Podiatric Surgeons Unregulated?

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netizens


From the BBC London News
http://news.bbc.co.uk/local/london/hi/tv_and_radio/newsid_8400000/8400189.stm


toeslayer

 

From the BBC

 

mmm, I wonder if there is a motive behind the story, ok othopedic surgeons do more than the foot and take 16 years, well if they are doing more then feet you would hope so.

They also go to med school to learn about the workings of the brain, and the sexual reproductive organs, but does that realy mean they are better on the foot and ankle, a podiatrist has spent three years studying the foot a MD probably spends two weeks in med school.

maybe this story will put podiatry on the map and the public will stop thinking we just cut toe nails. interesting anyway.

 

Do I feel another raft of regulation and restriction being fiested upon the "Chiropodist" ? (Interesting choice of terminology by ALL concerned)
Time will tell
Cheers
Derek

 

netizens

me thinks, if this article catches the wider attention of Brown and Co there maybe ramifications to come as the GBP (Great British Public) will need to be reassuranced the NHS has only regulated practitioners.

toeslayer

 

a few thoughts.....

1. Isn't it interesting that this comes at a time where independent prescriber status has been recommended for uk pods

2. the report details pod surgery failures but doesn't mention orthopaedic surgical failures

3. pod surgeons have to pass a final exam to gain fellowship.....orthopaedic surgeons don't

4. pod surgeons are cheaper, and consistently get better outcomes for foot and ankle surgery than orthopaedics, yet none of this evidence was included in the report

5. orthopaedic surgeons in private practice are complaining bitterly that their workload has reduced due to the recession, however most podiatric surgeons have seen little difference in work loads and income......perhaps they want our work to pay for their winter skiing?

6. The interview with Mr Prior was an hour long and covered a lot more than was used in the report......an element of bias perhaps?

7. pod surgery training is directed at the foot and ankle and does not need to include shoulders, spines etc....surely this explains the length of training rather than the quality of training.....was this mentioned in the report?

8. the title surgeon was used instead of doctor as traditionally surgeons served an apprenticeship and did not do medical training. Just because they now have to do a medical degree first does not mean they weren't good surgeons before...

9. maybe the fact that our pod surgery training is getting longer and includes pretty similar stuff to orth surgeons means its time to merge the training schools....and they don't like this thought?

10. why was the term chiropodist used? Wasn't that consigned to the dustbin in approx 1990 when training schools awarded degrees in Podiatry/podiatric medicine? So most people trained in that last 19 years are not Chiropodists they are Podiatrists.......but using an old fashioned term presents us as more limited in our scope of practice to the general public....

11. what will the right of redress be? will it be unbiased? how about a documentary following training of pods through to pod surgery......facts always win over fiction.......

Julian

 

Interesting response Julian - would you be willing to put these points to the BBC and see what response (if any) you get?

 

AND the SOP dropped the title Chiropodist recently but it would appear to be still alive and well, living in the halls of power behind closed doors perhaps ??

Makes me wonder if a storm is about to break especially with Brown & Co after saving loadsadosh to get the country out of the mire ??.

Tin hats at the ready perhaps:boxing:

Cheers
Derek

 

nothing to worry about there then.....Podiatric Surgery is significantly cheaper at the point of delivery than orthopaedic surgery......primarily due to the amount of day case surgery performed using regional anaesthesia rather than GA....no need for overnight stays.......

 

Anyone else have thoughts on this matter?

 

I gather Trevor Prior already made these points in the interview and they didn't use them.....wonder why......

Trevor spoke at the conference extensively about this matter calling for transparency and support, and delivered all the evidence including studies comparing the two professions (by patient outcome and satisfaction). Guess who came out better....?

I had another interesting thought......it takes 10 years for Podiatric Surgeons to train in this country and the Orthopods don't like us using the word surgery (even though we do surgery on the feet so how else would one describe the work done?), however, dental surgeons only take 5 years to train. Do the orthopods have a problem with them using the title surgeon..........?

So, what's the real issue?

 

That needs to be stated in the appropriate places BUT it wont command the news at 10 Julian anything like "unqualified" Surgeons working in the NHS will.

Sorry but IMHO a swift response is required by the professional bodies to counter and grab headlines to prevent the public disquiet that you so rightly state will follow.
Cheers
Derek

 

I agree but in a measured way......ask yourself why this has come via the media......do you not think that interested parties may have already tried the government route and failed?

I spoke to lots of people today about the report (I have the joy of living in the south east where it was broadcast) and I simply asked them 2 questions:

1. why are dentists allowed to use the title surgeon when they only study for 5 years (half the time Podiatric Surgeons train)? Maybe this isn't the real issue but an "add-on" issue.....

2. Do you think the NHS would condone payment for almost 100 Podiatric Surgeons at consultant grade, 100 registrars, surgical trainees, specialist Podiatrists and the nursing and admin staff if they weren't confident in the training, outcomes and regulation of Podiatric Surgery......?

Have a look at the Royal College of Surgeons website and see where they came from.....and why they use the title Mr/Mrs?Miss rather than Dr.......http://www.rcseng.ac.uk/patient_information/faqs/surgeons.html#dr

The HPC regulates Podiatrists in all forms (including enhanced scope practitioners such as Podiatric Surgeons), the GMC regulates doctors in all forms (including surgeons). The Royal College of Surgeons is responsible for surgical training, the faculty of Podiatric Surgery is responsible for Podiatric Surgical training (including validating MSc syllabi).

Can regulation be improved? Of course!! We can always improve regulation....but when does it get to the point where a profession is so regulated that it cannot function.

Many Podiatric Surgeons work with and alongside Orthopaedic Surgeons and have done successfully for years, wonder how many of the Orthopods agree with the "vocal"?

Ask yourself why this has suddenly been raised, Podiatric Surgery has been around for many years.........

 

Because as I said some time ago, the orthopaedic surgeons are going to take their ball back...

http://www.youtube.com/watch?v=MCQ7VLoY7bQ

 

Julian,
If this is true and can evidenced then if I were a podiatric surgeon, I would be shoving this and the DOH paper: "An NHS of all the talents" under the noses of the BBC reporter responsible.

But me thinks the RCS has more power than the SCP, SOCAP, SOP, whatever the acronym is now.

 

I believe Trevor Prior already pointed this out during the interview......love the BBC.....so unbiased........

As for the DOH paper....is it available as a download?

 

Whoa, where have you BEEN?

By and large, a pretty bias and rubbish report. Although that said there may be a grain of truth in it...

It does trouble me that there seem to be few "checks and balances" on Pod Surgeons once qualified and given that many work in a relative vacuum (unlike Orthopods) their is no means for them to be flagged or monitored.

There is pascom of course. Possibly the most profoundly useless outcome audit tool I've ever seen. Here is how it works in my area. Patients are given a pascom form on discharge. The patients who have poor outcomes are simply not discharged. I can think of patients still being seen 2 years on from the initial surgery who are still having serious ongoing problems. They get a stream of "hmmm well we could do a steroid injection... tell you what, come back in 6 months and we'll see if its settled down." type appointments and NEVER get discharged. Some have had 3 or more ops to try to "sort things out". No discharge, no form. So the pascom data looks fantastic because only the patients with good outcomes get to take part and the surgeons get to refer to a success rate based on that data. :craig: If that is the basis for the statistics on the success of pod surgery I'm afraid I cannot take it too seriously!

Do I think orthopods do it better? No. Do I think that all is rosy in the garden? No.

Is that tar I can smell boiling?

Regards
Robert

 

It's probably 7 or 8 years old now, but it basically stated that the right people to be doing the job were the ones who could demonstrate with evidence that they were the best at it. Check DoH website to see if you can still get it, you used to be able to.

 

No. But I can smell a pot of dripping on the go. DO you understand the word "dripping" in the South East? It's something occasionally eaten with bread by your poor cousins in the rest of the country

 

BTW, you are right Robert, if we want to compare podiatric surgery with orthopaedic surgery in terms of outcomes the same audit tool and protocol must be employed across the professions. Has this been done?

 

Are they hell as not.

So our data is better. Shows we're better at cooking the stats. Nothing more.

Of course that's not to say we're NOT better. But as audit tools go Pascom has holes you can drive a bus through.

Hey ho.

Cheers
Robert
PS. Can't honestly say I've ever eaten dripping although I am aware of it. I come from norf london stock which means jellied eels are my raison d'etre. Do you have eels up north?

 

Yep as an old S E London boy who's father toasted the bread over an open fire and slapped the drippin on thick( coz in the days of ration books after the war that was a good meal,) and I have done the same over many years, until the GP gave me a Bo*****ng and put me on the Cholesterol pills

The whole point is :- This story made News at 10 probably the most viewed news programme in the country.

The point has been made on there however much we think it is biased the reply should be made BY the professional bodies to get back and put the case for the profession on the same media to retaliate on the same level.

To my knowledge this has not been done as yet so now it is old news and the likelihood of gaining media interest is fading fast so now all the relevant government departments mindset will be working from that broadcast as they have nothing more to go on.

IMHO missed the boat ....wait for the outcome, yet again :bang:

Cheers
Derek

 

netizens

From the Society (FEETFORLIFE.ORG)

BBC London news broadcast a story about podiatric surgeons (on 7 December 2009)

The piece has highlighted there is further work to do in increasing the understanding of podiatric surgery and the Society of Chiropodists and Podiatrists is committed to doing this.

Podiatric Surgeons, who work as part of the NHS and private practice, are the only profession who train specifically to manage foot and ankle related pathology and are highly skilled professionals with a minimum of 10 years training. Most referrals for treatment are made from consultants in rheumatology, diabetes and dermatology and GPs.

Podiatric surgeons can be identified through the website here by checking the 'find a podiatric surgeon' option, and if you have any questions relating to this subject, please contact Nita Parmar, Director of Marketing and Communications at np@scpod.org



Not exactly a strong rebutal?
The BBCs story is really a storm in a tea cup and will probably pass unnoticed but it does rather expose the fragile nature of podiatric surgery in the UK. Bearing in mind what happens there is reflected in other Commonwealth countries. Whilst the fiscal nature of training costs compares well against orthopaedics the absence of regulation is a weak link. No matter the sterling work of the past, on the grounds of safeguarding the public, it might be an attractive option politically to up the anti for practicing in the NHS. Brown and Co are looking for simple and effective policies in the wake of the election and I can image the lobby from the medical sector would potentially be in favour of such a move. However conspiracy theories aside I guess there may be bigger fish to fry and this "beefed up story" is not anti podiatry per se. However it is a salutary lesson none the less and warning to all working with the media. My sympathies on this occassion lie with Trevor and all the take outs that are lying on the cutting room floor.

toeslayer

 

Ermm dont you think whoever made this statement should at least use the agreed ?? title of the organisation they represent
Cheers
Derek

 

There are some very valid points raised in this thread and I am in general agreement.

Robert, regarding the above quote, how do you know? Ever heard of clinical governance? Peer review? Other audit/ research within podiatric surgery units nationwide?

As far as PASCOM goes, yes there's plenty of bad points, but how many other sections of our profession consistently use a national audit scheme? It's certainly something that could be improved upon, but at least it's a start. My orthopaedic collegues have nothing even vaguely similar. Try looking for published infection rates following orthopaedic foot and ankle surgery as an example. If you find a decent report, post it up on here - I'd buy you a virtual beer if you do.

Regarding the 'investigative journalism' - simply brilliant work. Amazing. Fantastic. Astounding. Phenomenal. Well done beeb. :craig:

 

Yep. Heard of them. Not seen the tracks though.

I'm certain many units have those in place. I'm certain many have abundant peer review of outcomes and processes. I'm certain many carry out research. I would suspect that most if not all do so better than their Orthopaedic counterparts.

But I am also certain that not ALL departments do these things in a meaningful way.

What is the point of a national audit scheme if it can be so easily abused? Generating biased data could be argued to be worse than generating no data at all because it can be (note I say CAN be) so misleading.

Lets say we have two surgery units. One gives their patients the pascom questionaire 6 months after surgery with true academic zeal and integrity, regardless of outcome. Over a 2 year period they do 300 proceedures and produce 300 completed questionaires. The other gives the questionaire "on discharge" which may be after successful surgery or after several years, steroid injections, additional surgeries and suchlike. Perhaps they also have a few patients who get fed up of coming / go elsewhere / die before they can be formally discharged. They produce only 200 questionaires for the same number of proceedures.

I, as an informed patient, access the data for the two units to see which one I want for my surgery. Unit one will have a far higher complication rate than unit two, not so? Does this mean unit two is doing better work?

To take another example, if i proposed an outcome measure for biomechanics wherin patients who were happy with their devices, discharged, then given a satisfaction questionaire were included, but patients who were not happy were given a constant stream of adjustments and remoulds and never given a questionaire. I could produce a success rate which would bring a warm glow to Les Bailey's heart! Would that be a fair reflection of my practice? Course not. And if it were published I would be quite rightly torn to shreds.

Pascom is, as you say, a start. And it does perhaps represent a framework upon which to build and I applaud those who are trying! But in its present form it is so open to abuse that I'm afraid I cannot lend the figures derived from it much weight.

Can I have a Dr Pepper instead of a beer please? I'm drying out before Christmas.

Regards

 

Sorry Robert, but ALL surgery units HAVE to go through peer review, etc...

I'm certainly not disagreeing with you on any of your points, but as we say, it's a start.

NO! Damn you! I said beer! Now DRINK IT YOU SOFTIE! :santa:

 

Ah, takes me back to my university days!



Now I've had my misty moment of happy memory, here's fun.

As you say, pascom is a good start and a laudible effort. I was really blinged at the SCP conference by the idea of all the data being available online. For me the biggest flaw is the fact that the inclusion criteria are so open to abuse.

What if each surgeons pascom stats were audited (randomly or by peers) so that the number of operations carried out is compared to the number of questionaires being returned. That might highlight where an excessive number of patients are falling through the cracks.

Further, should there be guidelines (or indeed are there already) on how long post operatively the form should be filled in?

Regards
Robert

 

Is this your "Think Tank" photo, Robert? Black and white for dramatic effect?

 

Perioperative wound infection in elective orthopaedic surgery
G. J. S. Taylor, G. C. Bannister and S. Calder Journal of Hospital Infection
Volume 16, Issue 3, October 1990, Pages 241-247

that's 20 years old......found anything current? These days antibiotic prophylaxis has moved on a bit.....

Julian

 

The article is a familiar diatribe that appears periodically, instigated by known mischief makers. This is not uncommon when young professions emerge and prove successful.

The term 'surgeon' is used quite legitimately, the NHS spokesperson (if they exist) is quite wrong. All that is mentioned pertains to registered medical practitioners, the Privy Council once wrote to the Royal College of Surgeons informing them that they did not own the word 'surgeon' and that their control only covered medics !

Dental Surgeons, Podiatric Surgeons......

This problem highlights the inadequacy of the HPC and reinforces the need for a General Podiatric Council. The SCP fell short when the time was right, being too concerned with increasing its membership at the expense of quality !

Perhaps Podiatric Surgeons should have a separate organisation, their credibility cannot be helped by being part of an organisation that admits 'anyone' and where numbers count more than quality !

 

It's hardly new! check this out from 2004

http://www.timesonline.co.uk/tol/news/uk/health/article476416.ece

gonna go round and round ...........

 

I was taken fishing by my Dad once in my teenage years: all I caught was eels! (Northumberland way). Gutted 'em, skinned 'em and grilled them before we went home - bloody lovely!
p.s. We don't have dripping in our "up North" but we do have pease pudding which divides the inhabitants along the same lines as Marmite does.

 

R. On R booits

 

Lmao!!!

Seriously, to our colleagues who visit to lecture and wish to broaden their educations, forget fish and chips. Jellied eels are the truly English dish. Fish flavoured jelly. What could be better!

Regards
Robert.

Ps for our US cousins I mean jelly in the sense of what you call jello. Not jam.

 

And by a strange coincidence (the bold type has been added by me - these bits seem very indicative of the mindset of the Author (Publicist? Spindoctor?) :

From The BMJ Published 27 November 2009, doi:10.1136/bmj.b4835:

So do we have the guts (as a profession) to stand up and spin right back in a situation that has very obligingly opened the door to the opportunity to really start to tell the Public what we can do?

Its perhaps interesting to note some of the content and comments made by the DOH Chief Health Professions Officer; Karen Middleton at the CHPO conference last month (conference title : Allied Health Professionals: ‘right People, right Place, right Time’ - bold bits again are mine)

Or will we just chunter sub voce on, and on, and on.................?

Martin

 

Hi Martin

Nice to see you back mate :drinks
Cheers
Derek

 

Interesting paper comparing GPs satisfaction with Orthopaedics and Podiatric Surgery in Doncaster.......

View attachment podiatric surgery orth surgery customer satisfaction survey.pdf

Julian

 

I was referred to a podiatrist and he should have referred me to an orthopaedic surgeon as he was not qualified to deal with my feet but instead he just bulldozed in causing more harm than good.

Podiatrists are qualified to do some procedures but the problem the BBC uncovered which lead to this feature was that no one ensures they do not operate outside of their capability.

An orthopaedic surgeon does not work on patients spines and legs just because they are attached to the areas they are qualified to work on. They have set areas they can deal with. If an issue is outside this area they refer them on to the relevant doctor.

The podiatrists that dealt with the people featured in this program and myself have been egotistical, greedy men who are more concerned about doing operations for money than the good of the patient.

I have been in touch with the BBC and am contacting the London MP mentioned in the feature.

This is not an attack of podiatry. It has its place in the world of foot problems but it should stick to it. There should be an independent agency that oversees the profession to protect the unsuspecting patients.

I feel podiatrists rely on the well known phrase 'trust me, I'm a doctor' which allows them to get away with a lot more than they should. They are not orthopaedic surgeons and should not encroach on their field of work. Stick to minor bunions and in growing toe nails.

 

Sorry to hear that. If you don't mind me asking, what procedure did your surgeon undertake?