Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Hot Pota'toe' Nail Surgery question

Discussion in 'General Issues and Discussion Forum' started by shelleybean, Oct 3, 2014.

  1. shelleybean

    shelleybean Member

    Members do not see these Ads. Sign Up.
    Ok so i have had the strangest request today.

    A girl requesting a bilat' TNA for her partner who has a "foot pain fetish" and wants his both big toenails removed without anaesthesia!!!

    Not that I could, but where would you stand legally ?? You are capable of performing the proceedure, but without anaesthetic it goes against your ethical nature.

    So as a hypothetical question..............What would you do?? Answers on a postcard, best answer wins a holiday ;) ...
  2. rosherville

    rosherville Active Member

    Yes, that`s perfectly fine if you can do it that way.

    But, first get a letter from a Consultant Psychiatrist saying that he has examined the patient and that he considers the requested procedure is necessary for the patients psychological health !

    ps. do video the event , I`m sure we`d all (most) love to see it !
  3. My solution? Refer the patient to one of your podiatric colleagues who better "deserves" such a patient.:rolleyes:
  4. efuller

    efuller MVP

    I had a patient once who had a moderately red and swollen toe with some pus, who was more afraid of needles than he was of the pain of the partial avulsion. It had to be done and it was. The guy didn't flinch and I'm quite sure he did not enjoy it.

    I'm not hungry enough to do the procedure on a perfectly good nail.

  5. W J Liggins

    W J Liggins Well-Known Member

    Send it to an orthopaedic surgeon. (cheap shot!)

    Bill Liggins
  6. Rob Kidd

    Rob Kidd Well-Known Member

    Two things come to mind here. First, I once (1978) did a TNA under hypnosis - - the Doc/hypnotist did the business and all was good. Second, through having a graduate student who is a heroin addict, I have learned a little about their issues. She tells me that now she in her very later 30's, it is actually the pain of the injection that she is addicted to, not the heroin itself - which she has not taken for several years. She still injects herself with normal saline. Call me old, call me stupid, some things I will never understand.
  7. Ros Kidd

    Ros Kidd Active Member

    I feel a barge pole is required for this type of patient.....and they don't fit in autoclaves!
  8. OptimistPod

    OptimistPod Member

    Hi Shelleybean,

    I had the exact same request via text a few months ago! Where are you based, south east? I just presumed it was a friend pulling my leg...obviously not though!

    I do hope he can resolve his issues soon though as he's been waiting a while now! ;)
  9. W J Liggins

    W J Liggins Well-Known Member

    Seriously: As RosKidd has inferred, hospital treatment under an anaesthetist should be considered. I strongly advise against dealing with a patient who is suffering from what is a clear pathological phobia, and as rosherville has stated, this is a case for team working. If absolutely necessary Entonox could be employed to allow L.A. to take place but type out a new and comprehensive consent form specific to this patient.

    Bill Liggins
  10. Ross Walker

    Ross Walker Member

    had a similar issue earlier this year with a patient in my nhs clinic. i contacted the legal department for advice.. They were not exaclty sure what the protcol would be. They suggested it would be of benefit that i get written confirmation from a Consultant Psychiatrist about the patients state of mind. They also advised a letter from the GP to say that they were ok for the patient to have this proceedure done without LA. They finished off with, at the end off the day if the patient is of sound mind, the final decision is down to the patient. Then its just a question of do you want to do it. Just make sure you get written consent from the patient...

    in the end the patient decided against the entire proceedure..

    ross w
  11. Dieter Fellner

    Dieter Fellner Well-Known Member

    Woa..... too much work to indulge this type of psychosis. I'd decline

    PS see below
  12. Congratulations Deiter - great news!

    Best wishes
  13. W J Liggins

    W J Liggins Well-Known Member

    I suspect that Deiter was referring to 'First, do no harm'. I understand that he achieved his DPM some time ago, although he will doubtless correct me if I am wrong.

    All the best

  14. blinda

    blinda MVP


    Do both 1st nails require avulsion for medical reasons? If not, then no I wouldn`t, with or without LA. Fetishism is all fine and dandy, but there is a time and a place and a podiatry clinic aint neither....unless you have an out of hours service for those little extras.
  15. Do you have an out of hours service, Miss Longhurst?? I know that some colleagues certainly do having been handed a menu and price list several years ago when visiting a very engaging femme-fatale fettler in a south coast seaside town, who offered relief by an altogether unexpected and different kind of practise than I was expecting....

    I would think fetishism is just as rife in podiatry clinics as it is elsewhere but it's very much a shibboleth - if you notice then you probably play the game too. In fiction, Alan Bennett alluded to the profession's affliction with the unusual with Mr Dunderdale (Miss Fozzard Finds Her Feet - Talking Heads) enjoying being trampled by female patients with stiletto heels après les affaires.

    I'm sure Syd Kippen will confirm that our little profession is no exception to the mysterious and peculiar world of fetishisms - I know of two prominent podiatrists who have a nappy (diaper) fetish but unfortunately are separated by an ocean and a number of years, but who would be eternally happy if they ever met.

    Rubber gloves, latex and silicone putty. You just got to know where to look....:empathy:
  16. blinda

    blinda MVP

    If I did, I doubt you could afford me :empathy:
  17. Dieter Fellner

    Dieter Fellner Well-Known Member

    DPM (2013) ... came after the FCPod(Surg) which came after the BSc(Hons) which came after the DPodMed .... ok, this is boring
  18. Dieter Fellner

    Dieter Fellner Well-Known Member

    That's what now?! .... yikes, I'm leading a sheltered life, based on that account, lol
  19. Would it count as CPD? I'm sure we could organise a crowd...and a whip round :eek:
  20. Dieter Fellner

    Dieter Fellner Well-Known Member

    wait, I'm confused ...is this part of the fetish discourse?
  21. efuller

    efuller MVP

    It was nice meeting you in Spain.
  22. W J Liggins

    W J Liggins Well-Known Member

    No it's not. It is worthy of celebration that the exceptional 'gopher' at a Podiatry Association conference - who I remember fondly - has, by his own efforts, become an exceptional DPM. One of the few. Good on you.

  23. blinda

    blinda MVP

  24. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    How many comply with the requests they might get from time to time from their patients? "Would you cut my nails really tight (short) for me - it doesn't matter if they bleed?" or "Would you put a dressing on that for me?" (when no dressing is required.) Surely this path of compliance to patient request has led the medical profession to the abyss with antibiotic resistance? The questionable ethics of having anything you want to have done provided by someone simply for the fee is obvious here - because you can do it doesn't mean that you should do it. Personally, I'd decline the requested treatment unless it was absolutely necessary.
  25. rosherville

    rosherville Active Member

    Mr C. Kerans

    and if a GP & Consultant Psychiatrist requested you do something, though clinically normally unnecessary, that was essential for their overall well being ?
  26. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Like what? If a doctor was not prepared to refer a questionable case to another doctor to undertake, then I would still follow my own instinct in the matter and decline the requested procedure - its the choice of the person to try to have the procedure carried out, and it is my choice whether or not to perform the procedure - individual choice applies.
  27. rosherville

    rosherville Active Member

    Like what ? If it's a request from a Psychiatrist you are not qualified to judge, like he could not judge you.

    Presumably you are not working within the NHS and therefore part of a wider team, in which you are 'another doctor'. I'm not sure that 'your choice' is paramount in deciding what is in the best interests of the patient overall !
  28. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    You're opinion, Mr Mason, to which you are entitled, but my decision in this hypothetical situation remains as before - let the hypothetical psychiatrist source the patient in question someone to perform their desired procedure, but it wouldn't be me.
  29. rosherville

    rosherville Active Member

    Mr Kerans

    These situations are far from hypothetical, for those in 'teams'.

    I have certainly refused requests for certain treatments and after requests from GPs still refused. Only after conference with Consultant Psychiatrists have I gone ahead, not pressurised but in appreciating the overall well being of the patient. These patients are suffering from Body Integrity Identity Disorder.

    Fortunately, you apparently, are unlikely to be in such a position !
  30. efuller

    efuller MVP

  31. blinda

    blinda MVP

    Not at all, Eric. I just have the unfortunate habit of dropping clangers. All good fun :morning:
  32. Dieter Fellner

    Dieter Fellner Well-Known Member


Share This Page