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A Family Doctor’s “Footnotes”

Regular readers have heard me rant about the fragmentation of medical care in this country. Each body part not only has its own medical specialist, but in some cases its own allied health profession. Such is the case with the feet.

Doctors of podiatric medicine have to complete a four-year course of study after college, followed by a three-year podiatry residency. At the end of all that, I grant, they are expert in the care and management of complex disorders and conditions of the foot, ankle, and lower leg. I refer to them regularly, especially for stubborn ingrown toenails. (I did indeed learn how to remove offending portions of nail bed, but over the years I’ve gotten away from it.) They fail, though, when they try to extend their reach beyond their grasp, which is the case of the podiatrist above the knees.

I’ve had a slew of calls from panicked patients whose podiatrists have either scared the crap out of them or have screwed up their diagnosis or treatment.

There was the woman with a non-healing wound on the side of one of her toes which the podiatrist had been treating for months. All he did each month was “clean it out” and tell her to soak it. It continued to hurt so she came to me. The first thing I did was order a bone scan, and low and behold she had osteomyelitis — a nasty bone infection that ended up requiring surgical debridement and weeks of IV antibiotics.

Then there was the patient whose podiatrist noted that I ought to check for nerve damage in the elbow, because of muscle wasting in the hands. I already knew about the problem, but my first thought was: “Why was he looking at the patient’s upper extremities? Does this patient walk on his hands?”

But the one that really ticked me off was the frantic weekend phone call:

My feet are swollen and my podiatrist says I have chronic kidney failure. I have to see a nephrologist right away!

Hey, Foot Guys: Even if you happen to work with physicians (orthopedists, actually — it’s not like they’re really doctors either), you’re still not qualified to diagnose anything above the knees. There are plenty of reasons for swollen feet besides chronic kidney failure, and shooting the patient straight off to nephrology is a truly ridiculous waste of time, effort, and money. Send my patients back to me, please, and let me take care of their medical needs. But thanks for offering to fix her bunion.

*This blog post was originally published at Musings of a Dinosaur*


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