Why Refining Our Podiatric Skills Is A Lifelong Process

Bryan Markinson DPM FASPD

“Not perfection as a final goal but the ever enduring process of perfecting, maturing, refining is the aim of living.” — John Dewey

For the past several years, I have traveled all over the country for the predominant purpose of sharing with colleagues the essentials of podiatric dermatology, incorporating dermatology into your practice, the how and why of biopsy procedures, and risk management associated with what is for many a new dimension of practice. This has been in the form of straight lectures as well as “hands-on” pig feet workshops.

More frequently than not, I have shared the podium with Brad Bakotic, DPM, DO, G. “Dock” Dockery, DPM, Harvey Lemont, DPM, and Tracy Vlahovic, DPM, among others who have also been dedicated to a better understanding of skin diseases. I have been fortunate — through my work on the Council for Nail Disorders among other things — to always be learning something new for myself that I can share with you.

One truth I know is that in the past 30 years, there has only recently been an explosion in the embracing of dermatology as part of CME programs and inclusion in practice management discussions. We still have a long way to go. The skin biopsy is still at the very bottom of the list of most frequent procedures done by podiatrists.

It is not uncommon for me, Dr. Bakotic or Dr. Dockery to hear that after starting to concentrate on podiatric dermatology and performing skin biopsies, our colleagues find themselves dealing with more specific diagnoses. These diagnoses help them provide more specific targeted therapies and uncover malignant processes on the skin. For me, this in itself is the most rewarding aspect of these endeavors.

This blog, however, is about the next thing we hear from many of these same practitioners. That is something like, “I can’t believe that all these years I have possibly let these things walk out of my office.” This common sentiment indicates that as our colleagues look back, they were missing an important part of patient care and actually feeling bad about it.

However, the truth is that this is actually a wonderful thing to occur. We should always be learning. We should not look back at what was but embrace new knowledge and skills as the “ever enduring process of perfecting, maturing and refining,” which, according to John Dewey, is the “aim of living.” It certainly is the aim of doctoring.

When we learn a new osteotomy for a bunion correction, we do not look back at what we were doing previously as inferior. Instead, we become armed with a greater skill set that helps us with the bunions yet to come. If we employ advanced wound care modalities in our practices, we do not despair at the failures of the past but exult at the new possibilities. To be sure, learning new things should give us a healthy respect for how things are improving rather than reflect on how things were less than optimum at some time in the past.

One may assert that missing a melanoma is different than achieving a better intermetatarsal angle correction or healing a wound faster, but the truth is that far more collective misery has been wrought by poor foot surgery and digit or limb loss than by failure to do a biopsy. In any case, none of us has the ability to change what happened yesterday.

Perhaps you find yourself practicing more and more podiatric dermatology, and experiencing regularly what you never did before. Take heart in the fact that your patients are now getting more expert care than ever before and that you and your practice are continually refining and maturing. This is the essence of a podiatric life well lived.

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