How A Mystery Novel Spurred A Look At Our Patient Care Ethics

Author(s): 
John H. McCord, DPM

A mystery novel, The Burglar Who Studied Spinoza by Lawrence Block, first circulated in the early 1980s. The novel horrified podiatrists worldwide. The problem was that the villain in the mystery was a podiatrist.

   A British podiatrist gave me a copy, asked me to read it and let him know my thoughts. I read it on a train from Manchester to London, and totally loved it. The best part for me was when the detective, who was actually a book thief and ran a bookshop in New York City, was trying to steal a rare copy of Baruch Spinoza’s Ethics from a customer.

   The detective/book thief/bookseller discovered his victim dead and the rare book missing. He now needed to solve the mystery to discover the real murderer/book thief, hence clearing himself of possible suspicion and hopefully latching onto the rare book.
Evidence eventually led the detective to the victim’s podiatrist. The detective made an appointment with the podiatrist for help with an imaginary foot problem.

   The podiatrist was a nice, enthusiastic gentleman who immediately diagnosed subtalar pronation, which would respond to a custom-molded orthotic that came at a substantial cost.

   The detective declined the opportunity to be casted for orthotics and the podiatrist began a speech about the importance of success in his practice, explaining that dispensing orthotics was integral to his success. The detective left and worked up the case to prove that the podiatrist was guilty of breaking into the victim’s apartment, murdering him and stealing Spinoza’s Ethics.

   I loved the book. It was funny and caused me to evaluate my patient care plans to always put the patient’s needs ahead of my own.

   Most podiatrists hated the book. It wasn’t because the podiatrist was guilty of burglary and murder. They were upset that the author insinuated that podiatrists peddle expensive orthotics for their own gain.

   I shared my thoughts with my British colleague and that ended our friendship.

   I reviewed my practice protocol for use of orthotics. I always used the best laboratories for custom orthotics and kept the markup reasonable. I actually kept the markup too reasonable and got complaints from my competitors that my low prices were hurting podiatry.

   One of my patients was changing his shoes at a golf course and removed his orthotics. Another golfer commented that he also wore them and commented about the $400 cost. My patient admitted that his orthotics were only $85. I quickly got a call from an irate Portland podiatrist who dressed me down for unfair competition and accused me of trying to ruin podiatry. I apologized and let him know that at that point I had no local competition but I would try to keep my patients off Portland golf courses.

   I did carry off-the-shelf premade orthotics that I ordered from a medical supply house. A high percentage of patients did not need custom-molded devices and the premade supports fit most of their needs at a lower cost. The problem bothering my conscience was that there was a necessary markup. I was prescribing and dispensing a device on which I was making a profit.

   I quickly resolved that by getting a local shoe store to dispense the devices. They also handled quality extra-depth shoes, thus getting me out of the retail business. I slept better. Patients who were unhappy about their premade devices would often opt for a custom-molded device. Fortunately, the shoe store allowed them to return their orthotics with a full refund. It was a winning situation for all of us, except that one Portland podiatrist who threatened to report me to the ethics committee. I offered to get the phone number for him.

   National healthcare reform has created a fear in many doctors that they must have devices to sell patients to ensure a profit. Patients are complaining to me that things have changed since I retired. “The doctor spent more time trying to sell me arch supports than talking about my foot problem,” they say. “Then I found the same supports at a sporting goods place for a third of the price the doctor wanted.”

   We need to wake up and focus on our patients’ needs rather than our own. I have seen every kind of gimmick peddled in podiatry offices. One DPM near me offers spray tanning. Another offers LASER hair removal. So-called “cosmetic foot surgery” really baffles me.

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