Ok so i have had the strangest request today.
Members do not see these Ads. Sign Up.
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 ;) ...
-
-
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 ! -
-
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.
Eric -
Send it to an orthopaedic surgeon. (cheap shot!)
Bill Liggins -
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.
-
I feel a barge pole is required for this type of patient.....and they don't fit in autoclaves!
Ros -
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! ;) -
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 -
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 -
Woa..... too much work to indulge this type of psychosis. I'd decline
PS see below -
Best wishes
Mark -
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
Bill -
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. -
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: -
-
-
-
-
-
-
Bill -
http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=352082&postcount=3
Not, because he can afford me.....at least I think so :eek: -
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.
-
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 ? -
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.
-
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 ! -
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.
-
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 ! -
-
-
-
Loading...
- Similar Threads - Hot Pota'toe' Nail
-
- Replies:
- 0
- Views:
- 190
-
- Replies:
- 0
- Views:
- 269
-
- Replies:
- 1
- Views:
- 582
-
- Replies:
- 5
- Views:
- 868
-
- Replies:
- 15
- Views:
- 1,571
-
- Replies:
- 2
- Views:
- 1,187
-
- Replies:
- 1
- Views:
- 594