Comparisons!

Hi Arztin,

A few comments re. your Post above, I hope without malice,

1. I think, '....when and where podiatry was invented. And why....'. This has been shown and answered in English History in the 16th.,17th.Century I think? Sorry but I cannot remember which historian?

Answer, "The Barber Surgeon who did it all because the Physicians just might have been killing to many people at the time? There were some good physicians about, however, they where HERBALISTS!" Not to happy going to the barbers these days to have my hair off, teeth out and toes off, however! Although I don't know though!!! Have a look at 'The Royal College of Surgeons' Website I'm sure they will have one?

2. I don't mean any disrespect but if, (US., UK. and EU. (Who I'm trying to give up, a terrible malfunction of the brain!), and Australia, (If I can spell it at this time in the morning?)), as I strongly suspect are all different with respect to PODIATRY as defined by different ruling bodies. I can only quote mine, 'A chiropodist/podiatrist diagnoses and treats disorders, diseases and deformities of the feet.' [HPC. Windows Screen Registration Section May,2005! www.hpc-uk.org/.

The Nouns, Podiatrist/ Podiatry, I think have several meanings in several country's around the world?

3. Using Websites to diagnose foot problems fills me with horror, I'm strongly opposed!!! It's bad enough diagnosing a foot complaint face to face let alone using what I believe to be attempting to use a crystal ball? But if I where living in the USA., I could, however, suspect that I could be wrong about this as it appears everyone in the USA are doing it?

Regards,

Colin.

No P.S. Here, I could be sueded!

 

Yikes!

It was an interesting debate to read until the rant near the end. May I clarify a few things?
First, Nursing has "lost" many tasks as the need for a practitioner with more highly specialized training became evident. It was not because nurses were not doing a good job!!!!! The needs of the client changed and a new specialty developed in order to fill the need. Just as the role of the podiatrist has changed and evolved, so has the role of the foot care nurse. We are a nursing specialty where extra training is required.
Nursing foot care is not new. I have been doing it for over 10 years and it was being done long before I started.
I also have reservations/concerns about what is happening in nursing foot care. there is a huge movement amongst foot care nurses to standardize. The WOCNB (? - I always get it wrong) exam concerns me as well. For example, the education requirements are low even to me. I am going to write the exam to see what it's all about. I'll get back to you about it if you're interested...
I work as a professor for a nursing foot care course. Might I suggest that when discussing the role of another health care provider, you actually speak with some and look at what they learn? Again, I would be more than happy to accommodate...
I rememeber when I was in nursing school how shocked the medical students were are what we were studying and what we were required to know in order to become RNs. This has led to more mutual understanding and respect. Lesson to be learned here????
We are not trying to be podiatrists. We have no desire to be podiatrists. We are not trying to replace or fill a shortage of podiatrists. We have a role to play and function well as a member of the team. I work quite well with all the podiatrists in my city. I know my limits and refer up to the podiatrist or seek their opinions as necessary. They send clients to me. Team work...
J

 

Foot Care Nurses

:) Sooo delighted to read your common sense appraisal of our foot care role, am in total agreement. I have set up my clinic in my home (home business) with a Shire permit and backed by NEIS for the first yearto fill an obvious gap in the market and my mobile, elderly clients are flocking to the door to have their nails cut 4-6 weekly, any problems I refer to the local Pod. Part of my service includes B/P and diagnostic diabetic test. I love my work, and will continue. I was taught primary nursing care (nail cutting) in my degree for nursing and use it! Good Luck to all involved with preserving mobility!!!--Anita

 

It would seem to me that this is simply about allocation of resources.
Does it require a degree educated podiatrist to adequately assess a patient ??
Does it require a degree educated podiatrist to provide the technical elements of routine foot care??

The fact is that within the NHS in the UK, the initiation of the assistant practitioner role is to allocate technical work to Grade 4 , whilst being clinically supervised by Podiatrists.
Is this not a better form of resource allocation?

Tony

 

Tony

There are merits with introducing an assistant practitioner role in podiatry, but there are dangers too, especially if they can practice unsupervised and if the regulatory mechanisms allow independent practice in the private marketplace. We could end up in the uneviable position of the previous forty years with a regulated podiatric workforce and an unregulated foot health professional workforce, which will severely undermine the market potential for graduate practitioners. Provided assistant practitioners work under direct supervision both within the NHS and in private practice and have their scope of practice strictly defined, I don't have a problem with their introduction.

Mark

 

NHS. Ward Nurses Treatment of Feet!

________________________________________________________
Hi Tony,

Sounds interesting, my experience from the outside looking in is that Nurses on the Wards are being offered short courses in Nail cutting and general Chiropody as expected now that nail cutting appears to have been downgraded out of NHS. Podiatry?

I have new patients who are prepared to pay to have their toe nails and corns cut and treated mainly because some of them need a doctor's letter locally everytime they seek a new appointment! Of course the toe could have fallen off before they get one? (Only joking, I think!).

The hospital seems to be working well with the odd nurse on the Ward taking the course and using it! The next generation of Podiatrists perhaps, (Nursing Degree standard always a good start for the next step into Podiatry?). But where have all the NHS. Podiatrists gone? Flown south for the winter perhaps and haven't returned?

Is there a drop in NHS. Podiatrists numbers or is it just my imagination?

Yours,

Colin.

PS. Two for the price of one a most definite improvement on management profitability perhaps? Always a good Element in the Industrial Revolution? Down grade skills. Semi-skilled much more numerous and cheaper to train and employ. Good for numbers of patients treated too. Much needed Jobs in the NHS. and a promotion for good management?

PPS. Trouble is it is beginning to sound like a broken record all over again?

 

Couldn't agree more, Mark.

 

No.

No.

So why do we need Podiatrist's to be degree educated at all?

 

Hi All,

It is the Guild-monopoly all over again. History does repeat itself. The perfect world for the expert! Control and keep the skill to oneself don't you think!

Excuse or main argument, It will be safer for the patient! But can the expert in such as the NHS. give the time to justify their case? Only if they jettison work such as nail cutting.

But just a minute, if they do that they will not see the feet until there is something dropping off perhaps. Which is more important, the Patient or the Practitioner bearing in mind the NHS. is now run as a business in part???

Yours,

Colin.

 

Who fixes your cars brakes? The mailman?

Simon, I'm interested in your reasoning behind the first No. Also your definition of 'adequate'

Perhaps one good reason could be that even when we are cutting nails we are using our eyes and noses and ears. However, none of the foregoing is any use at all without a personal knowledge base, I thought higher education was supposed to provide this. ........; look at that mole (but is it an MM?) What a funny shaped toe! (hold on. what about - empyema, pulmonary carcinoma?) That little lumpy thing (wait- synovial sarcoma?) and so on and so on.

I'm sure that my Postman COULD change my cars brakes, but could I blame him if nobody had told him to check the brake hoses, personally I'll stick with a skilled mechanic, even for the simple jobs. If people choose to pay our charges to have us cut their nails (and keep our brains in gear while we do so), when I'm sure a pedicurist would be cheaper, then personally for me, thats fine.

If you think our routine cases are boring, just ask a GP. Sometimes, the ones I work alongside come into the break room glassy eyed, from saying the same thing dozens of times a day, day in and day out. And I think they train just a little longer than we do. But, the very next 'routine' case they see may just end up owing their life to that Doctors knowledge.

Perhaps they don't need degrees either?

Regards,

Martin

 

Not sure I agree with you Martin. Most graduates will tell you they are over-qualified for most of the work they do - especially in the NHS - where most practice these days is restricted to changing wound care dressings, something nurses used to do. The problem we have is that the present three year podiatry degree and scope of practice falls between something that is overqualified for general footcare and underqualified for a foot specialist. Personally I would like to see podiatry education extended to a five year doctorate course encompassing foot surgery at undergraduate level, but as the NHS still funds podiatry education, this may not be possible for some time yet. The big question is - are thirteen podiatry schools viable in the UK?

 

Netizens

Always an interesting topic.

I am working in chronic disease management at present and almost come to a cathartic conclusion that our profession works on two separate levels. The majority promote total patient dependence on podiatry and the rest encourage negociated care with their clients (empowerment) The former view nail care (pedicure) as either non essential housekeeping which frustratingly forms a large part of the workload; or a normal part of foot health care within their patient demographic. In truth more people seek help out with podiatry (including self-care) than go to podiatrists, so I think this makes it all the more essential practitioners acknowledge what they do for a living, and asimportant,what their limitations are asapractitioner. Alternatively, pinning for "greener grass' is not healthy and much cause for work related stress as has been seen in reported surveys on stress.

As to how best to prepare a work force to meet these challenges.

That is worth a bottle of good brandy, and an evening in by the fire (winter in Oz), or a BBQ in the Northern Hemisphere.

Cameron
Hey,what do I know ?

 

Martin what you should remember here is that up until 1990/1 degree's in podiatry didn't exist. I think I'm right in saying that my cohort at Eastbourne were the first to graduate (although I'm not sure whether the year above got retrospective degrees- hence the 90/1 thing above) so anyone qualifying before this time were diplomates. So in other words these people, many of whom may not have converted their diplomas to degrees, are still working in practice and are as capable as any degree bearing individual in performing said assessment of patient.

Also, what if I trained an individual to do one task, lets say an ABPI. Are you telling me that with enough training this individual could not perofrm this single assessment and interpret the results?

We all like to think that what we do is really technically challenging, in isolation each task is not. It is the whole which is worthy of degree- but this wasn't the question. Moreover, the degree is just the indicator of the level of learning BTW. In my years of teaching I came across an number of first class students who I wouldn't have trusted to sit the right way around on a toilet seat, let alone look after my feet. They could however play the academic game. Equally, I worked with a number of students who ended up with pretty crappy degrees but were excellent clinicians.

 

level of practice

Hi, Mark, Cameron, Simon.

Mark, I certainly understand the frustration of practitioners in the NHS, after all, you probably can't choose your caseload. But equally, in private practice, I can't afford to turn away 'boring' pedicures either(if I did how would I buy the Laphroig, and other essentials). Sure, wall to wall nail and skin surgery, and daily challenging gait pathologies etc might be nice - but be careful what you wish for ..and so on. What makes it easier for me of course is that I dont suffer from the same time constraints, I can give them 30 minutes plus, and if something piques my curiosity I can go galloping off on a tangent without having to justify it to an administrator wearing money - goggles. You are right about different levels of practice, thats why IMHO everbody who works on the foot from FHP to Pod Surg' should be regulated by the HPC (or something better), with UK wide defined common training syllabii and legally defined scopes of practice, common infection control policies, and work as a TEAM referring cases to where they need to go, upwards, sideways, downwards. But of course it would mean that we would actually have to have professional discourses with each other instead of some of the "I'm a proper Pod but your'e not" slanging matches that we have seen on this site over the years. Anyway another man, well known to this forum, and far more highly qualified than I will ever be, suggested that, and said it far better than I could, quite a while ago. And got pilloried for it by his peers. Good idea about that Doctorate - but as you say, who pays?

Cameron, apt and seductive suggestion (about the BBQ and Brandy I mean)

Simon, I take your point, I was using the degree as a simple label for a high level of theoretical knowledge and clinical skill, - I should have said degree - standard perhaps. However, granting the highly trained ABPI technician is mustard at ABPI's, how will they react to that odd lesion, that ?mole, that little erythematous rash running up the leg etc, etc. They need a catholic knowledge base in order to mentally flag something as 'suspicious' and take appropriate action, whatever is 'appropriate' in each case.


Regards,

Martin

 

Netizens

Degree level education relates more to the way the content is processeed by the learner rather than the level or volume of content within the subject. In the taxonomy of cognition, analysis, synthesis and evaluation are stressed in graduate education whereas recall, comprehension and application are skills which related more to training. Vocational degree contain both elements (because of the job) and often some components are favoured over others by participants. "I liked the practical component of my time at university/ college, the essays were always a struggle." This is not uncommonly heard in the pub.

Cameron

 

I see you took your advice

;) Cameron, Must be good brandy that!

let me have the recipe!!

 

Netizens

I can finish my post now I have dropped "she who must be obeyed" at her place of work.

The move to graduate education in the UK and Australasia was not borne out by a need to change podiatry practice, quite the reverse, it was a move by the polytechnic universities to gather together non university programs to forge a non medical faculty which would consist of nursing and allied health. These professions had potential to be moved from diploma status to degree with the intention that one day the paramedical faculties could compete for research monies alongside the traditional medical faculties. A lot has happened in the last 20 years or so with the bigger disciplines such as nursing becoming centres by themself. Ironically there is now a -major move to incoporporate allied health into their faculties which is being encouraged by the UK government. Graduate entry courses also support career development and retraining. Mark suggested a five year undergraduate program for podiatry, this is more likely to be achieved by graduate entry i. e. a nursing degree followed by two year graduate entry podiatry program based on accelerated learning (or other combinations) .

The pattern is already established in the states and now across the rest of the globe. Concerns have been expressed as to the potential for academic creep in these programs (graduate entry) which sometimes leave students to process volumes of content with no real attempt by the providers to use appropriate intellectual processing. At worst this type of cross over course has been criticised as income generation for universities ill prepared or unwilling to invest in appropriate teaching and learning technologies. However the program remain popular and are likely to remain becuase they do offer bridges and ladders to graduates keen to change their vocation.

Meantime back to podiatry, practitioners now are presented with a vast range of information some genuine and the rest, less credible. To be a descerning practitioner is part of being a professional and the need to provide for the client requires modern practitioners must be congnisant with "the scientific method" Whether this is taught or self taught is of no consequence, if in the end we become more able to care for others.


Have a good one

Cameron

 

That's actually a really great idea.

No doubt it would reduce profession attrition by reducing the number of students who select Podiatry because they can't think of anything else they want to do and increasing the numbers of those who choose it because it is really what they want.

 

I have to agree with Cameron in that the only way a 5 yr programme in the UK would exist is through graduate entry and an accelerated programme.
The current proviso is to create a 2 + 2 model for foundation degree practitioners to step onto yr 2 of BSc (Hons) Podiatry programme.
However,foot in the grave, you are mistaken in believing that there are large numbers of potential students who dash to undertake a 5 yr programme. Dentistry has been reduced to 4yrs via graduate entry and is far more lucrative, with greater professional kudos.
I think you only need to look at how many Podiatry schools there are in the US, and the difficulties they have in recruitment.
Let's also not forget the widening participation agenda and the issues surrounding recruitment and the Disability Discrimination act.
Food for thought!!
Cheers
Tony

 

Hi - I am a (mature) podiatry student and, with my limited experience, have come to a couple of conclusions. There appears to be three types of student on my course.
1 - Intelligent, young, dynamic A-level students who are genuinely interested in podiatry. I see them becoming specialists and/or surgeons.
2 - Older students like myself (many who are mums with school age children) who are happy to become Chiropodists.
3 - Young, not so accademic, students who drifted into podiatry for a variety of reasons.
For group 1 the course is too easy and a few are disgruntled with at least 2 leaving last year. For groups 2 and 3 the course is either too long or too hard with many re-sits or people leaving due to other comitments.

Would it be better to have a 2 tier system with a Chiropody Diploma of say a 2 year (1 and 1/2 with a 6 week summer holiday would be better) very practically based course, and a 5 year, American style Podiatric Doctorate. there could then be 2 titles - Chiropodist and Podiatist.
This would, possibly, have a number of advantages.
Firstly the public would come to know (eventually) and understand the differences between the proffessions. Secondly it would raise the profile and status of Podiatry, attracting not only more but higher quality graduates. thirdly it would attract and retain more people into the Chiropody spectrum: many of whom would have become foot care assistants, foot care proffesionals etc. And finally it might make it easier to regulate the profession where foot care professionals etc are concerned.
Just a few thoughts, although I have no experience, for the forum
Regards
GS

 

Hi GS.,

Now there is an original thought for you,

1. Podiatrists with degrees, specializing!

2. Chiropodists with Diploma's working!

3. Some of us about to break out in hysterical laughter at your two suggestions!

Regards,

Colin.

PS. No GS. not sarcasm regarding your common sense just amazed that somebody still reaches that conclusion of yours. Afraid not held by those in power and authority though! Lots of pensioners limping as a result in the very near future I suspect?

 

Have some of you considered that the nurses who provide basic foot care do it for the good of their patients? We know our limits, we refer patients to their physician or podiatrist if they have infections, ingrown nails, etc. The reason they utilize foot care nurses is because Medicare does not pay for basic foot care, and doctors will not make house calls. Would you prefer these patients or their family members provide their own foot care (most of them can barely see or touch their feet), possible causing injury or infection? I think it is a better solution for them to have this care performed by a Certified Foot Care Nurse. These nurses have specialized training and have been certified to provide this care. If physicians work closely with these nurses they may find it helps all of us (patients and health care professionals). You may also find your patient load increases from referrals from these nurses.

 

Before you decide if you want Nurses certified to preform services in your profession, consider Wal-green's Drug Stores, CVS Drug Stores, and even Kroger's Groceries who have all opened Offices in their stores with national chains of "Nurse Practitioners" directly competing with local primary care doctors. As a C.Ped myself, I thought it was ok for our organization to certify orthopedic shoe fitters who could assist in our practices. Then the certified fitters found they could list themselves as pedorthists; and, go into business on their own selling shoes to Medicare Diabetic patients. This, in turn, led to all of us C.Peds being required to have surety bonds, in addition to everything else, in order to do business with Medicare and other insurance payers.