My perspective on Podiatry as a new graduate working in the NHS

Hi Cornmerchant

you are not alone there !!

We seem to all be getting patients that traditionally were treated by the NHS being left without any proper care and inappropriate advice

Perhaps this is to be read in conjunction with your comment

I have never been shouted at by any patient in 20 years of practice...

Must tell you something I guess ??

Hah Hum

Cheers

Derek

 

Mark,

While I can appreciate your need to voice your opinion on Suzys post I personally feel that is possibly wrong infer that the Podiatry department who declined these two patients access to treatment are at fault. Indeed both patients appear to be in great need of podiatric intervention but is that what the original GPs referral said? Or could it have possibly read: 'Pt. X. Requires nail care?'Surely a NHS provider of services can only provide access to the appropriate T/X when all the facts are offered.

I feel certain of the many referrals received by NHS depts. nationally this is indeed often the case. :bang:

I do not believe that any podiatrist would knowingly refuse either of these patients appropriate treatment. However as you indicated:

Surely this implies that neither referral included the appropriate patient details so would therefore not have been provided with an assessment.

Only my opinion of course but Suzy highlights a problem which I would anticipate more than a few new graduates encounter. Namely, leaving university filled with enthusiasm for their chosen career only to be met with apathetic, ineffectual managers who are too far removed from the practice of podiatry & too involved in the politics to provide both appropriate care to their patients & to further encourage newly qualified individuals to continue to learn, improve on their knowledge base & confidence.

If this is not the case then other than the weather why do so many of our potentially brilliant young practitioners head for Australia?

I liked Craigs new laws.

My understanding of Suzys responses are not her implying she is 'above' providing routine care to patients in need, rather to continue to improve upon her acquired skills thereby making her a hopefully excellant clinician in all aspects of podiatry in the future.

Again, just my thoughts.

Regards, Mandy.

 

Hi Del,

I have been yelled at, prodded with walking stick & even bitten (more gummed really) by a toothless lady.

However, all of the above happened during my service as an NHS clinician.

Could it not be possible the improvement on a patients perception of the provided service is not entirely due just to the clinician (although you know I think you are wonderful Del ) but to the fact that private patients choose their clinician & their optimum return?



Mandy

 

Hi Twirls

:good:

BUT

We all need to do that but Suzy has not the experience ( which she will need to acquire) in general Podiatry to adopt the attitude she has IMHO.


Not wanting to steal Marks thunder ..

or could it be that it should be assumed that the referrer being a busy trained heath care professional should not be dismissed in such a way thereby denying the patient proper care ??

A look wouldn't hurt would it and to have confidence there is a REASON for the referral in the first place ??

My thoughts there

Cheers
Derek

 

Hi Twirls

Nicely put but that boils down to " you get what you pay for".

I have said many times "there is a different patient in PP than that in the NHS" and I still believe that.

What I cannot have is the practitioner telling the patient they can or cant have treatment when there is as Mark says and obvious need.

your very kind But

Until the day they replace political correctness with common sense in the NHS, patients like Mark describes will alway fall through the net:bang:

cheers
Derek

 

Me again

1) Surely Podiatrists are among those 'busy health care professionals'?
Should the same referral etiquette not apply to Podiatry as to any other professional department referral. eg. If the GP was concerned enough about a patient presenting with persistant loss of sight & headaches refer to the Neurologist with: 'Mr. Xs head hurts?

2) Would the previous example of an inappropriate referral format elicit an urgent response from the Neurology Dept.?

Methinks not.

:drinks Mandy

P.S.

Or encourage CPD on 'How to write an appropriate referral' for everyone with the ability to hold a pen.

 

Hello Me Again

Of course they are Twirls

BUT

They are the receiver not the referrer.

In an ideal world your points would ring true but we do not live in an ideal world as you know, and poor referrals happen.

Is that any worse than when I make an urgent referral ( properly) to a diabetic clinic specialist pod and do not even get the courtesy of a reply ??

The patient then presents back to me some months later for me to carry on their treatments because someone (pod) has decided they no longer fulfill their criteria for tx

The end result in either case is the PATIENT loses out and that cannot be right.

We have to work with what we are given with all it's faults.

Running away from a situation or venting an opinion to the patient to cause anger and abuse in return I do not believe is the way forward for ANY podiatrist leave alone a newly qualified inexperienced one.

I do know that "quaint" patients abound in the NHS and because it is free they feel they can abuse the staff for the least thing but I worked as you know in A & E situations with those same patients for 24 years in my previous life.

Never had a problem then either with the sensible lucid ones

Cheers mate

Derek

 

Mandy

I haven't seen the GP referrals to the NHS department, but his letter to me included the relevent medial history, current mediaction and a brief clinical assesment - i.e. neglected gryphotic toenails. Neither of the patients are diabetic; neither have any "qualifying" medical eligibility criteria - so I guess the triage system, where a podiatrist or administrator reads the referral letter and makes a decision on whether the patient is treated based on the information presented, is at fault. If, that is, you consider these patients should be eligible for NHS care in the first instance.

 

Hello Mark,

Thank you for responding.

In that instance Mark it is an outrage & a disgrace for these individuals to have been denied treatment.

I understand & also agree with many of the recent policy changes RE: discharging certain patients with appropriate advice etc.

However, these ideas should never be regarded as areas of black & white. No policy should ever be in place which leaves individuals without access to appropriate care.

To exclude swathes of the population entirely because they do not meet the 'appropriate' criteria is tantamount to neglect & therefore abuse.

Each referral (bonus when the referer has taken the time as yours did Mark) warrants an assessment. Face to face/foot contact with the service in question.

So yes I would certainly agree that these patients (in my opinion) should have been granted appointments with the NHS team.

This type of willful neglect makes a mockery of what has been termed a caring profession.

I still lay much of the blame upon weak managers who are too quick to apply rules to which they rarely see the consequences of.

Kind regards,

Mandy.

 

Mandy

We've been round this stump so many times before that it almost feels like an annual event. Weak managers? Maybe. Attitudes within the profession? Maybe. Funding? Maybe. Patient expectation? Maybe. Probably a bit of everything.

However, at the end of the day you make a judgement on whether you want to be part of a failing system of care or whether you want to be able to undertake your professional skills to the best of your ability - unhindered by bureaucracy, funding or departmental limitations - and provide your care in the private sector. There's an ideological argument to whether this should be the case, but if the patient understands there is a cost involved and they can meet that cost, then in my opinion, this is much better than getting screwed by a system that promises everything and delivers very little.

Kindest

 

Gosh this one has gotten lively!

I would pick up on something Simon said (make a good game that)

I wholeheartedly agree. The more biomechanics i do, the more multidisciplinery teams i work with, the more interesting and challenging cases i get sent, the more i long for the days of "cut and come again".

I did such a clinic last month (covering sick leave), i have not enjoyed a day so much in ages!

There is wisdom in the saying "the grass is always greener on the other side of the fence." . Regardless of what you do i suspect there will always be a nagging yearning for the other.

The best advice, IMHO, is therefore as Dave "cut and come again" Smith suggested. Take pride in your work at whatever level. If you cut nails, do it better than anyone else. If you treat corns, do it better than anyone else. Seek the detail which others have missed, all corns have a cause, maybe you can stop it coming back. Later when you are a top surgeon take pride in that in the same way. When you do research do the BEST research.

That, perhaps, is the path to joy. Its surprising how often when one does a "routine" clinic one can find ways to improve on the last treatment. If you're not, you should be!

Kind regards

Robert

PS
Dave, you really should do some training or something. I've noticed you're deskilling on your biomechanics. You want to watch that. igs:igs:

PPS
Not trying to be facetious with the above suzy, its a local joke. Dave is one of the most frighteningly intelligent people you will ever meet, there are only a few people in the WORLD who can keep up with him on mechanics. I certainly can't!!!

 

Sage words I think from my late father, Kenneth Evan Spooner Esq.: "I don't care how good you, or anyone else thinks you are. Or, how many letters you've got after your name. You still get up and **** in the morning just like the rest of us- right?. Are you going to cut my nails now or not? If not, I'll put my socks on".

Y'all see where I get it from now?

 

And the converse is true; When I “only did nails and corns” I longed to understand the biomechanics behind tissue stress, then when the complex physics (or Dave cut-and-come-again`s scribbles) left me in a tiz, I longed for the routine work. But that is what I love about podiatry, it`s diversity. Mundane it certainly is not.

This thought has sustained me through exams and interviews alike.

Cheers,
Bel

 

And there are very few of the "famous names" who don't still do it from time to time. Cut nails that is.

Almost forgot this one:
"it's no secret ambition bites the nails of success"- U2: The Fly

 

I think I would have got on very well with him Simon.

Like minded people usually do get on you know

Cheers

Derek

 

Just thought I'd add my perspective. I qualified just over 3 years ago and gained employment as a band 5 Pod in a local PCT.

I was lucky in that my Manager and 'team lead' were excellent. However for the first two years I mostly did routine clinics (cutting & filing and corns and callus etc) although I was fortunate enough to observe specialist clinics too.

Admittedly I was becoming very bored. However, this is the case in anything you do (employment wise) if you do it day in day out no matter what it is.

BUT, you do develop your skill level and if you get head down/work hard and try to learn as you work, it should get noticed and new doors will open.

I recently was succesful in gaining a position (within the same pct at Band 6) as a Triage Podiatrist. I prioritise referrals (some of which are surprisingly poor - often bearing little resemblance to the patient when I see them). I see almost every new patient that has been referred to the service and offer a Package of Care which maybe a one off treatment, a number of appointments with the aim of 'curing' the problem (or referring elsewhere if it looks like Podiatry treatments may not be helping or the correct treatment option) or if the patient is deemed high risk, ongoing podiatric care.

This allows me to see a vast array of different patients and as I am responsible for auditing the success of this scheme I get to see how well patients are progressing throughout. I find it interesting and rewarding but hard work.

With regard to those who seem to talk down to you; it's our job to educate and inform the patients of our scope of practice and the importance of foot health. Those who just aren't interested or continue to degrade you, treat professionally - no more no less. The chances are they are like that with everyone they come into contact with, Consultants etc included. Unfortuneately some people are like that.

Also, I would advise you not to degrade the core clinics. They certainly are important and can nip things in the bud early and that takes a trained eye. They give a solid grounding in all areas of Podiatry particularly if you keep striving to learn.

Finally, I would advise you to stick with it for a year at least. See how things progress. If you have a good Podiatry dept good things will come. If not it might be worth moving elsewhere.
I know from talking to fellow Pods that I trained with that all PCT's/NHS Pod depts are not the same.

Good luck.