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Seen as pedicurist and not as podiatrist

Discussion in 'General Issues and Discussion Forum' started by USADOC, Oct 27, 2010.


    USADOC Welcome New Poster

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    I work for a clinic and I most of my patient come for routine foot care. I hate when my patient make comments like " I am coming here to get a pedicure".or "Could you put nail polish on my toes" I feel like kicking out of the chair...but I don't. I feel so insulted. Having a pedicure only beautifies the feet & toes...and I didn't go to school to become just cut nail...but most of my patient come to the clinic for that.

    I know I can't be the only podiatrist who experience this with their patient. How do you handle this....what do you say to these patienst? Even the medical assistance who the clinic assign say thing in a joking matter...but it still hurt
  2. The respect of your patients can only be earned, never demanded. No amount of pointing at certificates or protestations to the contrary will convince them of your higher status. So what you say is irrelvant.

    If it hurts, I'd be asking yourself why. If they are wrong its their issue, not yours. Why are you taking ownership of their error?

    Nosce te ipsum.

    Be a podiatrist and you will be recognised as such.
  3. David Smith

    David Smith Well-Known Member

    Hello USADOC

    First are you an American Doctor of Podiatry as you pseudonym suggests?

    2nd In private practice, in some ways you have to give what the Customer wants.

    That is if you enjoy the income your receive from cutting nails then do a good job that the customer also feels pleased with. You have to make a decision where that principle ends though. E.G. Many of my customers say 'can you cut my nails really short' but I decide when they are short enough. They can decide to go somewhere else that's their prerogative but I don't give sub standard treatment just because the customer wants it.
    On the other hand I do make the nails look as good as possible, stopping short of nail varnish although I see nothing wrong in doing that if you wished. There is a new "Well Being Centre" opened right next door to my clinic. It offers, amongst many other treatments, manicures and pedicures, a luxury pedicure costs £6 more than I charge for a 1/2 hour chiropody appointment. They cut the nails 'exfoliate' with a cream, standard nail polish and foot massage. So my customers could choose to go next door if they didn't like what I did but they don't and while my chair is full all day, next doors is hardly ever occupied and many of their customers come and see me to have their feet done.
    So what I'm saying is a good job keeps the customer and earns the money so do a good job but keep your standards or perhaps raise them in this case and finish the nails to a neat pleasing finish. Maybe you already do that, so be happy that they come to you for the pedicure and not the nail bar down the road. They obviously know what's good and what's not and vote with their feet:D

    One more thing is customer impression, a drippy, scolding, groaning and moaning person will send customers away and make you feel like a loser, a smiley happy authoritative but empathetic clinician will give the right message and make you feel good about yourself. IMHO ;) So next time a customer (note I always say customer not patient, it changes your relationship and this is about relationship) ask for a pedicure, don't think P-ss off, think I certainly will give you the best I can and then do what she needs but then put just a bit more effort into the finished appearance she wants. Shape the nail, finish them with a bit of nail oil perhaps. You've done the same job, your customer feels so much happier about her treatment and so will you. Come on, this isn't the NHS you know.:eek:

    USADOC you are an amazing person and you can do an great job.

    Regards Dave

    PS see Robert just said the same thing in a less verbose manner:rolleyes:
    Last edited: Oct 27, 2010
  4. Chirotech

    Chirotech Member

    Hi USDOC,

    I could agree more of Dave and Robert. It is true that we have to be proud of what we are doing, either the customers treat us as a pedicurist or as a doctor down the line it is the quality of service we provide for them, customer satisfaction will make them come back and it is good for the business.
    I practice for the last 9 years and still i have regular clients thought that i am doing a pedicure for them, they think my service is the best compare to the beauty pedicurist especially the French customers as they called it pedicure in France.
    Also they trust me to look after their feet as i have the knowledge for that and also i provide a sterile instruments for them, clean practice environment and always handles customers professionally.
    Never get offended just show them what you can do and do it best they will be coming back to you very soon than you think...:)

  5. David Smith

    David Smith Well-Known Member


    You wrote

    It made me wonder, does this indicate that you never cause your patients any pain?? If so how do you achieve this?

    PS I just stick something sharp in them and if they complain I slap them and tell them not to be a wimp - isn't this best practice?:D

    Ahh! perhaps you mean if it hurts USADOC i.e. emotionally hurt DoH! (ahh yes I remember emotion funny stuff never had much use for it anywaaayyyy - Ok just ignore that last bit then;)

  6. MCA

    MCA Member

    I agree with the previous posts. If you are doing good work, be proud of what you do. Perhaps you can also take some time to educate your patients when the opportunity arises. Demonstrate that you are medically trained by commenting intelligently on other aspects of their foot health or any underlying pathology or health issues. Take the time to present at diabetes groups etc so your community gets to know you better.
  7. I think best practice involves slapping them AFTER you've finished treating them. Cross infection and that.

    Yeah, I was be huggy and psychomalogical.

    Co-incidentally, I cause my patients a lot less pain since I started offering tib blocks for anyone who wants one! Some people run a mile (cardiovascular benefit) but others are much happier having VPs and painful fiberous / nv / smokers corns treated this way. I figure dentists base whether to use LA on patient preference, why should'nt I?
  8. MCA

    MCA Member

    Perhaps David Smith and Robert Isaacs should remember that a patient "Google-ing" you can see you posts on Podiatry Arena. While you think your comments are funny, a prospective patient may not.
  9. The funny thing Dave´s got at least one patient to travel out their country to come and see him from his posts here on PA so it can´t be that all people don´t have a sense of humour.
  10. It's the nature of the game Mike. No matter if you are an internationally renowned biomechanist with years of experience, a higher degree, and published articles in Japma, the leading publication on biomechanics, one jocular reference to sticking sharp things in people and you're finished!!

    Its a cruel world to be sure. Best bet is to post anonymously. Then you can say what the hell you like ;)

    I guess its a risk we all take.
  11. MCA

    MCA Member

    Sorry to have ruffled your feathers Robert. Thanks for feeling the need to share your CV!
  12. Not mine, Dave's. I'm just an NHS peon struggling with a year long waiting list. He's the brainy one ;).

    Never fear. No feathers rufffled. We're a pretty chilled out bunch here.
  13. Dr. Bates

    Dr. Bates Member

    If your patients think this is all you do, it is your fault for not educating them. I tell patients I provide them with what they need. If they need surgery I do it for them, and if they only need nails cut I do it for them. If they ask for nail polish I tell them I do not have a license for that, and I am not willing to go to jail for them. Dentists do not do surgery on every tooth on every patient every time. Sometimes dentists just provide routine care. Doctor means teacher. Teach your patients!
  14. USADOC

    USADOC Welcome New Poster

    Dr. Bates....I do educated my patients...I tell them that I am not a pedicurist but a doctor...but their little jokes...bugs me...it just does. I went four year to podiatry school and two year residency. Listen ..i know it the bread and butter of our profession...just like ear wax is the bead and butter of ENT doctor...but to be seen as a pedicurist is just not right.

    I also don't have time to educate my patient. I see like 34 patients a day..a patient ever 15 min.
  15. Chirotech

    Chirotech Member

    That could be the reason, as you do not have time to educate them, 15 mins. is very quick, every foot is different, i guess you are just treating the main complain, and have you got enough time for everything else or probably you have an assisstant to help you keep up. In most cases our work can get messy, or foot can be messy even they come regularly (within 2-3 wks. max. 4-6 wks). 15 mins. is nothing at all, even you are good in what you are doing. "Going for a pedicure is 45 mins. at least for pampering them". I used to have a client that goes to the hospital with NHS in London, she managed to get her appt. only after 3 mths. So she waited 3 months for her corns to be removed and the Podiatrist spend 15 mins. with her and she think it was a waste of time as the Podiatrist did not do a good job, but the Podiatrist think that she was sorted out after 15 mins. :) I have treated her foot she really have few bad corns to take care of and it does need more than 15 mins. to clear them all...i guess trimming nails definitely takes 5 mins. for me....So it all depends what need to be done on the foot....Goodluck...

  16. Stirling

    Stirling Active Member

    Maybe the reason it bugs you is because it is what you have become? 15 minutes of routine nail care with no education is the same as what a pedicurist does.

    15 minutes is still a fair amount of time to educate. You do not need to continually tell your patients you are a doctor you need to demonstrate it, and it is as easy as feeling their pedal pulses (as the chair is going up) and letting them know the results and what this means to them. The moment a patient enters my room I greet and start talking BSL's or new medications they may have started or simply how their feet have felt since the last treatment, this is all before their shoes are off and are on the chair.

    I often hear from new patients who have previously seen a podiatrist, "They never tested my feet for that (eg. proprioception or monofilament), they just cut my nails."
    In my experience once a patient understands you want to know about their whole wellbeing and how it is affecting their foot health they treat you with the respect I think you are after.

    Just my 2c worth.
  17. ndidi ufondu

    ndidi ufondu Welcome New Poster

    I quite agree with the original post. Why do we podiatrists have clip toes nails? I do not know of any orthopaedic foot and ankle specialist who clips toe nails.

    I too have been insulted with patients who asked me to paint their toenails while laughing sarcastically. I have been asked if I massage feet. I have been asked to clip finger nails while at it. I been tipped $10 for cutting a patients' toenails in the ICU - I promptly asked him if had tipped his wife's cardiologist, he said no. I asked him to keep his money.

    So long as we continue to clip toe nails and calluses in the name of it being "our bread and butter" we will never gain the respect of the general public, let alone the medical community.
  18. twirly

    twirly Well-Known Member

    Hi USADOC,

    I suspect your previous comment is where the problem lies.

    Surely your patients deserve a complete treatment which I would have considered includes diagnosis, advice & treatment options. Providing patients with pertinent information regarding the care of their foot problem increases their understanding of their foot health in future.

    I am fortunate that my practice allows me to be flexible with appointment times. Routine allocation for a general appointment I allow 30 mins.

    My practice is centred around my patients needs not mine. My patients call me Mandy ;)

    However, I am not a doctor.

    Kind regards,

  19. :deadhorse:

    Attached Files:

  20. David Smith

    David Smith Well-Known Member

    Wow I have to agree with Mark.

    Guy's I don't know the set up in USA are there chiropodists and Podiatry Doctors i.e. two separate 'professions' or just DPMs?

    Because there is no law (God's Man's or Nature') that says you are obliged to cut nails, if you feel its beneath you then don't do it, it's that simple.
    I kind of get the impression that Kevin Kirby doesn't do nails but if he did I bet he would do them to the best of his ability and publish a paper on how to achieve that and then a book to back that up and pretty soon he would be the worlds number one professional nail cutter. Do you get the idea? Why not let the Chiropodists do what they do and you do whatever you feel is your work?

    34 patients a day!!!! - Your like a chef who trains for his master chef diploma in haute cuisine them does a 'residency' at Chez Manger Terriffique and then goes on to work a Burger King and doesn't understand why the customers do not recognise his skills as Chef De Cuisine.

    You can make choices, you can choose to carry on as you are, you can choose to not do what you do presently do or you can choose to change what you do or how you think about it. What you cannot do is change someone else no matter how hard you try. That road lead to frustration and anger as you have already found out.

    Regards Dave
  21. blinda

    blinda MVP

    All of the above posts are not just good advice, they have all highlighted the absolute necessity to create a good rapport with your patients. After all, without them you would not have a job. Respect from others can only come when you respect yourself, i.e; You have the capability to turn every situation to your advantage, it all comes down to how you approach tasks and react to patients conceptions, be they accurate or not . A negative attitude only breeds further negativity.

    Sure, I have frequently been asked to do `pedicures`. My reaction; I smile and recommend a good beautician who can offer what I cannot. Once their little misconception is cleared up (without berating the patient) we can then talk lower limb health and treatment plans. Works for me.

  22. Freddy

    Freddy Member

    Assessing patients individual needs and meeting them. If an arthritic, diabetic sight-impared patient, who lives alone, needs their nails cut, then that is what that patient needs. However, this is always backed up with education and advice to the patient and any carer involved with the physically or cognitively impared. All part of the treatment! In my previous profession as a senior nursing sister. If a patient needed a bedpan and the care assistant wasn't available, I would meet that patient's needs. It is your duty of care. Perhaps a move to a different department would better utilise the other skills you have. Freddy
  23. Deborah Ferguson

    Deborah Ferguson Active Member

    Hi All
    I agree with all the above posts regarding giving the patients adequate time in an appointment to carry out treatment and education and I feel very strongly that a high standard of basic podiatry care is essential. Many patients gain immense benefit from high quality, low tech. care and I don't think that's anything to be ashamed of.
    I don't mind painting the odd set of nails if that's what a patient really wants and can't manage to do it themselves.
  24. Snowstorm

    Snowstorm Active Member

    You are not alone on this one!

    It will improve if you start educating your patients.
    If you are working for the NHS it's a different matter. The NHS is only interested in the number of patients you push through the system and that will dictate the time you spend with each patient who invariably only attends because the treatment is free and because they are entitled to it.
    In private practice you give them what they want and when they want it, with plenty of education for good measure.
    I prescribe POMs and administer corticosteroids which assists in indicating to patients that we have more to offer than pedicurists.

    Keep your sanity and don't let them walk all over you:boxing:
  25. Tim VS

    Tim VS Active Member

    I have observed that some posters (fortunately not the majority) seem to have a somewhat adversarial relationship with their patients, seeming to view their perfectly reasonable needs and requests as a slur on their 'professional skills and qualifications'. I must admit find it hard to understand this mind set. Like David, I regard my patients as customers and my raison d'etre. After all, without them any of our highly won qualifications amount to nothing! Therefore, nothing within reason is too much trouble as far as I am concerned. One of the many reasons I like my job is the broadness of its scope, encompassing everything from complex biomechanics to basic footcare. Sometimes it's actually quite pleasant to do a simple pedicure and switch the brain off for 10 minutes! I feel sorry for the original poster that he is obviously so miserable in his work. Must be tough.


  26. :good:

    Amen. Preach, sister!

    Unfortunatley this aspect of podiatry earns little esteem and thats a shame. I suspect more benefit has been done with this than with orthoses and surgery put together. Its not sexy, its not glamourous, but it IS important.

    The lack of importance attatched to this in training and the apparent lack of regard that it is held in (not least by the SCP) Is in danger of creating a world where the truly skilled "old school" podiatrist is a dying breed. Which is a real shame.

    You don't have to specialise to be an expert.
  27. Deborah Ferguson

    Deborah Ferguson Active Member

    Thanks Robert
    I do sometimes wonder if the rise and rise of academic qualifications is inversely proportional to the standard of care.

  28. It shouldn't be, but sometimes it does seem that way.
  29. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Duty of care is where it begins and ends. I don't think there ia a right or wrong, just a matter of personal practice. I will oblige with cutting toenails, but my personal choice is not to wax legs, apply or remove nail varnish. I do not provide coffee or permit smoking. Each to their own. The quality of a professional delivery of any care in a 15 minute timeframe is limited, and the associated matters of record keeping, maintaining a high standard of hygiene, dealing with soiled instruments, patient education and interaction on any level, etc, etc, gives me a feeling of unease with regard to the original post
  30. Gibby

    Gibby Active Member

    The reason patients see you as a manicurist is because there are still hundreds and hundreds of podiatrists who only perform primary care- nail and callous debridement.
    The more time you spend educating patients and other doctors, nurses, staff- the less you will be seen as a manicurist.
    If you are seeing that many patients, you don't have time to do much else than cut their nails. A podiatric exam (vascular, dermatologic, orthopedic, neurological) takes at least fifteen or twenty minutes on a new patient. Then you need time for minor procedures, patient education, treatment plan, and possibly scheduling surgery.
    Consider seeing less patients with more attention and quality-
  31. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Fully agree with Dr Fasick's view above.
  32. mtdpm

    mtdpm Welcome New Poster

    I have plenty of patients that come in for C&C. Lots of C&C. I get paid well for C&C. It takes less years off my life compared to when I do TMA's. But I still do TMA's. I keep a few pics in the office of some of the nasty things I deal with and do a little show and tell....I respect my patients and I think for the most part they respect me. When I am questioned as to what I do besides C&C I tell them. Opens their eyes a little. But I still do C&C. And I still do surgery. I certainly don't get wrapped up about it. My dentist did my crown. He also cleaned my teeth.
  33. Gibby

    Gibby Active Member

    I agree with mtdpm. Nicely put.
  34. Freddy

    Freddy Member

    I believe you can fulfill your professional role and give a high standard of care incorporating initial vascular, neuros, basic biomechanical assessment, education and preliminary treatment within a reasonable time-frame. It's called multi-tasking! My new patients usually comment favourably on the comprehensive treatment and see the rationale behind diagnosis and advice. They are more likely to be compliant if they can see it is in their best interest. The usual comment is...I didn't get all this information and health checks from my last Chiropodist, they just cut my nails!
  35. Tkemp

    Tkemp Active Member

    I agree Freddy. Each new client has a comprehensive assessment and medical history taken. After that, even if it is just routine care required, they respect you.
    Nice biomechanical and anatomical posters, models and charts also help.

    Remember that to clients who are vascular impaired, diabetic, low mobility, etc, basic nail care can reduce the risk of further complications and prevent more intensive treatments.

    When you see a dentist 6 monthly for a check-up, you dont always need a filling or crowns or surgery. Normally a scale and polish is all that is required, but boy you feel good after knowing that you have been checked by a professional and that everything is fine!

    Maybe your clients tease you because they do get a rise out of you. Perhaps you should write down a couple of humourous replies and practise them. Then when you are next asked, you can joke and then change the subject gently.

    One more thing. The fact you are so busy is excellent, but maybe you are suffering from slight burn-out. Perhaps you should reconsider appointment times and what exactly you want to achieve from your job and then gradually adapt things to optimise your abilities for both you and your clients.

    All the best.
  36. stephaniepod

    stephaniepod Member

    I can empathise. I think it's because for this generation of patients (In the UK) many podiatrists were educated to diploma level and mostly did basic foot care. Now podiatry is a degree and we are taught pharmacology medicine, surgery ect.

    Hopefully the next generation of patients and healthcare workers will realise the important role we play and the level of education that we have.
  37. charlie70

    charlie70 Active Member

    I think you'll find the general public will respect the practitioner who takes away the pain that they are feeling in their feet - if that pain is caused by long nails they are physically unable to cut, pathological nails or callus/corns then that is part of our job.
  38. Adopting the same philosophy stephaniepod, as one of the podiatrists who was educated to Diploma level (DPodM) almost 30 years ago - I can assure you that as a general podiatric practitioner I've delivered all aspects of foot care - from routine and basic nail care to minor surgery and orthotic management. The level of education is simply a starting point on one's career-line and education and professional development continues every day and week as you continue to practise. Regrettably, I've also met a number of BSc graduates whose level and standard of practice was comparable to a retarded hippopotamus.

    Kind regards.
  39. stephaniepod

    stephaniepod Member

    'The level of education is simply a starting point on one's career-line and education and professional development continues every day and week as you continue to practise. Regrettably, I've also met a number of BSc graduates whose level and standard of practice was comparable to a retarded hippopotamus.'

    Mark Russell I was just trying to make the point that podiatry is constantly evolving and it may be hard for the public to keep up with our increased skills.
  40. Of course it is - but read you last post again and see if you could have expressed it more accurately. Every time a patient sits in front of you is an opportunity to educate - what most of the contributors are suggesting on this thread is that respect is earned. And that respect can be gained in a multitude of ways - by imparting your knowledge, empathy, kindness, fairness and good communication. There are plenty people who work in healthcare - some very educated - to whom I wouldn't give the time of day. Good professional skills encompass a great deal more than what you learned during your training. And Joe Public is much more discerning that what you might imagine.....

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