Are we glorified toenail cutters?

A tricky issue this one.

On the one hand, George makes a good point. Although I hate the term, we should see patients holistically. They're psyche is a part of this and a good case can be made that non compliance can be a risk factor as valid as any other. In the words of Elizabeth 1 (blackadder 2)

On the other hand

This may be overstating the case somewhat. In a global sense, I'd tend to agree that there is a culture of limiting services to reduce expenses. At the coalface, where patients are discharged, however things are a bit different.

We are placed in an impossible position in the NHS. We are given very finite and dwindling resources and told to direct them to the areas of greatest need. That means we HAVE to discharge patients who have clinical need. Usually, patients who are in pain rather than those with risk of becoming more expensive to the NHS.

Nobody likes this. We are here to help people and to turn away a 24 year old with crippling plantar fasciitis is highly counter intuitive. However the cold mathematics of the situation demand it.

So the question is not whether to discharge, if it were the answer would be simple. The question, tragically, is who to discharge.

It could be argued that if you have one appointment to offer and two patients who want it, the one who is willing to help themselves would be the better use of resources. Given the choice, and remember it IS a choice, you can't help both, a good case could be made that you will be more likely to do more good in the compliant patient, all else being equal.

The finite resources of the NHS is another debate. But lets not lose sight of the fact that the NHS clinicians discharging patients are not the ones who set the agenda. They are simply offered the impossible choice. It is, perhaps, a little unfair to clump the people in this position with the socioeconomic situation / mangement / policy which placed them in it.

 

The finite resources of the NHS is another debate. But lets not lose sight of the fact that the NHS clinicians discharging patients are not the ones who set the agenda. They are simply offered the impossible choice. It is, perhaps, a little unfair to clump the people in this position with the socioeconomic situation / mangement / policy which placed them in it.

With respect Robert, I have not done this. I appreciate that discharge of patients is distressing for all involved - patient and practitioner. I am well aware that in many instances the decision makers regarding funding are not members of the profession of Podiatry - probably many have no clinical skills whatsoever. Their remit is to cut costs regardless of patient outcome.

But when a practitioner desires to discharge patients who are non-compliant in an environment where there is no need, potentially without exploring the cause of their non-compliance, in my opinion this is a cause for concern.

The original poster has chosen to remain anonymous, which I respect and has allowed him/her to be open and honest. I will be the same. It appears the original poster trained in the UK and has 2.5 years of post graduate experience in Australia...

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.

With respect to the OP, to have trained in an environment where placements have been affected by DoH policy and management intention of cost cutting then it must influence your approach and attitude towards patients. Whilst I may be saddened by the attitude of new Podiatrists to the more general aspects of work it should not prevent us exploring why their attitude has changed and hopefully the sharing of different approaches to work may alter their perception of patients.

I stand by my statement that "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 and hope and pray that our talented Podiatrists of the future will step back at times and endeavour to find out why a patient remains non-compliant. If they won't then the DoH will continue to beat this profession into submission.

For 22 years I was a non-compliant dental patient but I have never been discharged from NHS dental services. Dentists have never been submissive to the DoH.

GB

 

I have been asked by many why I chose to focus on foot and nail care with all the realms of nursing specialities available. I simply reply, "Other than labor and delivery, where else can I receive immediate gratification for a job well done?" Sure there are those that come "just for a trim", but they do come because it makes them feel better. I get pretty good compliance on recommendations that I make and I love going to work even though work rather takes on a life of its own. Hard to structure hours to allow time for living. But if I didn't love what I do and feel that I am truly helping, it could soon be a drudge.

 

A very good summary, Elisa6.

:good:


regards

Catfoot

 

I am currently a 3yr student currently on placement, only yesterday I was asked by an elderly gentleman, do you enjoy your study? I said yes, then he said so you like cutting nails, with due respect I said yes, but I took pride in educating him about our roles which I summrised as the health gate keepers as we have the knowledge to pick systemic diseases that manifest in the foot and skin.
I am proud to be a pod because we are an interface between the patient and the MDT.

 

I appreciate what you're saying ajs164, you've had a bad day and want to let off some steam. All other posts are right in what they're saying also, that we're here to help and offer support to patients etc but sometimes you give so much and get so little which is fine as we dont do it for the glory, however, every now and again it makes you a little stressed. Podiatrists are people too! I hope your week got better mate

 

Hi thanks for the post - yeah that was a bad week!! Things have improved and have implemented much of the advice given on here into my practice! I think it is important to remember that the majority of clients simply fogret much of the advice we suggest to. I now no-longer take it personally. Anyway merry xmas to all!

 

Ahh...Bad weeks I remember them well.

Just remember it is not about you it is about them...then sneak in a bit extra.

The no. of times whilst cutting toenails I would be talking about OTHER things an low and behold they would come back even years later and want to talk to me about those OTHER things (Bunion, diabetes,etc etc)

It may be the way the profession is marketed to the students and then reality hits once graduated but I think it has always been the way.

How many of your colleges are still practicing 25 years down the track??

Create the future you want or someone else will...

I like cutting toenails because it gives me time to enjoy the person.

 

that what we are !some people make a damn good living out of it. my advice to you is leave nhs and set up on your own but make sure you have the nouse and good accountant. thats all i can advise you young lady. be happy and move on honey.