We Are Podiatrists. Nothing More, Nothing Less.

Ladies and gentlemen, I have an earth shattering confession to make. Wait for it … I am extremely proud and honored to call myself a podiatrist.

As silly and simple as this revelation may seem, when I look around at what is going on in our profession today, that term that so eloquently describes what we do everyday seems to be whispered these days instead of proclaimed loudly and proudly. It is almost blasphemous to actually refer to ourselves as what exactly we are. We are podiatrists, the foot and ankle experts, nothing more and nothing less.

Let’s review what I do just about all day everyday. I cut toenails for the elderly who either can’t physically do it themselves or who present with comorbid factors that make it better for a trained professional to take care of this seemingly simple task. Should I then call myself an onychomycologist? I am not sure that really applies because my very next patient could be in need of an ingrown toenail removal and also may ask me to kill the nail root, using carbolic acid as a destruction agent. Maybe I should be known as a phenol and alcoholic. Hmm … that doesn’t sound very appealing to me.

I generally see patients with diabetes in the hospital almost every day. I field their medical issues relating to their feet, potentially order appropriate testing and possibly even take them to the operating room for an incision and drainage, or even an amputation. So am I known as a podiatric hospitalist or should I refer to myself as a foot amputation specialist? That is also not very appealing to the average person, wouldn’t you say?

I personally like to review the actual films when I send my patients for computed tomography (CT) or magnetic resonance imaging (MRI), so am I now a podiatric radiologist? Believe it or not, I went so far as to try to get malpractice insurance to practice strictly as a podiatric radiologist but my carrier turned me down, saying I was not licensed to read these films. I was “just” a podiatrist, you see. So now the MRI identifies a nerve issue and I think I could use injection therapy to relieve the symptoms. A podiatric acupuncturist sounds a little mystical, doesn’t it? If I happen to do the injection with ultrasound guidance, am I now a podiatric interventionalist?

By the end of my week, I have my surgery schedule so I head over the hospital and perform my cases for the week. A podiatric surgeon … hold the phone. Now that sounds sexy. I am actually a board certified podiatric surgeon. Whoa … now we are talking. Let’s try something else. If I am a foot and ankle expert, let’s put something else in there and see what happens. Oh, I am a board certified foot and ankle surgeon. That’s the ticket.

Hmm … the problem with that terminology is that it implies that all I do is foot and ankle surgery. I do not really like that because even though it may describe a small part of what I do as a podiatrist, it really does not accurately reflect how I help my patients in most situations. It is only maybe one-tenth (a half day a week of a six-day work week or so) of what I do most of the time. So why is it that I hear our colleagues refer to themselves as foot and ankle surgeons rather than what it is we truly do for our patients in most situations? This is especially true when we start putting things like “fellowship trained foot and ankle surgeon” in front of our names instead of DPM after our names.

I am not poking fun (well, maybe just a little) but I’m not a foot and ankle surgeon. It is part of what I do every week to help people feel better but it is not who I am as a professional. I am a podiatrist, plain and simple.

Has This Conversation Ever Happened To You?

Since I am such a fan of role-playing games (I played the massive multiplayer online role playing game World of Warcraft for years and now am a Star Wars: The Old Republic junkie), let’s role play through a scenario that, believe it or not, I encounter frequently.

A new doctor in town (let’s call him Dr. Nu Youngblood or “YB” for short) gets invited to a party with his new wife in the new town they just moved to where he is newly in practice. He meets another young professional (Brian, whom we’ll call “B”) at this party and their conversation goes something like this.

B: Hi, I’m Brian.
YB: Hi Brian, I’m Nu.
B: Hey Nu, so what do you do for a living?
YB: Well, I’m a foot and ankle surgeon.
B: Wow, that sounds great. Where did you go to medical school?
YB: I went to Temple but I didn’t go to medical school, I went to the podiatry school there.
B (looks a little confused): I thought you said you were a foot and ankle surgeon?
YB: I am.
B: My mom sees a podiatrist. She goes there every few months to have her nails cut. She is diabetic. So, do you do that?
YB: Some but I like being in the OR more.
B: Well, what’s the difference between you and the guy that cuts my mom’s nails?
YB: He might not be a surgeon.
B: Oh, he is a surgeon. He did a really great job when he fixed her bunions ten years ago, but on his business card, it says he is a podiatrist. What is the difference?
YB: Well … um … nothing really …
B: Huh? So you’re a podiatrist, too?
YB: Yes, I am.
B: Why didn’t you say that in the first place?!

I hear this kind of thing all the time. I chuckle every time but can’t seem to put a finger on why this scenario bothers me so much.

Here is the same scenario that plays out when I’ve been to the same types of parties over my career.

B: Hi, I’m Brian!
Ron: Pleasure to meet you, Brian. I am Ron.
B: So Ron, what do you do for a living?
Ron: I’m a podiatrist, Brian.
B: Ha … foot fetish?
Ron (laughs): Not so much. I stay pretty busy taking care of all kinds of foot stuff.
B: Oh?
Ron: Yeah, I see patients with diabetes in my office and prevent them from having problems with their feet from bad circulation or nerve problems. I can also see them in the hospitals and in a couple of wound care centers here locally. I also see all kinds of sports injuries and treat kids who have bad feet. I do perform surgery if people need it. I do everything from bunion surgery to fixing Achilles tendon tears. Most of my time is spent taking care of patients in the office and hospitals. I like to write and contribute to online magazines, and have been published too. Once in awhile, I lecture at national conferences about kids and surgery.
B: Wow! You stay pretty busy, don’t you? Here I thought all podiatrists do is wiggle toes (laughs). You know, come to think of it, my mom sees a podiatrist here locally to get her toenails cut. She is diabetic, you know. He did surgery on her ten years ago or so. She had really bad bunions but is really doing well with that now. My wife is always complaining about how much her feet hurt. Maybe you can help her. Anyway, it was really nice to meet you. Good luck to you. Do you have a card?

I have absolutely nothing against our push forward to more techniques and technologies in the surgical realm. What I do take issue with is not that we focus too much on surgery these days but that we only focus on surgery. There is so much more to what we do as professionals than the skills we practice in the operating room. If you take a hard look at strict finances, I think any practicing podiatrist will tell you that to certain degree, one can make more money doing simple office procedures than the time and money it takes each of us to make our way and spend our time in the operating room.

One other alarming trend I see now is that the aspiration is turning away from the more humble and “simple” aspects of our art, and more toward the “big” stuff. If that is what you want to do, go for it. More power to you. I personally find the “simple” stuff much more rewarding. I also find that patients tend to appreciate it more. Your personal and family life will appreciate it more too, I think. Mine does.

I am a podiatrist. Nothing more and nothing less. There. I said it.