Not listened to me - gone elsewhere and come back

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I'm new to the forum - often read it never posted on it!

I'm really frustrated that I saw a client last week and debrided callus interdigitally that had a very small ulcer beneath it. gave the client strict instructions and to call me if any problems. It turns out the very next day the lady went to her doctor who advised her to put tea tree and surgical spirit on it!! Apparently the toe is now very red, sore, painful etc and she's rung me.....I feel absolutely worthless doing this job when people constantly seek verification for everything you say elsewhere and then this sort of thing happens. I really don't know what to do about it and would be very grateful for anyone's opinion???

Thanks....

 

Tell her to see her doctor :bash:

 

You get these prats from time to time. Sometimes, you wander if it is worth writing a letter to the GP after the consultation explaining what you did, and what advice you gave.

A few years ago, a colleague put me in a very difficult posiiton by playing on words to imply that a patient was housebound. I could not do as good job as I wanted to but felt it unprofessional to expose my colleague as a liar. I was bad-mouthed for being rubbish and the anger made me ill.

To this day, the patient does not know the truth about what bull**** I was told before going there. If it were to happen again, I would (in a professional way) expose my colleague for telling porky pies.

We really need to hear both sides of the story!

 

People are people where ever you are.....if you don't like them....get out of health care. This kind of stuff is always going to happen...one local story about a gynie showing up at a birth late but just in time for the delivery, witnessed by a couple of reliable midwife/nurses....the gynie told the very grateful mother that it was a good thing he showed up when he did or she might have had a "downs syndrome baby".....now you can't beat that kind of saviour can you...
regards Phill Carter

 

Annoys me more when suddenly the neighbour over the back fence is an expert..............!!:craig:

 

Hello again,
thanks to all of you for your replies. I do love my work but sometimes you really do need people to bounce ideas off of, ask for support, opinion and sometimes just a sounding board when you're really annoyed LOL.

It is a very good point about dropping a line to the GP - I'm going to do just that right now so thank you very much all of you for your comments and support. I'll make sure I'm a Podiatry Arena regular from now on and support others when I can - sure made me feel better knowing i'm not alone!
amanda

 

Just a thought.......
perhaps this is a symptom of a larger problem.

Why does you patient not have faith in you?

IF this is not an isolated event, maybe you need to access your practice, your image, your
routine.

I know from my own practice how important it is to establish an image, one you want. Try to see your practice, your physical surroundings, yourself from the patient's perspective.

Steve

 

Hi Amanda, I think this client wanted you to follow up with a repeat visit, although she never intimated that to you, she nevertheless went to her doctor. I dont think that she was planning to undermine you deliberately. however, if rather than saying "call me if you have a prob", you had made a repeat appt for her for a couple of days later she would not have felt she needed the dr`s reassurance. sometimes the clinical situation does not merit a follow up appt but the pt themselves feel they need "looking after".
my colleague in a neighbouring town elected to treat (on a weekly basis) a tiny painless verruca rather than suggest the client try OTC preps, as 2 other pods had done, the client himself was delighted as he felt the other pods had dismissed his problem as inconsequental and not worthy of the pods time. to date the client has spent just shy of €600 treating his verruca and its not resolving but he is very happy to continue treatment. definitely a case of giving the customer what they want! ... hope this helps, F

 

I agree with irish frank...sounds like she needed more reassurance that it would be ok...and that's not to say she had no faith in your treatment, or that "doctor knows best"...she wanted a follow-up that she didn't think you were going to provide her. You gave her instructions to follow, but sometimes I think patients want their hand held until something's fully resolved; to feel totally reassured. Along with giving her the post-care instructions, you possibly should have re-booked her, telling her that you wanted to be satisfied it was healing well. It gives the patient the reassurance that you're following through to resolution. Whether she really needed to be seen again or not is irrelevant - she obviously felt she needed further treatment. Obviously this all depends on time factors...how busy are you? Have you got time to do quick follow-ups?

This is where I think public & private has the biggest divide...those of us in the private sector get criticized for getting patients back so often, in an ongoing care environment rather than purely results based. However, I think private patients expect more service. They don't want to be in & out of the chair within 5mins. They want the cream massaged in at the end. I have had patients come to me because the last pod just cut out their corn, but neglected their nails or their heel callus. Private practitioners cannot afford to be purely results driven (obviously you still need to be effective in your treatment), but you want them to keep coming back...and they want it too!

 

Regretfully, as the patients like it, rubbing in cream is now only an option if you give the remainder of the cream to the patient, due to infection control guidelines in the UK. Once a cream has been opened it cannot be re-used for fear of pathogens landing in it.

Regarding the initial comment, it is a fact of life that there is a medical heirarchy in place and the family doctor will usually supercede the Podiatrist. I may write to the doctor in your position but it would be carefully written to prevent antagonism. Lets face it, it is the doctors who work hardest to keep their heirarchical position.

 

"Regretfully, as the patients like it, rubbing in cream is now only an option if you give the remainder of the cream to the patient, due to infection control guidelines in the UK. Once a cream has been opened it cannot be re-used for fear of pathogens landing in it".

Not so if you use a pump dispenser and an antiseptic cream - simple solution in the event of inadequate and should be uneccessary guidelines. You are mostly going to use it on the external surface of the foot of those with competent circulation and normal immunological status, ergo little likelihood of infection from this source.

Cream should not be 'rubbed-in' - leave this is for the salon. It can be professionally employed as a massage lubricant medium where massage can be physiologically efficacious, or applied with a spreading action to the surface for dermatological improvement.

An alternative post-op is to spray with surgical spirits, and this can be applied even where the vascular and immunological status are compromised. Patients like this, too.

 

I think you will find that these odds are no longer acceptable, despite how reasonable they sound.

 

Common sense has officially left the building.

How would this become relevant? I really can't see a patient successfully suing for using the same tube of cream on more than one patient. But then we are now living in a world gone mad so who knows?!

Unfortunately this is a problem most of us have been faced with, particularly in the UK. I had a patient with an ingrown toenail seek a second opinion from an orthopaedic surgeon recently (privately of course). The surgeon, BTW said that nail surgery sounded "a bit gestapo" and sent them for an MRI.

Look at it this way.

If Simon Spooner, Janet McInness, and Ali Foster had assessed this patient and they had still gone to their GP the next day, would it imply a lack of worth on their part? Or would it imply that the patient is a twit who failed to appreciate the expertise of the initial assessment.

If the latter, then why are you beating yourself up about it?

No one can make you feel worthless without your consent. You need to pick yourself up by the collar and shake yourself about a bit. You did the right thing. Your treatment was correct. If you think that that being so will be apparent to everyone you are doomed to limitless frustration.:bang:

Shrug, smile, and move on.

Regards

 

So common sense has officially left the building? Indeed it has! And the sooner it is invited back, the better.

The world has indeed gone mad - and professional people have helped it to happen.

Old fools were set on this planet to prevent young fools having their way. Seems they have totally failed. It has taken 4.6 billion years to reach this level of civilised sophistication - and it's all been thrown away since the millenium.

Guidelines are guidelines - for guidance!!! Why would anyone need guidance on when to apply cream?? What did university education do for you?

Private practice requires good sense, not slavish adherence to guidelines written by those who have no idea.

Gone elsewhere? Anyone surprised?

 

Oh I like that. Very true indeed.

Its a similar syndrome that has the NHS paying about £4 extra per treatment to use disposables rather than benchtop sterilizers. The lunatics have taken over the asylum!

Although to be fair it was not the OP who said about the cream.

Regards

 

patients need to be clear about what is expected of them after they leave your surgery, i agree that its a good idea to rebook for a check up and to call if they have any concerns. The only problem i have had in the past has been when my advice and check up have been declined. I believe that the patient is responsible for their well being if they fail to take your professional advice and listen to friends and relatives instead. i now have a paragraph on my new patient leaflet about my responsibility to them and their responsibility to me and themselves. I often advise clients to seek the advice of their GP if they have serious concerns but still always offer a check up. Perhaps one of the greatest benefits of private practice is that we can "make time" (if we want). Don't give up - toughen up!

 

To be honest, I would have given the patient a follow up appointment as par for the course: an ulcer (even a small one) is a big issue to a patient. Also, as they can deteriorate I feel we should do treatment from discovering its prescence to it healing up: if we're not the ones checking/redressing/debriding we should refer on to district/wound clinic nurses or GPs.
I'm not surprised the patient went to the GP to get it checked out.
Here in the beleagured NHS if we discover an ulcer we would get the patient back in a week to check it again and communicate with nurses if they were sharing care. Hell, if I've someone with aseptic subungal necrosis I get them back a week after their appointment to check its healed up. I book them into my break as it only takes 10 mins maximum but I'm reassured, the patients' reassured and if things haven't gone according to plan we've caught it earlier, rather than when its progressed badly.

 

Hi Charlie,
Thanks for your comments. Iwould like to assure you i was NHS trained and as such fully aware of the need for regular treatment of ulcers. Unfortunately in private practice I am dictated to by the patient when they'll see me again . There was a treatment plan in place with this lady that we were to talk on the phone the following week to arrange another appointment hence the fact I was quite miffed all my advise, dressings and care had cast aside in favour of rushing off to her GP who she was then also dissatisifed with and came back to me. I have now communicated with her GP and it turns out this lady was an NHS patient originally with the same problem and stopped going to her appointments as she was also dissatisifed with that service. I guess this is frustrating to us all and an example of someone who is looking for a magic fix when there isn't one. I have re-referred the patient back to the NHS service where they can see her regularly at no charge so she's more likely to attend. I think this was a case of me not being given all the facts .....turns out i'm about the fourth podiatrist she's attended with this problem. THanks for your comments I totally agree with you !

 

Hi Irish Frank as well - no this lady refused a follow up appointment - I find this is my biggest problem in private practice I'm dictated to when the client will see me for obvious reasons. I have not had a problem like this before and as I've replied elsewhere it turns out I'm not the only podiatrist whose tried to resolve this problem a fact I was unaware of until I recieved another call from her telling me she was not happy with her GP's care either...... I always follow up these sort of problems one way or the other be it myself or if this is declined by the client a referral is always made to local NHS podiatry team, district nurses or GP. Either way the lady is now very satisfied with my intervention I'm looking after her myself temporarily in liaison with the GP while she awaits a new appointment to the NHS clinic she had previously attended..... many thanks for your suggestions and advice