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Are we glorified toenail cutters?

Discussion in 'General Issues and Discussion Forum' started by ajs604, Nov 10, 2010.

  1. ajs604

    ajs604 Active Member

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    This post is not intended to upset people so I apologise in advance if it does. Do you ever have clients that really annoy you! I do and must admit that in some cases it is like banging your head against a brick wall. Example you try and provide a diabetic with footcare education & all they are intrested in is having there nails cut & you cannot discharge them because the GP would hunt you down. I do not know why I bother!! It just feels that you spend all this time at uni and it is to no avail. Another example would be someone with a heloma durum on the dorsum of there LF 5th - say for example they have closed toe box shoes - you try and give them footwear advice. When you see them again 6 weeks later they have not done anything to improve there footwear.

    I just feel that in podiatry we are seen as toenail cutters. We and particular younger people know that podiatrists are much more specalised that that. However, the perception of the current aged community is that all we do is cut toe nails and debride calluses. The majority of aged people do not realise that Pods spend 3-4 years at uni getting a degree - in what I would say is a complex subject.

    I have started to question whether I want to be a pod anymore. I know that our profession is a complex and very good in improving the quality of lives of many individuals. Please discuss - be good to know others opinions.
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    At many times in my career (and I am sure others on this list would agree) I have felt a similar way. Particularly when I was fresh faced in full of enthusiasm for biomechanics, sports medicine and surgery.

    Age and experience then make you reflect on what your role is within your community. At the end of the day, there is simply a strong need for general podiatry care, particularly in the aged care setting.

    However, one needs to take a leaf out of how other professions handle this issue. In dentistry there has historically been a hug demand for 'scale and clean' services, once only performed by qualified dentists - our equivalent of 'nail and callus care'. However, it is now increasingly rare that general dentists undertake this work - it is performed by dental hygienists usually under dentists supervision.

    There is much talk on the role of 'podiatry assistants' doing similar tasks in our sphere. I would much prefer the title 'podiatric hygienist', as stated many times before. Then, my friend, this would free you up to market and promote yourself for the services you feel most qualified to do. Turn it around.

    But remember. Its the 'old grannies' with corns, digital defomrity and degenerative arthrosis that often need more help than the self inflicted sportsperson or weekend warrior. Don't neglect them, as they are often the most interesting and challenging biomechanics cases of all.


    PS - and never try and tell a female what shoes to wear...
  3. As supportive as LL Post is and I agree I would add to answer the question from the title of the thread are we glorified toenail cutters ? My answer only if you want to be. The world of Podiatry is for you to do what you want with it, if palliative care is not your thing then make something else yours just be the best you can be at it if sports podiatry, children, surg etc. Only you decide what you will be,you can educate and promote the profession by explaining to your patients your scope of practice - maybe get some of the grand kids in for BA assessments from a palliative care treatment with the grandparents happened all the time to me.

    BUT you make of this game whatever you want, its up to you to decide what you want to be.
  4. Admin2

    Admin2 Administrator Staff Member

  5. Catfoot

    Catfoot Well-Known Member

    Hi ajs604,
    Some excellent advice from two of our veteran posters here on PA.

    I'm afraid that if you choose a profession that is client-centred then you will come across individuals who seem determined to drive you up the wall and round the bend(or both) on a daily basis.

    Remember, patients have the Right of Self Determination. They don't have to come and see you and they don't have to take your advice. They are also entitled to refuse treatment.
    If you are in PP you also have a choice - you can discharge them for non-compliance. I'm not sure how you would stand in the Public Sector though.

    I would suggest you document all your treatments carefully. Record their non-complaince. Record your advice. Make sure they understand the consequences of not taking it and then forget about them and move to the next patient.

    I could cite numerous examples of self harm done by patients who would not heed advice - diabetics who use corn plasters, razor blades, refused to stop smoking, patients who insisted on footwear 2 sizes too small, etc etc.

    You can win 'em all.

    As for "being a glorified toenail cutter" that's only in your mind. Podiatry has great opportunities for advancing one's knowledge and developing one's skills in regard to the foot and learning new modalities and therapies. It's up to you whether or not you embrace them.


    Last edited: Nov 10, 2010
  6. carol

    carol Active Member

    I take it you are not in Private Practice, when and if you do you will welcome these clients as they are your 'bread and butter' income.
    I'm afraid, as an 'old timer' who qualifed by experience and hard graft as opposed to University, I am coming up against Graduates in Podiatry (and Nursing) who are far too academacally qualified for the actual job. But as one poster has already said, choose your speciality and go for it, but you will probably have to take a leap of faith and go into private practice. But don't give up, we've all been there, 'people' are annoying, as an NHS Practice Manager said to me recently " Chiropody is no longer a an essential service" Now I could have cheerfully have throttled her!!!:bang:
  7. blinda

    blinda MVP

    careful... you might wanna reword some of your comments. Unless of course you are being deliberately provocative :boxing:
  8. Ian Drakard

    Ian Drakard Active Member

    You're right they don't- and occasionally I think that some of our medical colleagues don't either. But it's up to you to tell them. That way in 10 years (or 20 or 30 :bang:) you may come up against this slightly less.

    You can't change the public perception single handed, but by doing something you enjoy well you can at least educate the people you come into contact with.
  9. rosherville

    rosherville Active Member

    An NHS Practice Manager said to me recently " Chiropody is no longer a an essential service"

    And she is quite right, from her standpoint. Practices are being told to cut many of their integrated services and chiropody was sure to be in the front line.

    It has nothing to do with clinical necessity, it is all being run by accountants !
  10. Before this become an NHS witch-hunt bear in mind ajs604 is located ( according to their info bit on the right hand side ) in Australia where there is no NHS.
  11. Lizzy1so

    Lizzy1so Active Member

    AJS604 I have often felt like this, gone home and thought about getting a job in the pub, but then something nice happens and I feel I am doing an ok, if sometimes routine, job. This week someone brought me a bottle of wine and a thank you card for resolving what i consider a routine problem. Nail cutting is my bread and butter and most of my clients are grateful for the service I provide, to them I am essential otherwise they wouldnt pay me and i would be out of business. I may not be setting the world on fire, but its pretty warm an cosy sometimes.
  12. carol

    carol Active Member

    I'm not trying wind anyone up, I'm just stating a fact..sadly across the board (not just in health care) the younger generation, if they want any decent career, are being forced to earn their qualifications at University, there is nothing wrong with this, but some of them come out with very high expectations, again nothing wrong with this either, but sometimes you just have to take a step backwards and get a bit of practical experience first..
    But in all caring professions you will get those who wind you up, but you have to accept that not everyone wants to be 'educated' regarding their problems.
    But you are so right that we need to educate, not just the patients but Doctors and other Health Care workers how much we actually do have to study.
  13. A question I often get asked is: "why do you want to treat feet?" My stock response is: I don't, I treat people. A wise old sage once said to me: "only a proportion of the care is what you achieve at the foot".

    Personally, I love cutting toe-nails, it gives me a break from dealing with sports people. The older I get, the more I realise the importance of doing this well, and moreover, making sure my patients are "well" at the same time.

    Remember, for some patients you might be the only social interaction that they have that day, or even that week. Make it good for them, please! I heard a frightening stat on the radio today about how many elderly people in care homes never receive a visit from family members. Unless you're a rock n roll star you'll be old too one day. And to be honest, these days even if you are a rock n roll star, you'll be old too one day. Try to imagine a situation in which the only person you speak to for a day or two is your chiropodist, then realise that you are not just "treating feet" and put your heart and soul into every patient interaction.
  14. footsiegirl

    footsiegirl Active Member

    This is so true! One lady I visit, when I told her that she no longer required monthly visits now her foot condition was under control, and that we could try 6 - 8 weekly, told me that she looked forward to my visits every month because she doesnt get many visitors! Whilst not regarding me as a friend (careful maintainance of patient / professional boundaries etc), she is lonely, her feet feel better for my visits, and I represent someone who takes an interest in her life and health. She asks me what I have been doing, and she in turn tells me about her family etc

    Sometimes performing something simple can bring great rewards. :empathy:
  15. That should be printed out and given to every graduate, wherever they practise. Well said, Simon.
  16. Cheers, Mark. I'd enter it for quote of the year, but you'd only beat me. Got this coming years calenders done?
  17. They're at the printers - should be done by the end of the month. Proving very popular with patients this year - have orders for 250+ so far!
  18. Not surprised, you have a great eye. My patients have loved this years.
  19. George Brandy

    George Brandy Active Member

    Does that mean we have to pay for our copy this year?

    I have a couple of ladies who want the calendar when we get to 31 December. Its brought back lots of happy memories for them. They can't do the mountain walking now but my goodness we've been been to the summits of many mountains during our footcare sessions this year.

  20. ajs604

    ajs604 Active Member

    Thanks for all of your advice. I think I just had a bad day yesterday and had time to reflect in the evening. I have taken all of your points on board and appreciated all of your advice. I am infact fairly new to the profession as I only graduated 2 and a half years ago, trained in the UK then emigrated shortly afterwards to Australia so have little NHS expereince. However, my general perception from speaking with people I trained with in the UK - the NHS is quite similar to Australia's public system.

    Thanks again for all of the valid points.
  21. Tuckersm

    Tuckersm Well-Known Member

  22. MR NAKE

    MR NAKE Active Member

    Are we missing the point here?????its the quality of the content of our training (syllabus) that eventually reflects on our potential and what we can offer,,,,,,,padding and strapping (how many hours), nail trimming and callous reduction (how many hours), pathology and medicine(how many hours?) histology (how many hours?) Anatomy and physiology 1&2 @university level plus disection (how many hours?), biomechanics,,,,with current concepts inclusive,,,,,as other universities dont even touch on rotational equilibrium theory as it is deemed too difficult or confusing (how many hours), the list is endless,,,,,LOL, NOW! back to the qustion?, are we glorified toe nail cutters? HELL YEAH FOR SOME! AND HELL NOT FOR OTHERS!!!!!status quo????
  23. ajs604

    ajs604 Active Member

    Thanks for that video!
  24. Alison_D

    Alison_D Member

    Thought this thread looked lke a perfect oppurtunity to vent some of my own annoyances with some peoples attitudes to what a Podiatrists role is.

    I am currently working in a Public Hospital, which involves a certain amount of Nursing Home work for our oncampus residents. We have criteria in place regarding who we do and do not provide routine care to (based on an initial and annual basic assessment)...those who are deemed low risk are the responsibility of those nursing staff who have attended the Mayfield Course for foot care

    ....disappointing when nurses with this additional training under their belt won't attend to patients nail care, as its a task they hate, so tend to try and 'pass the buck' onto the 'toenail cutters'

    Also hate..."oh, i would love a foot massage..." (usually by one of these nurses as I'm treating someone....)

  25. neilnev

    neilnev Active Member

    Good morning folks - time for a rant!

    Speaking as a boring old fart (qualified Salford 1976), I often despair for podiatry 2010. Please don't misunderstand me - I read the journals, do my CPD etc and am often gobsmacked by the depth and quality of the research involved in our profession now.

    But scope of practice?? I work full time in the NHS (mostly management) and also have a small private practice. Within private practice, when patients are "crossing my palm with silver", if they ask for a nail trim, why should I complain. That doesn't mean that I don't do my foot health education etc as necessary (I started my career as a pod lecturer, and education is second nature as far as I'm concerned - and should be for all practitioners).

    In the NHS, things are very different. As previous posters have stated, to quote Mick Hucknall, "money's too tight to mention". I saw yesterday the criteria for dom visits for a PCT in the south of the country which effectively limits dom visits to patients who are bed-bound. Our trust boards are asking us to make savings which are impossible to carry out without losing jobs. And, as regards comments such as " Chiropody is no longer an essential service"; lets get real - not many of our patients will die if they don't receive podiatry, hence, their NHS jobs are at risk.

    But, returning to the 1970's, one of my reasons for studying "chiropody" was to help people - we are in a caring profession, and we SHOULD go that extra mile. Fair enough, younger capable patients can do their own nails (mostly - of course; we sometimes have to educate them on technique), but have we stopped looking at patient care holistically? I have the utmost respect for specialists, but we generalists (and, without wishing to sound big-headed, I am a bloody brilliant generalist) appear to be looked down upon WITHIN our profession. I treat people! I enjoy treating little old dears with bugger all wrong with them apart from the fact that it is a little bit difficult for them to get down to their feet. They aren't going to ulcerate or get O/Cs or have any real problems - but part of my treatment consists of asking how they are keeping in general - I cannot even think of the number of patients who I have suggested visit their GP to see to a none foot related condition - general medical knowledge IS part of our training and we are obliged to talk to our patients for 15 -20 minutes - a skill in itself.

    Yes, invasive surgical procedures carried out by surgical podiatrists is incredible progress for our profession, but is required by a very small percentage of our patients. And yes, my PCT employ a number of skilled footcare assistants - but I still do a better nait cutting job than they do (although, when I compare the nail cutting skills of some of the recently qualified staff, I'm not altogether sure that I can say the same thing).

    Anyway, I'm off to take my prozac now. Have a nice day.
  26. Good to see the replies on this thread and agree completely, Neil. I worked in the NHS on and off for 20+ years and almost 10 years in my own practice - with 3 years in the USA with a medical products company - so I've been around a bit. I despair with the attitude of some colleagues, especially some within the NHS who consider general podiatric practice as beneath them - and are not shy of making their views known to their patients and colleagues alike. Twenty five years ago chiropody was the profession that was at the top of almost every survey into patient satisfaction - now it's the regularly the one where most complaints are levelled at in the NHS. Much of this is due to capacity and unmet need, but sometimes its the attitude of some colleagues that astounds. Having just finished my morning list where I've seen 2 Premiership footballers for Rx - 1 interdigital lesion, 1 suture removal - 2 orthotic reviews, 1 nail removal on a patient undergoing chemotherapy, 1 VP and 3 nail care patients who cannot manage their own care. Just about to do 2 house calls on elderly ladies for simple nail care. Been a great day so far - but the second house call patient just lost her husband of 58 years marriage last week and as she has no family, it's likely I'll be there for a couple of hours - just talking. If you think general practice is the lowest of the low - then you're in the wrong job!
  27. andrea34

    andrea34 Member

    for those who feel there is little job satisfaction in the nhs, its nice to note that things are changing. i know several nhs trusts are now including non-compliance in their departmental discharge policy... you always feel better when you can really see a difference ina patients condition and therefore general wellbeing and having this 'warning' (if i can use that word) to hand its amazing how many patients do suddenly start following your advice and you and them can see an improvement.
  28. Lizzy1so

    Lizzy1so Active Member

    second house call patient just lost her husband of 58 years marriage last week and as she has no family, it's likely I'll be there for a couple of hours - just talking. If you think general practice is the lowest of the low - then you're in the wrong job!
    I am going to a funeral tomorrow of a client who became a friend (boundries!) a lovely warm person who suffered years of cancer treatment, how many times i treated chemo toes for her i have lost count. Her family rang to invite me to the funeral and then to a small gathering after. I was very touched and am really sad to have lost this client/friend. I couldnt agree more with what Mark said, it is important to remember there is a human being attached to the feet you are treating and act accordingly. many of my clients are carers themselves or have recently lost a partner - it comes with the territory of the age group we mainly treat, it is a real skill to be able to deal with the emotional aspect of this job, and no-one can teach you that at university.
  29. W J Liggins

    W J Liggins Well-Known Member

    Hi Neil

    I find that a drop of armangac or similar beats prozac every time!

    Just a plea to you and others, can you please use the proper term, Podiatric surgeon, rather than 'surgical podiatrist'. Just at the moment, the avowed and vicious enemies of the profession are trying to 'sell' this title to the Department of Health. My NHS contract stated that I was employed as a Podiatric surgeon as does my indemnity and I will be grateful for the support of both you and the profession in using this title whenever possible.

    All the best

  30. neilnev

    neilnev Active Member

    Hi Bill

    I am more than happy to refer to you as a gentleman, a scholar and a Podiatric surgeon. I would have got it right first time if it wasn't for the half bottle of Armagnac that I'd polished off before taking my Prozac :).

    Take care

  31. A subject close to my heart. But I think you are, to be blunt, reading too much into this.

    When I go to my GP he might tell me to exercise more / eat better / lose weight / stop smoking. That I don't is not a reflection on his status in the medical community, nor even my perception of him. He's a very good GP. Furthermore, I think he's right! I just choose not to act on it.

    If I tell a patient why a problem exists and how to stop it, I am are simply informing them, not instructing them. Whether they act on that information is not particularly my concern. If a smoker chooses to keep smoking, thats up to them.

    I never tell patients what to do or not to do. I tell them what I think will happen if they do X or Y. That makes us both happier, and ironically I have found better compliance with that approach because it keeps it clearly understood that they are doing what they are doing for themselves, not for me. People are contrary beasts, some will be more likely to pursue a behaviour specifically because they are told not to. Especially teenagers, who form a good proportion of my caseload! :rolleyes:

    So don't take it so personnally. Don't "own" your patients non compliance. They're not slighting you because they think you're a nurse, they're simply choosing to prefer smart shoes and sore feet.
  32. Don't you worry Jinglin' Geordie I'm sure you'll be getting a complimentary copy as per last year. Have to pay my dues somehow....!
  33. MJJ

    MJJ Active Member

    Sometimes this bugs me and sometimes it doesn't, depends on the situation. Some people won't change their shoes because they like their shoes, and they know that they are causing the problem. They are just happy to be able to wear their narrow shoes with no pain for a little while and I am ok with that. They come back without complaining.

    The ones that bug me are the ones that come back in the same narrow shoes and say "My corn came right back. I guess you didn't get the root last time."
  34. George Brandy

    George Brandy Active Member

    Am I a glorified nail cutter? Probably, but come on guys where has your sense of humour gone?

    Attached to every pair of feet that passes through my hands is a different personality some serious, some fun, some articulate, some not so, some stubborn, rude, pleasant and some eager to please and get things right every time. It makes every day that I go to work a pleasure and sometimes a challenge, to the point that Podiatry is sometimes second to the social aspect that work brings. Our social skills not only add to our Podiatry skills but they work to get the best out of our patients too. If you have a high rate of non-compliance, sit back and examine how you tell it. You might be surprised at your attitude.

    I never suffer the Monday morning blues (OK I don't work Mondays) nor post holiday blues. I can't wait to get back to see what has happened in my absence.

    But for anyone who is not a part of my wee clinic, who comes to observe or just happens to be passing through the biggest compliment I get is how much fun we seem to have, how much laughter there is and how patients go back to reception not only with feet feeling much better but with their spirits lifted too.

    As has been highlighted, there are sad times also and yes I have been known to put down my tools, stop and listen when a patient is pouring out their heart to me. A couple of weeks ago my 3 musketeers became two (three generations of the same family). The eldest musketeer suffered a horrendous death and daughter and grandaughter needed to talk about it. I couldn't see for a while so had to stop work whilst the old eyes dried out. But soon we were smiling at all the daft things gran/mum used to do, including watching over my shoulder as I worked.

    I am always saddened by the attitude of the "new breed" of Podiatrists that grumble at the more general aspect of our work. You just don't know what you are missing. So if you don't want to do it, send it my way.

  35. What a delightfully refreshing thread this is turning out to be! Simon and George's posts should be required reading by all podiatrists - under and post-graduate alike. It's the sheer variety of work in general practice that makes it so special. You never know what comes through your door each time a new patient seeks your help - whether it be simple footcare or more complex foot problems that makes it so challenging - and unpredictable.

    Earlier this week I saw a new patient - an elderly lady who wanted her thickened toenails treated 'properly'. Nothing too arduous but at the end of the consultation she asked if I were able to see her son - who was living with her - as he had an ingrown toenail which he was having trouble with. No problem - and he was duly booked in to see me yesterday.

    They turned up together. The son - a big lad, mid forties - came through the door on her coat-tails, wearing a sheepish grin and sporting a big scar that ran from his nose to his ear. First impression was that he was a little simple and and/or nervous - think Benny Hill crossed with a New Zealand prop forward and you might come close. I asked if Mum would like to come into the surgery at the same time - but he giggled and said he was old enough to go on his own - so in he came and sat up on my chair.

    He showed the offending nail - badly involuted and infected - and then explained that he was "an open book" and proceeded to tell me that he had treatment when he was away with a chiropodist who packed the nail fold regularly, but now that he was back home, the toe had deteriorated to the point it became infected and painful. I asked him where he had been - expecting to hear maybe away to a residential home or a job perhaps. But no. "Parkhurst" he replied. "Five years" he added. I should add that Parkhurst is a high security establishment of the Windsor Hotel Group AKA HM Prison variety. "And what took you to Parkhurst?" I enquired.

    "GBH and supply of Class A" he fired back - with the same sheepish grin. "Got caught by the squad in Scarborough" he explained. "Was doing £28,000 a week on a bad week - £35,000 on a good one! Is it going to hurt?"

    I explained the procedure - a digital block and phenol matrixectomy - to which he, rather nervously, explained, might have a problem. He had a needle phobia!

    At the end of a busy week such a sting in the tail can be sometimes disconcerting - turning my back on a big lad who had a history of GBH and drug supply and prison alongwith his history of needle phobia ensured that I relied on every minute of thirty years experience to treat him. But it worked out just fine - he was reasonably chilled and the LA administered very gently and soon the procedure was done and they were on their way home clutching their post op advice sheet and appointment for dressing review next Tuesday. And I went home with a bottle of wine and a sheepish grin with a mental note reminding me about covers and books and just how fortunate we are in this profession to see such interesting people who make us what we are.

    Best wishes
  36. ajs604

    ajs604 Active Member

    Thanks for all of your comments I really did not expect that much intrest. I have now taken it on myself to not take it to heart when a client does not follow my advice to a tee. I have also started to look at combining my practice with other areas of intrest - one being reflexology. I am justing waiting for some details of a reflexology course to arrive so may well be able to offer an additional skill to all of my clients.
  37. Agreed! More than once I have employed a "specialist" podiatrist who would be a much better specialist if they had done a few years of "proper" podiatry before trying to go into specialist areas. Too many planning their msc's before they've finished their BSc's. To many who are too keen to gain perceived seniority over their colleagues.

    I'd be a better biomechanist if the service requirements allowed me to do a routine clinic each week.
  38. carolethecatlover

    carolethecatlover Active Member

    Dental hygienists are now Oral Therapists, Thank you. I'm only in podiatry 'cos I couldn't get to be an Oral Therapist! (first bit of luck ever in my working life) How about the accepted term 'Medical Pedicurist'? I took a manicure and pedicure beautician's course to improve my toe nail cutting, and to cut the finger nails when asked. I have insurance for it. I have no problem whatsoever with being a glorified toe-nail cutter, so long as I can do a discreet diabetic foot check, and tell the seniors that walking 20 mins a day will slim her ankles. Being a podiatrist or a medical pedicurist means you can talk to your patients, can't do that if you are an Oral Therapist!
  39. ajs604

    ajs604 Active Member

    I am always saddened by the attitude of the "new breed" of Podiatrists that grumble at the more general aspect of our work. You just don't know what you are missing. So if you don't want to do it, send it my way.

    I have to say that I really do not agree with the above quote. I was mereley making an observational comment. My point is that in the public system there should be away of discharging patient if they continue to be non-complient as they are taking up valuable places which other people would benifit from. Regardless of whether they are diabetic or have mutiple pathologies in my opinion if they are non-compleint discharge them - which I would but my hands are tied as I work for a government organisation.

    On the other hand - if you work in private practice I realise that you would not discharge there clients as it would not do your bussiness reputation any good plus they would be your ' bread and butter clients as someone else said'.
  40. George Brandy

    George Brandy Active Member


    I have to say that I really do not agree with the above quote. I was mereley making an observational comment. My point is that in the public system there should be away of discharging patient if they continue to be non-complient as they are taking up valuable places which other people would benefit from. Regardless of whether they are diabetic or have mutiple pathologies in my opinion if they are non-compleint discharge them - which I would but my hands are tied as I work for a government organisation.

    In my opinion "discharge due to non-compliance" is a management term developed in this era of budget cutting and implemented to save money within government controlled health care environments.

    I hope to goodness that out of a duty of care as a Podiatrist you explore every avenue of why a patient does not do as you expect of them. There may be a socio-economic aspect to their inability to comply - perhaps that patient is too proud to discuss this with you or there may be a psychological barrier as to why they keep returning with no alteration to their foot health status. They may be scared out of their wits and denying these problems are happening. There is nothing like the complexity of a human being to challenge your working life.

    If you are considering discharging a patient with such health problems as diabetes or multiple pathologies due to non- compliance, in my opinion as a clinician you have failed. It is down to you to work with them and find out why that person will not follow advice for the best clinical outcome possible given their health status even if this takes months or years.

    On the other hand - if you work in private practice I realise that you would not discharge there clients as it would not do your bussiness reputation any good plus they would be your ' bread and butter clients as someone else said'.

    I think here you may be referring to people who want a quick and temporary fix to a problem and this is an entirely different subject. I tend to find these people do realise what they are doing wrong but maybe due to understandable fashion desires, they may be reluctant to change. They will also choose the cheapest supplier of footcare to satisfy their needs.

    If a patient with diabetes or multiple pathologies comes my way I work and better work with them to understand their continued need to damage their foot health and little by little I will strive with them to achieve improvement. Sometimes this will involve my NHS colleagues too. If improvement doesn't happen and they are daft enough to pay my fees at least I know that I am doing my utmost to maintain their health. Usually we have a breakthrough but sometimes it can be many years down the line.

    Perhaps in private practice we have the advantage of time and are not number crunching in the same manner as government employees therefore we don't have the same name need to label patients as "non-compliant".


    PS Thank goodness my dentist doesn't share your attitude - after 22 years with my dentist the penny has finally dropped why he wants me to use interdental brushes, brush twice a day with toothpaste for sensitive teeth and floss those overcrowded bottom teeth. Tooth decay was never going to happen to me!!!! I deeply respect his patience and understanding.

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