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Dear All,

Prior to surgery what do you discuss with your patients as part of your consent procedure and how do you evidence it? I have had several reports from expert witnesses (orthopaedic surgeons) about the work of podiatric surgeons that criticise the podiatric surgeon for not offering patients a choice of who does their surgery - each allegation is along the lines of "... patient A was not offered a second opinion by a fully qualified orthopaedic surgeon" or "... patient B was not made aware that Mr A was a surgical podiatrist and thus not a doctor, blah blah blah...".

- Do you offer patients a choice to have surgery by an orthopaedic surgeon instead of continuing to have surgery with you?
- Does your local orthopaedic department offer their patients a similar choice prior to having surgery with them?
- How do you make patients aware of your qualifications and how do you evidence this?

UK law is clearly different from US (and elsewhere), but it would be nice to hear how our colleagues around the world approach initial patient consultations and how you evidence your consent procedures so feel free to comment - I would appreciate everybody's viewpoint on this. If there any orthopods reading this, the same applies.

Thank you.

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Hi Bob

I can only speak personally and from the UK view. I like to tell people what I am, not what I am not. Even so, my pre-op. paperwork sent to all patients contains the statement "he is.................not a medical doctor." I certainly do not describe myself as a 'surgical podiatrist' since there is no such thing. I am a consultant podiatric surgeon and whilst I always try to offer alternative treatments starting with conservative where appropriate; I most certainly don't offer them treatment by a person who straightens children - the vast majority of my patients being adults. And to the best of my knowledge, no local orthopod who has an interest in feet has ever offered a patient the opportunity of being seen by someone who has studied feet from the outset of their graduate education. In fairness, I have had a few referrals from orthopods but they were interested in bigger fish - knees, hips, shoulders etc. Perhaps surprisingly those were all for private treatment, not NHS.

Bill

Hi Bill,
I think you have the same approach as I do and many of our colleagues. I have noticed a trend amongst the allegations made by patients against podiatric surgeons when I am reading complaints as part of expert witness work - all recent allegations include something along the lines of "... Mr X failed to inform the patient that he was not a registered medical practitioner or offer referral to a fully qualified orthopaedic surgeon as an alternative"
Of course, it is a silly statement but it is becoming more and more prevalent. I doubt any of our colleagues in general podiatry practice offer referral to a patient's GP as an alternative to having nail surgery performed in their private practice as routine and evidence this in their pre-surgical notes. Given the consistency, I can not help but feel that this is a small part of a larger initiative against podiatric surgery by more than one orthopaedic surgeon (the patient reports concerned are from different parts of the country). I struggle to understand the logic behind this 'allegation' though. It seems very strange to me.
Has anyone else noticed similar trends?
Kind regards,
Bob

Podiatric surgery doesn't exist in The Netherlands. Of course, there is podiatric surgery, but this is only carried out by orthopaedic surgeons. Podiatrists in The Netherlands only treat in a non-invasive way. We always have to refer our patient to the GP which will refer to an orthopaedic surgeon.

Dutch law states that you have the right to choose your own healthcare practionioner. So we can only recommend a surgeon of the Dutch Orthopaedic Foot and Ankle Association.