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I always had a feeling during my degree that Podiatry in the real world would not quite be as exciting and varied as we were led to believe during our studies, but I never quite expected to what extent!

I have worked in the NHS for just a few weeks and my days are occupied with nail cutting and care, callus and corns! I get the odd new patient assessment with something a little more interesting such as needing to make a chairside orthotic, but that is it! Oh and the one day I do nail surgery a month to look forward to.

I receive little respect from the majority of my patients who think I am little more than a beauty therapist and the referral forms from other HCPs aren't much more respectful either e.g 'patient has long nails'.

Now I don't know if my NHS trust is unique in this fact, but the patients actually dictate when they want to be seen and whether they will be kept on. Patients are being seen 6-8 weekly when they have no medical need but when I try to discharge them they shout and scream, some have even claimed racism, and the management back down and keep them on.

During my training I saw many patients in the training clinic and on placement but never did I come across many particularly rude or disrespectable patients, but since I have been working as a qualified professional I have been shouted at, patients have tried to tell me that I haven't done the treatment properly etc etc. As a band 5 I am trying to pick up my speed and confidence but I have almost took steps back as I am terrified of accidently nicking a patient in case they go loopey!

I get an hour lunch break with no other breaks during the day and often run into my lunch break and then have admin to do e.g typing and printing GP letters, filing away patient notes and pulling the patient files for the afternoon clinic.

Some may say welcome to the NHS!!! But I never quite prepared myself for this. I am actually considering leaving the NHS and seeing if I am better suited to working in a private clinic.

Sorry to moan but I was so proud of myself obtaining a degree and becoming a health care professional and can't believe I trained for 3 years to be a nail cutter and callus remover.

Start looking for a new job.

Unfortunately many new graduates are in the same boat as you and end up in dead end nail cutting jobs. Leave now while you still have some sanity.

If it means getting a job in a private clinic, or other NHS post, then do it.

Alternatively, try and get in and change the antiquated culture of your workplace.

If you continue on this path, most of those skills you developed in your training will evaporate, as will your self-esteem.

LL

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Remember, it's just a foot.

Hi Suzy Wuzy.

Speak to your manager about your concerns. If you don't get any assisstance there speak to his/her manager. Then go back to your Uni, speak to your old lecturers, get some advice.

I can totally hear were your coming from. I have had the same experience, the public think you are a pedicurist and have great demands. Time to re-educate the world about podiatry.

If i can give you any advice it would be to use this experience to get your skills up to speed, take on the challenge. Reflect on your practice day to day so you have evidence to take to your supervisiors about your issues. You may think of this as a negative experience, negative experiences now can make you a better clinician in the future.

Every day is a learning curve, some good some bad. Hang in their Suzy Wuzy you'll be fine.

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MON THE HOOPS

Brian Kelly

Hi Suzy Wuzy,

Wise words from LuckyLisfranc & bkelly:

My advice would echo theirs with the addition of use this time to your advantage. I can understand you feel like you are playing the 'number crunching game' at the moment. Swamped by patients who show little regard for your well earned degree. Well done by the way :

If you use this to your advantage try to view this time as an opportunity to hone your skills at the sometimes more mundane aspects of practise. However, a word of caution. Try not to lose sight of the bigger picture (this is only the very beginning in hopefully a long & fulfilling career).

Use each patient to your advantage. Quiz each one on their particular problems & try to see if you can improve on their treatment plan. Digest their history & add it to your knowledge base.

Continually test yourself on anatomy & structures (if you don't use it you lose it). The fire in your belly & the smile on your face are hard earned so try to remain positive. I would also ask your manager about shadowing other clinicians if possible (if your department have other specialties eg. diabetic clinics, RhA, Dermatology etc. ). Even request to attend events/courses that are not provided by your trust. Many departments have funding for education eg. Diabetes certificate.

If you feel overwhelmed by negativity I would really consider changing trusts. Some are better than others.

[http://www.jobs.nhs.uk/

All the very best,

Mandy.

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:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

Hi

It sounds like you have ended up in a job that is using you to treat the numbers and meet targets.

I worked in the NHS for 5 years but where i worked was a rotational post over 18 months which gave me 3 months experience 1 day a week in a specialist clinic eg diabetes, biomechanics, nail surgery, Rh and paeds. It gained me valuable experience which has eventaully allowed me to work in private practice and work in the field i like. You may be suited more to private work but first i would try and seek out a different NHS trust and make sure they develop your skills. Sometimes when we qualify we take the first job we are offered because we are worried about not getting a job.

Just bide your time and look around because the jobs do come up.

chris

Dear Suziewuzy,

Head south to Sunny and warm Australia.

I did and am enjoying it, and have been here two years and am now applying for permanent residency.

As a young recent degree graduate it is pretty damned easy to come here.

Get in contact with Global health Source in Perth Western Australia. They bring in pods to work in aus and NZ.

Look up Australian Podiatry Council and go to jobs section. Quite a good choice and variety.

Private Practice is mainly Bio Mech based as sports here are deriguer.

Nail Surgery is also a big thing .

Private health here like us Pods and so does MediCare the health system here.

The Health System is mainly now At Risk Foot Only all else is now in Private Practice.

I had 20 years in NHS which varied from wonderful to totally woeful dependent on management interest in Pods.

So head south you know it makes sense.

Come To Aus

Mind you they like their beer ICE COLD and think our beer is like cold tea.

regards david

Good post Davo !

Great scope for interesting caseloads, and earnings potential in most of Aus.....

Don't be a 'dog's body' Suzy Wuzy, I knew of a few other Pods who were in dead end jobs and left the profession. The time to change is now, don't let it get so bad that you toss the whole thing.


Eh up by gum !!!!

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A bientot...

Julian
Podiatrist-at-large

Hi Suzie,

my advice would be to hang in there, don't take any crap. Having only graduated 2 years ago i know what its like.

Especially don't get dumped on by robotic pods who "only" chop nails and have done for 20yrs. You tend to find they will take advantage of your up to date knowledge, rather than having to update theres.

Unfortunately the way to get respect from the public and other professionals is to demand it! don't let yourself be spoken to like that. Be a diva! management don't like it but it does earn respect. If you get a crappy referral, reject it!

I was fairly fortunate in that i worked for a trust which would give people with enthusiasm a chance rather than givea post to the person who has served there time!

I now work in a Podiatric Surgery unit and am in the middle of my pod surg MSc, and i love it. Stick at it, nobody gives you anything in this profession (as with most) you have to work for it.

Doing the simple clinics may seem boring but it gives you time to consider voluntary observation of other specialities and so on.

Prove to others that your skills are better placed, but bear in mind these clinics will keep you grounded!

Speak to your manager about your concerns, if he/she is not interested, thats where the problem lies. If thats the case, bad luck you picked a dud trust. But use that "dead" time and turn it into something positive. Hone your scalpel skills, as they will stand you in good stead when you show ambition and leave to work with high risk patients.
Some managers let newly graduated staff do the boring work to see if they have ambition, and hope they come back to them after 3 months saying they want to do something more interesting.

Ultimately, the interesting posts in the NHS are far and few between, and a new gradutae will not walk into such a post without experience.

Start to look for another post in a couple of months if you get nowhere with your manager.

BTW, which part of the country are you in?

Patients having no respect for this profession. Tell me something new! It's also amazing the no. of patients who are stunned at what training is involved in doing this job properly. The number of diabetics who get much more than they bargained for from me when they come, they now take me very seriously, the KEY thing is to explain the relavance/clinical significance of tests!

I am sometimes called in to do patients at my local hospital, and the number of nurses who say to me, "oh could you please give me a pedicure!" My reply, "I don't do pedicures, I do chiropody! If you want a pedicure, go to a pedicurist!" I joke.

The NHS trust I used to work for, WE decided when they came back, justified clinically! Any problems, then management would back us up! There were also pateints who swore blind thet were housebound. They had no option but to come to the clinic. NHS managers were not soft, but were fair!

I'm Going to be a bit different and suggest that the problem might be where you work...

Not universally true.

My trust has long since ceased to to "routine" clinics. To be eligable for treatment here you must have significant medical problems (DM etc) or really significant Podiatric problems. Bit of callus and can't reach nails need not apply. Better than half of what we do is biomechanics and the other half includes high risk clinics, Ulcer clinics, NS etc.

The problem new graduates tend to have with us is being overwhelmed by the complexity rather than bored by the tedium!

Perhaps you should seek pastures new, but do not discount the NHS as an employer. You might ask what there caseload is / what their discharge policy is. The NHS is where some of the most severe / interesting caseloads can be found, don't cut yourself off from that without serious thought!

Regards
Robert

(PS, i think there might be a post coming free in Jan)

Suzie it will get better your confidence will grow with experience, get on as many courses as possible, empower and educate your patient in the short time you have them and respect will follow. Just remember quite often a patients agressive behavour is their own insecurity and nerves.

Jude

In addition to my previous 2 laws, I would like to propose two more:

1. The longevity of a practitioner in the profession is inversely proportional to the quality of their first job.

2. The employers that complain the most about a shortage of practitioners in the profession are usually the one who provide those **** jobs.

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Too true Jude,

Often an aggressive attitude melts away once you politely but candidly challenge the aggressors position. Explain they are being condescending and it is improper. 99% of these 'verbal bullies' will back right down and have a healthy respect for you as a practitioner.

Over the years I have had to 'dismiss' patients because they are rude, aggressive verbally or condescending. I understand that the OP may not be personally empowered to dismiss a patient, but surely can explain that their attitude will not be tolerated, and a complaint will be lodged which may affect their ability to receive TX.

Dealing with the public is tough, and Pod School does not generally prepare you for it. Having said that, you have to establish yourself fairly early on.

Don't be rude or sink to their level, just be polite and affirmative !

Works for me 99%, the other 1% get fired!

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A bientot...

Julian
Podiatrist-at-large

Interesting views from a NHS perspective and certainly not that uncommon from employees in the state sector. Given that the UK, EU and USA are heading for anything between an economic recession and an economic collapse over the next 2-3 years, which will certainly impact on funding for non-essential services like podiatry in the state sector, it will be fascinating to revisit this thread in, say, 48 months to see whether views and attitudes to patients' needs and demands have changed.

Have a read at Dmitry Orlov's paper on the effects on society of an economic collapse and consider how you might be best prepared for survival.....

http://www.energybulletin.net/node/23259

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"citing an indisposition due to special circumstances"

My location

Mark trying to move things on to the post collaps gap myself have ended up bartering orthotics for a TV ariel, web site for orthotics, foot treatments for building work ..........

Jude

Hi Suzy,
I think you have a few options and all of the above advise is great. I found myself in a similar position when I got my first job (4 years ago). Not so much that the trust wasn't good, just that being a new start and fresh graduate, I didn't really get the roles that I wanted at first. Also being the youngest podiatrist in our team, I was constantly getting the "are you on work experience" or "when do you go back to university" lines. I got completely cheesed off with it and within a few months, I hated going to work. Doesn't have to stay that way though.
I think what you need to do is go and spend a bit of time with a few specialists. Whether it be biomechanics, diabetic foot care, surgery or whatever you are interested in. Showing a bit of an interest always goes a long way (and can end up getting you a job if you are lucky enough!). It can also give you that bit of inspiration you need so move onto the next step in your career. I found that anyone I contacted about shadowing were more than happy to have me come along and spend some time with them.
Another thing I think helps is getting yourself involved in some form of post grad education.
These are two of the things I have done and after making a big move away from home, I am lucky enough now to be in a job that I wouldn't change for anything (except maybe for a place on the Celtic bench!).
Its not all doom and gloom out there. You just need to find a job that will challenge and interest you. Good luck!
Ryan

Hey Jude.....

We'll be lucky to have electricity for a public service broadcaster or internet post collapse. Stockpile your essentials - padding, strapping, dressings, blades & etc - and make sure you have a decent number of instruments - and formaldehyde!

Would be interesting to see what value others put on their skills. Nail care - 1 bag of potatoes. Corns & Callous - 1 chicken. Nail avulsion - 1 lamb .....

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"citing an indisposition due to special circumstances"

My location

Paynes laws are cool. They deserve their own thread.

You could run a competition for somebody to come up with number 5!



Robert

Hi Suzy,

I'm with Robert on this one, there are 'good' and 'bad' Trusts to work for. Like Robert our Trust will only 'keep on' those patients with significant foot and medical pathologies. Also our new graduates are a bit shellshocked during their first few weeks. We have a good (I hope) support system to help them through their first few years in the profession.

As the others have said speak to your manager, make your interests known, ask to shadow other clinicians to see what goes on. If the response is anything other than a 'yes' or at the very least 'we can look into that' (but you might need to keep reminding) then I would seriously think about looking at working elsewhere. Keep your eyes open on the NHS jobsite.

Give it a bit more time and try not to get disillusioned, it is a great profession with loads of opportunities, but you need to go look as they very rarely come looking for you.

I have had a varied career as a Podiatrist working initially in a Mental Health and Learning Disabilities Service providing the usual treatments, but from a different angle, now I am specialising in orthopaedics working with a Pod Surgeon.

Good luck.

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Nikki

My location

Suzy

Ok firstly I have never worked in the NHS so I do not have that perspective but I'm
sorry to hear you are having such a bad time at work. I have read your post, taken on board your concerns and listend to what you have to say and what I'm hearing is

Bhoo hooo! poor me! Waaaaaaaaa! waaaaaa its not fair! bhooo hooo hooo whaaaa! whinge, bleat, sob whaaaaaaaa! poor me.

You might recognise this as a parody of a famous comdiens routine TV sketch and you might also think it a little rude or disrespectful. It was meant to be!

Get over yourself and look for the good things in your job instaed of focusing on the things you don't like, which from your posts, I would say, are mainly of your own making.

From the sound of it you have a bad attitude towards your patients, you see them as troublesome and petty and not worthy of your expert professional attention. This will not change wherever you go. Treat patients as customers, they are your bread and butter, without them you have no job. If you think that it is audacious of them to expect treatment when and where they need it then that is your poor attitude. This will reflect in the sort of responses you have got from the patients you are presented with.

Suzy, You get what you ask for and you asked for what you got.



I expect I will get some grief from those that do not understand. I hope you can understand, I hope you can take this as constructive critisism and leave your negative thoughts behind. We are all guilty of them, you just have to catch yourself.

All the best Dave

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Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

Dave
I thought your reply to suzy was spot on- and well said without being offensive.

Suzy, if you think private practise is a bowl of cherries, then think again. It is very hard work both in the building up of a practise and in the maintaining of it and quite honestly if you havent developed your clinical skills in all areas then you will not get patients returning. Use the NHS job as a learning curve, especially while you have other clinicians around you- in PP you are in isolation most of the time and need to make all your own decisions. A lot of the work is bread and butter stuff, personally , I love it and I enjoy good relationships with the patients who get to know me and I them. In the NHS there is lack of continuity as to who treats the patients and relationships are rarely established.

Another point about being employed is that to a certain extent you can remain mobile as to where you live and work. Once you have started in PP and build up a practise , it is much more difficult to up sticks and move,so it is better if you know you are settled in the area where you want to be long term.

All the best anyway
Cornmerchant

Hi Dave ,Suzy et al

Yes Suzy remember that very true statement from Dave.

His words are wise and should be taken as sage advice and not as a put down.

The routine is your bread and butter be good at it ( especially learn NOT "to nick patients") and the more interesting ( jam on the bread) will follow.

Unless your reputation is good in private practice you will not attract patients so learn and hone your skills now for the future.

Good luck

cheers

Derek

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My location

To Advance from "The Dark Side"

Hi Suzy,

Lots of well meaning advice in all the above posts. My tupence worth; stick at it for at least a year, you will find the experience invaluable in later practice. Derek is right about honing your locomotor skills now, you will need to be working at a very high standard to succeed in PP which is, in the main, `routine` callus reduction and nail care.

Wise words indeed. You have the capability to turn every situation to your advantage, it all comes down to your attitude and approach to tasks. You can`t expect others (including your manager and patients) to respect you unless you respect yourself. If you really feel undervalued in your assignments, ask for more challenging case loads.

NHS work as a recent grad is hard. Believe me I know, I had to get up in the morning at ten o'clock at night half an hour before I went to bed, drink a cup of sulphuric acid, work twenty-nine hours a day, and pay my Trust for permission to come to work…and you try and tell the next generation of graduates..... they won't believe you…they won`t

Thank you for the replies, there has been some very useful advice and tips and I will certainly take these on board.

I cannot agree with your comments David. If I wanted to cut nails and callus all day I would have completed a FYP course, not invested 3 years completing a degree. I guess you are a typical "cut and come again" Podiatrist. Of course, it is a very good money spinner for private practice but in the NHS I want to be looking at the biomechanics and other factors causing those lesions. It is the cut and come again attitude that stops our profession getting the respect and recognition it deserves.

For anyone who is interested I have secured a job with another NHS Trust and will be handing in my notice tomorrow. The new trust are giving me full support as a new graduate. I am also working with the biomechanics specialist once a week, the diabetic specialist once a week, doing general clinics two days and new patients one day. I am also on a regular rotation of nail surgery. This I see as being a position where I will not deskill myself and can contribute to clinical excellence.

Good for you for getting on the front foot - that appears to be a sensible caseload of varied work.

I think 2 days per week of general chiropody treatment is enough to hone your basic manual skills and understand what happens to a foot when it degenerates beyond the point where definitive treatment can occur.

LL

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Remember, it's just a foot.

Ouch!

How on earth do you come to the conclusion, Suzy, that David is a typical "cut and come again" Podiatrist. Yes he was harsh, but in amongst his response to you was a clear message regarding attitude.

OK.

How does palliative care fit into the your vision? Some of our more elderly patients just do not have a cat in hells chance of caring for there own feet. Our role, as Podiatrists, is to provide a service to these people so they can survive a maximum period of time between necessary appointments. Do you class this as cut and come?

Unless these patients are deemed high risk by their general health status, many are discharged to the hands of the not for profit and voluntary sector because PCT's cannot or do not want to provide this care. I am not just talking nail cutting here either.

Sadly this is having a major impact on the respect and recognition of the profession of Podiatry in the UK.

Funding is a big issue within the NHS, especially for the provision of Podiatry and one which our government continually overlooks. Therefore there is no easy answer to solving the problem of much needed palliative care but surely disrespecting one another for providing or not providing this service is not the attitude to take.

Suzy, I wish you luck with your new job and yes a change in attitude towards the needs of your patients and not just your needs would be beneficial. Each and every patient that passes through your hands from now on deserves your clinical judgement and needs assessment. Talk while you work, explain the pathomechanics behind each and every corn, callus and toenail that passes your way. You can make a difference, even on the days when you will be running general clinics.

GB

Suzy, when you have a few years under your belt you will realize that signs and symptoms presented by the pesky chiropody patient will give you clues to guide diagnosis of more systemic disease and pathology. These clues will be invaluable to you in other branches of podiatry.

In my opinion there are two areas where the podiatrist, in the UK, can excell. These are chiropody and biomechanics, everything else is done by others and usually done better.

In what terms is chiropody deskilling you? do you think that someone who is suffering from a deep seated corn has any less pain, or the need or right to relief from that pain, than some one with plantar fasiitis for instance? Endeavouring to make people better and relieve their pain, within your scope of practice, should be your bench mark of job satisfaction. I predict that you will never achieve job satisfaction if you see its achievement as some sort of superior position within the podiatry hierharchy. There will always be (in your eyes) someone better than you and there will always be those rude inconsiderate pesky patients to ruin your day.

Your changing your job, that's fair enough and good for you. Now start afresh and be a better practitioner for yourself . Fullfilment will only come from within not from without. You can only control how you are and what you do and how you think. Outside of that is beyond your control. When you realise that you will not have the turmoil within that you have now.

All the best Dave

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Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

I find this discussion an interesting reflection of the mood of podiatry/chiropody in the UK.

Being from Australia, I seem to observe a distinct categories of professional activity in general podiatry practice. Whereas here most people in practice tend to do everything, it almost appears to an outsider that within the NHS not all podiatrists are created equal. Some appear to relish, or are relegated (depending on your point of view) to basic chiropody - which appears to be a very devisive point. Its almost like the have's and the have not's?

When I spent time in with two podiatric surgeons in the UK, it seemed to crystallise this separation with the species even more so.

Podiatry is the sum of its parts, and any worthwhile general practitioner should have a range of skills that should be developed equally. Same as a general medical practitioner.

Admonishing this poor girl for wanting to do something other than cut nails and hard skin 5 days per week seems a litte strange to me. I too would be bored and disillusioned if it were me in her shoes.

No offence intended to my UK brethren.

LL

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Remember, it's just a foot.

Hi Suzy

BIG BIG MISTAKE

Might I respectfully suggest you check out Dave Smiths postings on the Biomechanics threads on this site and reflect then on your comment ?

That is the whole point of the advice you are offered here , you must do "the apprenticeship" first and fully understand all aspects of the profession however mundane some of that work is, it is as GB states a very important service to patients and the patients well being is what we should all be striving to improve.

Good luck in your new post

Cheers

Derek

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To Advance from "The Dark Side"