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What Kind of Doc Are You ?
 by Jarrod Shapiro, DPM Joined practice of John K Throckmorton,DPM,PC Lansing, Michigan July 2006 Have you ever asked yourself what kind of doctor you want to be when you're out in practice? I've asked myself this question during residency a couple of times, but the real answer doesn't come in the abstract. Answering this question for yourself doesn't come until you're given the opportunity during real life experiences. During my short time in practice, I've already had multiple occasions to answer this question for myself. Do I do what's expedient and make my life easier? Or do I do what I feel is best for my patients? This past weekend was one such example. I have a patient from my wound care clinic with ESRD on dialysis, DM II w/ neuropathy, PAD, CHF, CAD, and just about every other letter in the medical alphabet soup along with bilateral decubitus ulcerations with osteomyelitis. He was admitted to the hospital with sepsis while awaiting assistance from the vascular surgeon, and I performed a partial calcanectomy for his worsening osteomyelitis. He was offered a BKA but opted to give this a try as limb salvage. During this time he appeared to be going into DIC. Our first postop labs revealed he was thrombocytopenic and he subsequently continued to bleed postoperatively. Since it was the weekend there were few docs to be found, and I turned out to be the only physician in the vicinity of the ICU. A poor doctor would have let this fellow bleed. Let the internists take care of his problems, right? I decided to take the initiative, be a better doctor, and help my patient. During 5 follow-up rounds the patient received 6 units of blood and fresh frozen plasma to take care of his severe anemia (hemoglobin of 7.2) and assist with his clotting capability. Was I out of my scope of practice? Honestly, I'm not sure. Here's the way I look at it. His bleeding from the wound I created was a foot problem that was caused, among other things, by his coagulopathy. I treated this with several calls to ID and internal medicine (no need to step on any toes), along with some local interventions, and his bleeding slowed. He's feeling better and his blood counts are normalizing. By treating the etiology of the bleeding I resolved the problem in his foot. Am I foolish, opening myself up to a lawsuit? What about scope of practice? Is using Lyrica to treat neuropathy practicing out of our scope of practice? How far should a good doctor go? What do you think? Attendings often tell us to treat patients
like they're family. I've taken that to heart and try to do my best
for patients, even if it makes my life more stressful and difficult.
What's your philosophy? Do unto others as you would have them do
unto you? Or Do unto others as you would have them do unto you
during business hours only? You will have to answer this question
sooner than you think. Talk to me,
This program is supported by an
education grant from MAJOR SPONSORS
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