by
Jarrod Shapiro, DPM
Joined practice of
John K Throckmorton,DPM,PC
Lansing, Michigan
July 2006
As
residents, we spend much of our time absorbing the skills and
practice methods of our attendings, sometimes without much choice of
our own. Optimally, the way we treat patients should be some
combination of didactic understanding, experience, and evidence from
the literature. In reality, many of our treatment regimens during
residency are more reflections of how our attendings practice. Take
clinic, for example. During training I would offer what I thought to
be the most appropriate course of action for my patients, but the
bottom line in many instances came down to what my attendings wanted
to do.
Now it�s different. Now, for the most part, I
make my own decisions, and I�m creating my own treatment style. As a
new physician in practice, I have the opportunity to experiment to a
certain degree with my treatment regimens, and determine what works
best for my patients. For instance, one of the first components to
my treatment of plantar fasciitis is applying a reverse morton�s pad
made from � inch felt directly to the bottom of the patient�s foot
with athletic tape to hold it on. Patients are instructed to leave
this on from 2 to 7 days maximum. I additionally prescribe icing,
massage, calf stretches, and shoegear counseling. I�ve experimented
by incorporating this pad into a low dye strap with no real
difference. Generally, my patients are greatly improved within 2
days, noting a significant difference with this pad. I�m creating my
own practice style by staying open-minded and applying current
medical theory and evidence.
Of course, there are limitations. We can�t do
anything we want! Our treatments have to be within reason and a
certain standard. We�ve all heard about �standard of care.� This is
a legal maneuver to torture unlucky physicians during a lawsuit and
has little real utility. We�re all aware that the �standard of care�
for a particular disorder varies immensely around the country. The
Lapidus bunionectomy is not the most common procedure in Michigan,
whereas it is very common in the Northwest and other parts of the
country. The only time this term seems to apply is when a doc
deviates significantly far from the norm. An open, comminuted,
dislocated ankle fracture with vascular compromise in a 20 year-old
will almost always be treated with some form of joint realignment
and fixation. Deviation from this would under most circumstances be
negligent, much less �nonstandard.�
Under normal circumstances, though, we have the
opportunity in practice to create our own styles. Additionally, keep
in mind that when they�re your patients, you have to live with the
consequences of your actions! Absorb as many different treatment
pathways while you�re a resident, and when you�re in practice,
you�ll be the master of your patients� podiatric destinies.
Talk to me,

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

This program is supported by an
education grant from
DermPath Laboratories.

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