing Devil's advocate, I guess why would an orthopaedic surgeon who has spent God knows how many years training to be a medical doctor and then studied for God knows how many years to be an orthopaedic surgeon, accept someone who has done three years as an undergraduate chiropodist, or lest we forget as a diploma in chiropody and then a post-qualification course in "podiatric surgery" which is not recognised by the Royal College of Surgeons into their midst? No reason at all. Answer to your problem, Bob: go away and train as a medical doctor, then as an orthopaedic surgeon- problem solved- next? Take a look at it from their perspective, it's the equivalent of "but I did a SMAE course in shamopody, and now I'm on the HPC register", is it not? We all had to accept this because the people who govern our profession are weak and worthless. The people who govern orthopaedic surgery are far too strong for the likes of Johnny Shamopodist. I said a long time ago that "they" would take their balls back, "they" still will and you and "your" colleagues will ultimately have to accept this. Seem to recall that you disagreed at the time, Bob? Kid fishing.

    Personally, I'm more interested in why SimonF deleted his post, because it spoke about how the orthopaedic surgeons he worked with thought "how great" the podiatric surgery department he works within is. No pressure, but it gone now...
     
  5. bob

    bob Active Member

    I understand that Simon and can appreciate your point and why some may feel that way. It is a strange situation that podiatric surgery has - personally, I do not hope for a deep acceptance of me and my amazing skills, I would just like to be left alone by this other profession to get on with what I believe I do well. The NHS Trust I work for believes it too. And the HPC have not taken my registration from me either, so they seem OK with it. The vast majority of patients agree too. I will not detail the origins or development of podiatric surgery here as there are published accounts elsewhere that are more eloquent than my forum posts - but the fact is that podiatric surgery in the UK exists and has done for some time now. It is established, regulated and continues to develop.

    The SMAE/ podiatric surgery argument is interesting and I have thought about it before. Do you use local anaesthetic Simon? Do you ever do nail surgery? Do you believe that your former 'state registered' colleagues should not have access to LA or do skin/ nail surgery? It depends where you choose to put your cut off point. There has to be some definition and protection on scope of practice to protect patients and ensure quality services to the population and I am not the person to define these, but I am aware of some of the difficulties each profession suffers as a result of them.

    One option is to go back and do a medical degree and then go on to train as an orthopaedic surgeon. Apart from this being impossible for me personally due to my advancing years, my main concern would be the journey and the end result. Is a degree in medicine followed by training in orthopaedic surgery going to make me a better foot and ankle surgeon? How many of us really know what an average orthopod will learn through med school and training in orthopaedics these days? How much specific training in foot and ankle surgery do orthopaedics have? Are orthopods examined in foot and ankle pathology? Do they have practical exams? How long do they spend learning about the foot and ankle? How many foot and ankle operations does the average orthopaedic surgeon do each year? Do these things make a better foot and ankle surgeon? What is their success rate? What is their failure rate? What resources do the public and other professions have to see that orthopaedic surgeons have professional registration and are not currently subject to a disciplinary/ fitness to practice hearing? What 'makes' a consultant orthopaedic surgeon (foot and ankle specialist)?

    I can not answer all these questions. I do not have a complete understanding of their training and experience - and neither do they of mine or the current crop of younger podiatric surgeons. I do not begrudge them a living and I fail to understand why they would rather see me out of work at this festive time of year. How many people have feet in the UK? How many feet do they have collectively? How many podiatric surgeons are there? Orthopods? I'm guessing there are many more feet than people operating on them and I do not live in a very strange part of the country where most people have 2 feet and they bring them to me in their hundreds every year for surgery?

    I hope Bill is wrong about the type A personality thing and that this ridiculous situation ends at some point. As I said before, I find it rather boring. It would be nice to think that the adults in each of the professions concerned could get together and work it out once and for all for the good of patients and practitioners alike - I hope that happens within my lifetime anyway. Merry Christmas to one and all by the way, podiatric, orthopaedic, SMAE, etc.... :santa:

    I'd also like to thank you for taking the time to read my post and contribute to this discussion Simon. I hope other colleagues feel comfortable to pass comment even if they are not linked to podiatric surgery.
     
  6. I suspect that collectively they have looked at the training of podiatric surgeons here in the UK, if not you personally. I also suspect that they would like to see you out of work at this time of year because they perceive that the training you have is inferior to theirs and is not recognised by the Royal College of Surgeons. Moreover, I suspect they would rather have the money that you charge for foot surgery for themselves. And lets not be overly dramatic: if you weren't allowed to perform foot surgery tomorrow, you could still earn a living cutting toe-nails and callus- just like the vast majority of us do on a daily basis, despite the hype.

    Merry Christmas :santa: And don't worry, it's not happened, yet. And if you're really lucky, you'll get grand-parented on to their register (I wouldn't hold my breath on that last point though).
     
  7. bob

    bob Active Member

    Thanks Simon. Personally, I do not want to be 'grandparented onto their register'. I am proud to be a podiatric surgeon. I believe that my training and experience allows me and my colleagues to be the best at what we do (I do not believe that the training is fantastic, and I recognise that there is plenty of room to develop as there is in any profession). I do not want to be a medical doctor. I want to continue to offer foot and ankle surgery to my patients, develop my own skills and help to develop those around me. Several orthopaedic colleagues that I have spoken to are surprised at the level of training in podiatric surgery. Approximately a month ago, a local shoulder chap commented that we (podiatric surgeons) receive considerably more specific surgical training than they do. I do not think orthopaedics really know what podiatric surgery training involves.

    Greed is a funny thing. I have 2 hands and only so many hours in my day. Each day is more than filled doing what I was trained to do. Orthopods make plenty more money operating on hands, hips, knees, etc... than they or I do on feet. I find it bizarre that they think that they could manage all that work and feet as well. Odd :confused:
     
  8. footfan

    footfan Active Member

    Do you tell your patients this? I think if you did your case load would nose dive ..........off a cliff.

    Ive been in theatre with a few Pod surgeons and theyre very good, just dont understand why you would not just get your medical degree, do your surgical training and get the magical £120k+ instead of <£90K your all clearly capable and motivated.
     
  9. bob

    bob Active Member

    Of course I tell my patients what I am. As I said before, I am proud to be a podiatric surgeon - why would I pretend to be anything else? I do not see them rushing for the door when I have that conversation or when they talk to me about the leaflets we supply them with regarding podiatric surgery. There seems to be some strange asumption (mainly in orthopaedic foot and ankle surgery services in my experience) that podiatric surgeons wander around telling everyone they are medical doctors and cunningly mislead patients into thinking we are 'real doctors'. I do not believe orthopaedic foot surgery is any sort of panacea and I would never try to pass myself off as one - like I keep saying, I think podiatric surgeons are best placed to do this type of work.

    As far as the wages go, I am unsure where you are getting your figures from, but there are many ways to skin a cat and there are many practitioners out there who are happy with their current level of cat skins.
     
  10. W J Liggins

    W J Liggins Well-Known Member

    I'd just like to emphasise Bob's point here footfan.

    A few years ago, I stood up at a British Association of Day Surgery meeting (there was discussion of podiatric surgery) and made the point that BOFFS had already accepted what they then called 'podiatry' and we now describe as podiatric surgery. I have a copy of the minutes of their AGM from that time which confirms the fact. I also made the point that every patient who comes to me for surgical treatment has an information sheet which states explicitly that I am not a medical doctor - if you are such, then you will know that most 'doctors' of medicine do not possess a Doctrate. You will also know that medical insurance companies do not cover any work carried out which is not referred by the patient's GP. All the GPs who refer to my colleagues and I are well aware that we are podiatric surgeons and they refer because they tell me that appreciate the quality of work that we carry out.

    If you are an orthopod, I fear that you and your lurking brethren (and sisteren) are perpetuating a myth of your own making, which is that no informed patient would accept surgical treatment carried out by anyone other than your ilk. You are, of course, wrong, and podiatric surgery is not the only specialism involved; maxillo facial surgery being another.

    I suggest that you take a very close look at the establishment of your own profession, which was created by an 'ignorant' and 'unqualified' Welsh bone setter. Remove the beam from your own eye before attempting to remove the mote from that of others.

    All the best for the festive season :drinks

    Bill
     
  11. bob

    bob Active Member

    It seems strange to me that podiatric surgeons are the only profession that go out of their way to inform their patients about what they are not. I am not a medical doctor. I do not and have never claimed to be. I do not know of any podiatric surgeon in the UK that has ever falsely claimed this. As I have said previously, I do not want to be - I am a podiatric surgeon and I'm happy with that. The fact that this issue is brought up time and time again is strange and I suspect it is yet another red herring thrown in to muddy the argument against our existance by our competition. If we could keep the argument on track without these strange diversions, I presume things would have been sorted out a long time ago?

    Would having a medical degree make my surgery any better?
     
  12. footfan

    footfan Active Member

    OK a couple of points to clear up:

    1) I never stated that any Pod surgeon has claimed to be a doctor to a patient, I mentioned that if a patient was in a consult and you said to them "I do not want to be a medical doctor" when offering surgery they may not receive it well as they are there for medical treatment.

    2) The salary stated was from http://careersinpodiatry.com/lets-talk-money.html


    FF
     
  13. Even though I am not British, I am a podiatric surgeon and would like to say a few things.

    First of all, for the last 26+ years, I have practiced with orthopedic surgeons. For the first 16 years I was the only podiatric surgeon in a group of three orthopedic surgeons. For the past 10 years, I have my own practice and I have an orthopedic surgeon who works in my office two days a week. Therefore, for my whole practice career, I have worked very closely with a number of orthopedic surgeons.

    After all the training I have gone through to get where I am, I really don't want to be called a "medical doctor". I want to be called a "podiatric surgeon" or "podiatrist". When I first began practice over a quarter century ago, the orthopedic surgeons were watching me very closely to see how I did surgery, how my patients responded to my surgery and to see how I functioned as a clinician in practice. Once the orthopedic surgeons that I worked with over the last quarter century saw my surgical results and started doing surgery with me, over time they began to have no problem sending me patients for surgery that they didn't want to do or asking me for their advice on some of their own surgeries. Therefore, even though I didn't have an MD degree like my orthopedic surgery colleagues, I didn't feel the slightest bit below them in status since, in most cases, I simply knew more about the foot than they did.

    Over the years, I have often discussed difficult cases with my orthopedic surgery colleagues and I have asked advice of them as they have asked advice from me. This is the way things should work between medical specialties. There should be a mutual respect where one helps the other, with none of the petty bickering and turf battles that so often occurs. Unfortunately, this ideal is not always the case even here in the States, where podiatric surgery has been well established for at least the last 40 years.

    I see that what is happening now in the UK, and other countries, is probably very similar to what my podiatric surgical forefathers here in the States went through 30-40 years ago. During the infancy of podiatric surgical development at that time, podiatrists were trying to get hospital privileges, establish podiatric surgical residencies, and increase the surgical and medical training of podiatrists in the podiatric medical colleges. This process is still occurring here in the States even to this day.

    Even though I am not directly involved in this process, I know that many good podiatrists before my time spent a lot of effort, personal expense and countless hours to elevate the status of podiatric surgery here in the States that has allowed me to have the status and privileges I now have in my community as a podiatric surgeon. I am very, very grateful for those podiatric surgeons who have devoted their lives, before me, to elevate the level of podiatric surgery to the status it enjoys today in my own country. It basically allows me to function as a podiatric physician in the hospital and surgery center just like any of the other MD surgeons that also use these facilities for their patients.

    I believe that there is a valuable lesson to be learned in this for those podiatric surgeons in other countries that are struggling to elevate the level of excellence of podiatric surgery in their own countries. The hard work you do now for your profession, will likely not be fully appreciated by you in your practice career, but will be best realized by those podiatric surgeons in your country that follow you.:drinks
     
  14. bob

    bob Active Member

    Hello,

    Apologies if my post insinuated that you had said that, I was trying to be fairly general in the point about patients/ public and colleagues being misinformed about podiatric surgeons claiming to be medical doctors - there have even been previous newspaper articles/ propaganda in the war against podiatric surgery. For clarity - I had that very conversation with a patient the other day. I am always honest with my patients regarding my training and I told him about how I have no interest in training to be a medical doctor. I spoke of the training in podiatric surgery and had a frank discussion regarding his options, my opinion and what I can offer. I have listed him for a midfoot fusion with a calcaneal bone graft and he's keen to go ahead with it with full knowledge of who I am and what I do. He knows I am not a medical doctor and have no desire to be and he does not care - and why should he? I know many medics that would vehemently disagree that any surgeon (podiatric or orthopaedic) is able to offer 'medical treatment'. I offer my patients podiatric surgery, not medical treatment.

    Thank you for the info on pay. The maximum NHS pay is just short of 100k full time without on-call - after tax, would I complain? Do I envy my NHS orthopaedic colleagues' salaries? Personally, no - I am quite happy with the financial side of it thank you. Where are you getting your figures about orthopaedic surgeon's salaries from?

    I am interested in the foot and ankle and associated pathology. I am interested in all aspects of podiatry. Podiatry and podiatric surgery is the specialism for me. I do not believe that a medical degree, rotations, specialism and orthopaedic surgery training would allow me to treat my foot and ankle pathology patients more effectively overall.
     
  15. bob

    bob Active Member

    Hello Kevin,

    I would like to thank you for taking the time to read this and pass comment especially because you are not British and you are a podiatric surgeon. Your experience of working with orthopaedic surgeons in your country and seeing podiatric surgery develop and you access to colleagues that fought similar fights many years ago is invaluable to this discussion.

    In the past (or today) are there incidences of orthopaedic surgeons using the media to attack your profession in the US? Have podiatric surgeons adopted a similar tactic against their orthopaedic counterparts over there? How dirty did or does the fight get?

    My experience of orthopods varies. Any who do not specialise in the foot and ankle are fine. A few who do are OK too - and I have discussed cases as you have highlighted. I have also had experience of other orthopods who have deliberately encouraged patients to complain and attempt to sue me. Nice. I wholeheartedly agree with the mutual respect point which is my main motivation behind my original post. I would like to know how other countries/ practitioners such as your own have successfully managed to make positive steps towards mutual respect and getting on with the job at hand. I doubt that some of my colleagues will ever live in harmony side by side on pianos, but if we could draw a line in the sand and move on I feel that life could be a lot easier for all of us.

    Is there a document that details the development and adversity to podiatric surgery in the US?
     
  16. Bob:

    There are plenty of locations in the States where orthopedic surgeons and podiatrists do not get along. Luckily, here in Sacramento, most of the podiatrists get along fairly well with most of the orthopedic surgeons and the foot orthopedists. In fact, the doctor who I refer the most patients to here in Sacramento is a younger foot orthopedist who does more complex foot and ankle surgery than I do and he is, I believe, very happy for the many referrals I send his way, even though he sends little my way. His lack of referrals to me doesn't bother me since I am more busy in practice than I really want to be at this stage of my life (I see 25-32 patients per day on my full days).

    I don't know of any document that completely describes the development of the surgical aspect of podiatry here in the US however, I have found a few small articles which I have listed below.

    http://www.cwru.edu/med/epidbio/mphp439/Podiatry.htm

    http://www.acfas.org/Physicians/content.aspx?id=949

    Also, even though I don't have this paper (Kaplan EG: The last fifty years: a historical review of podiatric surgery. J Am Podiatry Assoc. 1974 May;64(5):346-56.), it might be a good one for you to track down since Earl Kaplan was one the earliest "godfathers" of podiatric surgery here in the US of A.

    Here are a few others for you which I don't have but may be of help to you:

    Levrio J. The evolution of a specialty. A study of podiatric surgery.J Am Podiatr Med Assoc. 1987 Aug;77(8):419-27.

    Levrio J. The residency in podiatric medicine. A brief historical overview. J Am Podiatr Med Assoc. 1992 Nov; 82(11):560-5.

    Merry Christmas!:santa::drinks
     
  17. rosherville

    rosherville Active Member

    It would be wrong to generalise; the opposition is sometimes based on territory, sometimes fear of losing private income, sometimes ignorance or fear of losing status.

    To illustrate the diversity i can recount that:

    i) when I gained admitting privilages at a private hospital (4 orthopods resident) my mail holder had my name removed for several months; (a porter told me it was the orthopods)!

    ii) I was approached by the Chairman of the MAC (a Cons. Aneasthetist) asking me to leave as the orthopods had threatened not to use him unless he 'got me out' !

    iii) when I refused, he came back saying that if I would refer the first ray and larger cases to the orthpods they would withdraw their opposition as long as I did only nails and lesser toes !

    iv) The fact that theatre nurses were advising patients that I was the best one to operate on feet probably antagonised a bit !

    v) I recently operated on a Head of Orthopaedics, he required bi-lateral procedures. I asked why he had not gone to one of his colleagues, his reply, 'you must be joking' !

    Make what you can out of all that !

    A Merry Christmas & a HNY
     
  18. Sounds like some of the same stories I heard from the older podiatrists here in the States as to what they went through to get hospital privileges.

    I have a similar story that happened during my surgical residency at the Veteran's Hospital in Palo Alto (VAPA) in 1983-1984. One of our weekly rotations at the VAPA as surgical residents was to go to Stanford (about 1.5 miles away from VAPA) and do Dermatology Grand Rounds at 7:00 AM with the Stanford dermatology department residents and attendings.

    Our residency director, Dr. Laine, had tried for years to have his podiatric surgery residents do surgeries at Stanford Hospital, but the chairman of the Orthopedic Surgery department at Stanford supposedly would have nothing to do with it. Supposedly he despised all podiatrists. During my year at VAPA, through his connections with the Dermatology department at Stanford, Dr. Laine had us start to do a podiatry clinic at Stanford within their Dermatology clinic. In this way, we were able to schedule surgeries at Stanford Hospital through the Dermatology Department, and therefore totally circumvent the roadblock put in front of us and other podiatrists for doing surgery at Stanford Hospital by the chairman of the orthopedic surgery at Stanford.

    Therefore, the first podiatrists to ever do surgery at Stanford Hospital were my co-residents at the time in 1984, and this was only due to the persistent hard work by Dr. Laine in just finding a way to get his "foot in the door" to the Stanford operating room. True story...how times have changed over the past 27 years since.
     
  19. DrBob

    DrBob Active Member

    Hi Bob,
    Infuriating I know, but its a fact of life. It used to frustrate me no-end until I realised a few things:
    1. There seems to be three types of people in the world.
    First, those who are so full of their own importance that they are never going to alter their attitudes, beliefs or opinions, or see life from another perspective. Don't waste your time with these people, your life is too short.
    Second, those who are prepared to see other perspectives and accept other attitudes and beliefs, but who are truly busy with their life. Keep these people in the loop, they may be valuable allies one day when they are less busy.
    Third, very open people who are willing to facilitate change, including change in themselves (these people seem to be able to escape from ego and arrogance). Build your relationships with these ones, and when you do so you will learn more flexibility with your own attitudes, beliefs and opinions. This isn't the same as capitulating, its thinking and acting outside the box and developing more effective strategies!
    2. The media has all three types of people and the same principles apply - find the open ones who are smart and, if you have a true cause, then it will eventually get heard (I believe this is a true and worthy cause).
    3. Do your best in your own field; it will get recognition from the smarter people in groups two and three and will lead gradually to the change you seek.
    4. Don't engage in mud-slinging, it only gives energy to the first group.
    Best wishes,
    DrBob
     
  20. bob

    bob Active Member

    Thank you very much for all the information Kevin.

    Thank you DrBob for the kind words of advice. I would not say that I am infuriated by orthopaedic opposition, more that I am growing tired of hearing the same old rubbish coming directly and indirectly from their direction. As the years pass by, it would be reasonable to assume that all creatures on the earth evolve. It would be nice to think that the relationships between people providing any sort of healthcare to patients would develop in a more positive manner. It all seems a bit 'playground' to me.
     
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