Help! I Need YOUR Advice

Jarrod Shapiro, DPM PRESENT Practice Perfect Editor Mountain View Medical & Surgical Associates, Madras, Oregon

I’ve spent much of my time writing for PRESENT Podiatry as the instigator of discussion for a variety of topics pertinent to podiatrists.  In several of these,  I have provided my own insights and opinions (I have no shortage of those!).  I would go so far as to say I've given advice on many of these topics. Now it’s my turn to ask for your advice and opinions.  I have a clinical dilemma that some (if not many) of our readers have experienced themselves.'

Since moving to Madras, Oregon last year, I’ve had essentially carte blanche to use any surgical instrumentation and clinical products I choose.   My office management has, for example, approved the use of expensive wound healing biologics in the clinic, trusting my judgment that these costly products would benefit my patients.  Similarly, my hospital OR manager has permitted the use of more costly fixation products, simply because I’ve asked.  It’s a very satisfying situation.

	Today's Lecture is The Non Compliant Wound Patient: Pitfalls, Advice, and Evidence from Kathleen Satterfield, DPM

If I want to determine an amputation level or I’m concerned about a patient with PAD, claudication or ischemic rest pain, I can order an ABI, MRA, or CTA, or refer them out for a classic arteriogram.  I know what you’re thinking.  “He’s practicing vascular medicine from the past.  ABIs are useless in diabetics and renal disease patients. Advanced imaging tests like an MRA should be ordered for patients pending revascularization, not for screening purposes.”  I agree completely (and, no, I don’t order MRAs for screening).  I’m left with my clinical judgment, and the last time I checked, my hands won’t tell me a patient’s skin perfusion pressure—which I really need to know before I do surgery or debride a wound.

Here’s another potential response from some of you:  “What a great chance to build a niche and add potential income to your practice.”  I agree with that too,  except my hospital – and its associated provider-based clinic attached to it – does not want to foot the $20,000 - $30,000 bill for Vasamed’s system (arguably the best noninvasive system it measures both micro- and macrovascular disease). Short-sighted, I know, but small rural hospitals have to watch their expenses even more than the big hospital systems.

So, here’s my question to the podiatry community:  what would you do?  How can I improve my situation?  All opinions are valid regardless of time in practice or residency.  This is an important factor for podiatry in general and specifically for those in rural areas...

In the future, we’re likely to see issues like this with new emerging technologies.  What’s a podiatrist to do?  Comment in on our etalk! Join in on an array of eTalk Topics taking place on PRESENT Podiatry, or create one of your own.

Keep writing in with your thoughts and comments or visit eTalk on PRESENT Podiatry and start or get in on the discussion. We'll see you next week. Best wishes!

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]

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