Look to the Youth to Look to the Future
There is no question that all of us want the best for total patent care. A great number of professionals now accept the team concept as the only way to satisfactorily meet patient needs. Podiatry is still suffering from a lack of visibility in the health care scene, and this diminishes its opportunity for full participation on the team.
Consider, as an example, the crowd around a movie theater snack bar during intermission. There is no defined line, and people are pressing up against the long counter trying to get the attention of the two or three people manning the snack bar. Often, how aggressive you are determines how soon you will eat. By analogy, a patient is like the person behind the snack bar counter—numbers of physicians and other health personnel are available to offer their services to the patient. Since there are comparatively few podiatrists, most patients have an overwhelmingly greater chance of contacting health care professionals other than podiatrists. In addition, the few podiatrists can get lost in the shuffle of misunderstanding—podiatrics isn’t pediatrics, and chiropody isn’t chiropractic.
Now is the time to establish the high visibility that is needed and to correct misconceptions by the patient public and practicing physicians. If you can intensify efforts to reach the critical mass, the ensuing reaction will firmly establish podiatry as a co-responsible branch of medical practice in the total care of the patient.
Why do I say that now is the time?
- Podiatric education has blossomed in the past ten years
- The new SAMA liaison has provided access to the major groups in medical affairs
- HMO’s and prepaid group practices are coming into prominence
- PSRO holds innumerable unanswered questions for the new future
- Licensure and certification procedures are being actively debated in allopathic circles
These are converging on the medical scene and now is the time for podiatry to impress fully upon the minds of physicians and the patient public that foot problems are the specialty of the podiatrist.
I see three issues as important in assembling this critical mass: organize, humanize and educate.
By organize, I mean develop long range goals and immediate actions. By humanize, I mean that the essence of medical practice is people sense—a response to the needs of human beings. You can direct podiatry into the forefront of this revolution in medicine. By educate, I mean that what podiatry is and what it can do must be emphasized both to others and to your own students.
If you will indulge me the opportunity to offer some personal perspectives, then let me share some ideas that might speak to the excitement you too are feeling for the future of podiatry.
My first topic is to organize.
We must integrate podiatry into the mainstream American medicine. In our current system, the only way podiatry can fully participate in total patient care is by its acceptance as a functional, separate professional field of medical practice.
The thing that literally distinguishes “foot specialists” from “eye specialists” is that the former train for and receive a D.P.M., while the latter train for and receive an M.D. Certain elements and emphasis of their training and advanced experience admittedly are different, but the basic problem with acceptance of D.P.M.’s is that they are not in “The Club.” To enlarge “The Club” beyond the limitations of a single membership card, you will have to negotiate with the AMA, AOA, American Hospital Association, Joint Commission on Accreditation of Hospitals, and of course, the orthopedists.
I urge you to continue your efforts to adopt comprehensive, long-range, sweeping strategies—to determine short-range, immediate actions—and to utilize to fullest advantage the APSA-SAMA channels.
SAMA has liaisons to major AMA councils and commissions, to the American Academy of Family Physicians, and other major organizations. Our liaisons are charged with presenting SAM’s concerns for agenda consideration at these various meetings. All that remains now is for the APA to work closely with the APSA and SAMA National Liaisons to see what new ways podiatrists can bring their concerns to the somber halls of the AMA and other organizations. SAMA, as the largest independent organization representing American’s allopathic medical students, has given fullest blessings to enhancing the professional relationship between allopathy and podiatry. Since we can introduce items to committee consideration, the leaders of American medicine must listen to our views.
When formulating the long-range goals, give due consideration to the possibility that podiatry might introduce a wholly novel and exciting dimension to medical education. With your efforts, in 20 or 30 years your schools might combine basic and specialty training into one continuum, whereby your students could receive an M.D. degree with certification as a specialist in foot care. It gives me a “heady” feeling to realize that senior podiatrists could be training a new kind of practitioner, one who would graduate form school with training that M.D.’s now wait to acquire in their residencies. These professionals could be the elite in a dramatically changing g medical educational system—and you hold the potential for those changes right here. You are the foot specialists of today who train those of tomorrow.
Organize as you see fit, then turn to your student channels to see in what ways the contacts that they have formed and nurtured can help right now to advance the profession.
My second topic is to humanize.
Perhaps this seems a strange item at first thought, but not so much so when you consider that we all are together in the business of helping people. And helping and people are very human words. The new breed of practitioners and students are wrenching the superstructure of health care training and practice—and with good reason. All of us are familiar with how the phenomenal upsurge of technology has led to what some term the “dehumanization” of the patient. I prefer to think of it as treating the disease but not the illness, of focusing on the pathology but not the person.
In podiatry you have a distinct opportunity to demonstrate human compassion in the practice of medicine. Some jestingly say, “Let the podiatrist take care of the corns, calluses, and ingrown nails.” Let us put aside for a moment even the elegant surgical procedures of podiatry, Instead, just concentrate on the “trivial” problems that can be of paramount concern for the patient as a person. Reflect on your patients who were in otherwise good health but who could not easily move from bed to toilet or who could not easily move about in the kitchen. Each was as seriously ill as is someone with dramatic muscular or metabolic disease.
Podiatric research and practice has given us today the ability to take aggressive action to restore function, to relieve discomfort, and thereby to reinstill some of the vitality of living as an independent human being.
As physicians, we all see so much horrifying pathology that we drift into forgetting how debilitating seemingly trivial conditions can be. The technology is so complex for major restoration that we often focus our attention entirely there. Let us remember to pause with each person, to consider his needs, to reflect on how we have helped him, to suggest how he can best help himself. So when I say “humanize,” you can see that we are all into medicine—and living—are really about.
My final topic is to educate.
Let me remind you that I am a student. Educational issues are a daily part of my life. I am one of the practitioners of the future—so my thoughts today are some indication of how physicians will think tomorrow. Again, please indulge me some personal observations.
The idea of education is three-fold—you need to address: (1) the patient public, (2) the allopathic practitioners, and (3) your younger colleagues and students.
In educating the patient public, the major issue is visibility. We must share with others what podiatry is and what it can do. Each of you can personally, actively bring the message to people in their everyday activities—in the schools, at PTA meetings, in factories, at bowling leagues. As an organization, you must continue to develop media presentations of a public service nature for television, radio and magazines.
In your daily practice, continue to subscribe to standards of care that emphasize patient education. Every patient should become well aware not only of his particular foot problems, but also of how you as a podiatrist contribute to his total health are.
In education allopathic practioners, again the issue is visibility. A basic tenet is that no one seeks learning that he does not realize he needs. Your responsibility is to demonstrate where and how podiatry fits into the team concept of total patient care.
Liaison with local medical societies and groups will help take the “the unknown” dimensions out of podiatry. You will become familiar as a person and as a podiatric medical practioner. This familiarity is a critical part of medicine. Physicians and patients alike are much more comfortable in referrals made to colleagues who are personally known and respected as individuals. Likewise, your referrals can become more firmly based on personal knowledge of which allopathic physicians give special care to people with diabetes or with joint disease, as well as recognizing which physicians are good persons.
Your participation in HMO’s group clinics, and hospital services will go far to establish these professional bonds. Practitioners who respect the quality of your work-ups in referral to them will be more inclined to send other patients to you. Physicians who appreciate a well evaluated referral will encourage the patient to return to you for continued management of his foot problems.
Many other points could be made about integration with the mainstream of medicine, but the issue of quality medical work-ups leads directly to my last topic.
In education your students and younger colleagues, the emphasis must be toward the future. As with all else, the basic guideline is to do what is required for patient care. Let me share some personal observations.
“Just a foot doctor” and “doesn’t practice medicine” have been jestingly used with reference to podiatrists. It is important to remember as practitioners that the feet are indeed attached to myriad systems above the malleoli. A podiatrist is responsible for assessing how these other systems relate not only to problems with the feet but also to a patient’s total health as well.
If I were a student of podiatric medicine today, I would very much want my educational programs to be tailored so that:
…every podiatrist would use a blood pressure cuff routinely to assess circulatory function; allopathic physicians predominately feel that “blood pressure should be required reading for all doctors”
…every podiatrist would use an opthalmoscope routinely to assess peripheral Bessel status and to detect unrealized changes in refraction.
…every podiatrist would use a stethoscope routinely to assess total body sensory function and to detect unrecognized deterioration of hearing.
…every podiatrist would use urine test-sticks routinely to screen for potentially devastating renal and metabolic diseases
These are but a few of the practices required by the philosophy of contributing to total patient care.
When you refer a person to further diagnosis and treatment, the notation of a complete work-up can contribute substantially to patient welfare. This will assist the recognition of podiatry as a responsible professional branch of medicine. Additionally, it will favor your continuing participation in the management of foot problems as they relate to a patient’s overall physical status.
How a student or younger colleague learns is as important as what he learns. Residency training is virtually essential in the medicine of today. The art of medicine is a certain style of practice. That style is embodied in the application of basic knowledge in ways that are best transmitted through repeated observation and practice under experience tutelage.
Continue your efforts to provide fro your youth expanded opportunities—both externships and residencies, HMO’s and prepaid group practice situations might offer immediate solutions to this need.
The lessons to be learned from senior practioners—lessons of both medical and business practices—cannot readily be grasped in any other way. I urge you, in realization of this, to give formal specialty recognition to further you, in realization of this, to give formal specialty recognition to further training. In allopathic medicine, the classifications “board-eligible” and “board-certified” have become fundamental indications of demonstrated competence.
Continuing education should be a habit you pass on early to your younger colleagues, so that all podiatrist remain abreast of the technology that is required for delivery of the finest health care. Where possible, joint seminars with dermatologists, ophthalmologists, physiatrists, orthopedist, and others—including students of allopathic and osteopathic medicine—will serve best the educational interests of the groups involved.
Free-standing schools of allopathic medicine some years ago found that association with major universities strengthened both their academic and economic situations. Consider, in your long range goals, whether you can afford private unaffiliated schools.
Many more schools are needed when you consider that four hundred million feet are wandering around and only 8000 podiatrists are available. In the push for more schools of podiatric medicine, strive to maintain and improve on the quality to which your schools have risen in the past ten years. Continue your efforts to recruit the brightest and best among you to serve as professors for your students. Again, how a student learns is critical, and much of that is through example. Fine teachers can inspire the idealism of youth to seek practical ways to maintain enthusiasm and zest through many years of service to their fellowmen. Only you can realistically impart this unique feeling, and thus it is a major responsibility you bear.
Always be mindful that the decisions you make today will dramatically affect your students in their practices of tomorrow. Many senior physicians have told me that they want major student input on the issues they are debating. Final decisions will have little impact on their practices. Rather, they point out their efforts are aimed at protecting for future physicians a legacy of medical practice that is satisfying, productive, and beneficial to the doctor-patient relationship.
As I close, let me emphasize how critical the decisions are that you will make regard in the training and practice of podiatry. Continue to give your students and young colleagues a growing voice in their own future. Their future is the fruit of your life’s labors.
The time is right for students of podiatry to actively work with you in assembling that critical mass that I referred to at the beginning .The opportunities are there, the interest is there, and they need your support. They need your trust, your encouragement, your advice, your efforts, and very much so they need your financial backing. Please work with them. Share with them their enthusiasm and vision for the changes for the future. Give them your time and the benefits of your experience.
If you will permit me to paraphrase—put your money where your youth is.