The Top Ten Ubiquitous Patients Who Present To Podiatry Offices

On the lighter side, I thought I would dedicate this blog to our patients. Here is a top ten list of the ubiquitous podiatric patients for your review and reflections.

1. “The Poor Historian.” The Poor Historian presents to your office for the first time. While you are reviewing his or her intake paperwork, you notice that the patient is not taking any medications, never had any surgery, and has no allergies. On paper, the Poor Historian looks like the epitome of good health.

However, when you walk into the room, you see an obese patient who is sipping on a Starbucks coffee, nibbling on a bag of chips, seems a little short of breath and has scars down the medial side of both legs. Now you get a different impression.

On the other hand, the Historian comes prepared for his or her visit with you. This patient has a diary of every symptom, dated and time stamped. These two patients are the extremes that make your day challenging.

2. “The Inspector.” The Inspector is watching you very closely. As you are debriding nails and move on to the other foot, the Inspector will gently dorsiflex the foot for a quick examination of the completed foot. The hard-core Inspector will also bend over and perform a tactile exam to make sure you have not left any rough or jagged edges. The Inspector will let you know where you need to do some touch-up work.

3. “The Engineer.” The Engineer is the patient who wants to know every detail about how the foot works. As you explain how orthotics work or how the patient’s surgery will be done, he or she will often have advice for you. You may have a riveting discussion on lever arms and hinges.

4. “The Industrious.” We have all heard the expression that necessity is the mother of invention. I have observed that my elderly patients who have advanced digital deformities will find a way to make their feet more comfortable. The Industrious patient is not going to Wal-Mart to buy pads and cushions. What this patient will do is utilize items around the house like tissue paper, rubber bands and maxi pads for toe separators and cushions. These patients refuse to have “special” shoes so they will simply cut a hole in their shoe to make room for their bunion.

5. “The Joker.” I don’t know about you but jokes in a professional atmosphere are probably not the best idea. However, the Joker must always try and make you laugh when you walk into the treatment room. I personally find it awkward and uneasy. I will generally give these patients a courteous nervous laugh.

6. “The Helper.” When examining a patient, you have your routine to systematically rule out certain pathologies. Part of any examination is palpation of key joints, tendons, bones, etc. The Helper will always tell you where the pain is located. When you palpate a structure and ask “Does this hurt?,” these patients will quickly stop you, pull up their foot to their hand and direct you to another location on the foot. So you try again and the same thing happens. You finally tell the Helper: “I will get to the sore spot. Don’t worry.”

7. “The Inquisitive.” Patient education is integral in an office visit encounter. After reviewing all of the pertinent pathology on the x-ray, the Inquisitive patient will always ask: “So what are those two round bones?”

8. “The Forgetful patient.” Plantar fasciitis is by far one of the most common complaints for patients who seek our professional care. I will generally provide a fairly intensive review of plantar fasciitis regarding what really causes the pain, the pathology, mechanical considerations and all of the treatment options. The Forgetful patient will always ask, just as you are walking out the door, “So what about the heel spur?”

9. “The Over-Compensating patient.” Your mother always said to wear a clean pair of underpants … because you never know. She also taught you to brush your teeth really well before you go to the dentist. The Over-Compensating patients will present to the podiatrist with either gobs of Vaseline to moisturize their dry feet, pour on heavy doses of powder which leaves billows of debris in the air as they pull off their socks or, better yet, douses of perfume for your smelling pleasure.

10. “The Show Off/Know It All.” I personally have not had to use crutches or had to be non-weightbearing. I am sure it is difficult. If my doctor told me to avoid walking on the foot after surgery in order to help prevent a compromised outcome, I am pretty sure I would figure something out to stay off my foot. The Show Off/Know It All will generally not do what he or she is told. These patients carry their crutches from their car to the office front door. Then once they are in the office, they diligently use their crutches as they enter the treatment room.

When you ask if the patient is staying off the foot completely, the Show Off/Know It All responds affirmatively. Unfortunately, my patients forget that my office has one-way glass so we can only look outside. As we all know, the Show Off/Know It All is only fooling him- or herself.

I hope you have enjoyed some levity in this blog. The reality is the patients make our job fun and interesting. They are the reason we get up in the morning and go to work. Without these “characters,” our jobs would get boring.



Anonymoussays: January 22, 2010 at 5:35 pm

Great column. Could I add 2 more "characters":
11. The detective. This patient has figured out the cause of all of their problems. They present with a bag of shoes, and a discovery: all their shoes have greater wear on the lateral side of their heel than the medial side.

12. The doubter. No matter what their diagnosis, the retort is: "But I never had that before" When I explain that the condition is not usually congenital, they reply, "But I'm not having the problem on my other foot".

Thanks for the column,
Robert Victor, DPM
Newport, OR

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