Uncomfortable with the diabetic foot

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Vertu

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Hi all,

After shadowing a podiatrist, I realized I am quite uncomfortable with diabetic foot wounds and ulcers. If I go down this path of becoming a podiatrist, is there any way I can avoid seeing patients with diabetes? What about during residency? My mentality might change down the line, but as of now I can't help but cringe when I see diabetic foot wounds.

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You will become desensitized to it the more you view it, which you will be doing a lot. If I were to hazard a guess, 40% of your time will be occupied by diabetics, 80% of whom will have wounds, the other 20% will need amputations. By the time you are a DPM, you would have seen so many busted up feet, that they just look normal to you, and you are thankful for the ones with only ingrown toenails.

I remember the first time I shadowed a podiatrist and saw what a necrotic toe looked like, I almost puked. It was black. A black toe. The smell didn't help either. When the podiatrist told the patient that the only course of action was amputation, I literally thought I was going to break down. I looked down for a bit and collected myself and just looked at the patient attached to the foot to get through the conversation.

That was burned into my memory pretty bad. However, several weeks after, I shadowed again and saw a similar scenario, and while my initial reaction was one of disgust, it was not nearly as bad. The mind will adapt to it.
 
Hi all,

After shadowing a podiatrist, I realized I am quite uncomfortable with diabetic foot wounds and ulcers. If I go down this path of becoming a podiatrist, is there any way I can avoid seeing patients with diabetes? What about during residency? My mentality might change down the line, but as of now I can't help but cringe when I see diabetic foot wounds.
You can certainly avoid it once you're out on your own. But in school and in residency you will have to deal with it.

Also, if you practice general podiatry you'll have to deal with it. Specializing is harder than general podiatry because you're limiting yourself to a smaller patient population and fewer job openings, but it is possible.

There are podiatrists who do only sports medicine or only orthopedics. I believe there's a podiatrist in Florida who only does lower extremity radiology (you can pretty much go up to the hip in Florida). So it's possible, but these podiatrists are definitely in the minority.


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If it makes you feel any better, my first day shadowing I saw a completely rotten leg! Great way to be introduced into pod hahaha. I still get a little unsettled with ulcers myself but am finding that the more I see them the less it makes me uneasy.
 
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Just wait until you're on an externship, and a patient has maggots crawling out of his foot saying he didn't even notice them..... yeah
 
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Podiatry and Diabetes go hand-in-hand. Without a concentration in diabetes/ulcers/wound care, we would be limiting ourselves to future employments and potential income. Hopefully, after the completion of the 4 years and a 3-year residency, you would have seen enough diabetic foot complications that it will be second nature to treat. Otherwise, like Bob said, you can choose another concentration.
 
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I think the grody stuff is pretty cool. On topic, if you don't treat diabetics you are cutting out a huge population of potential patients and the money that comes with it.
 
Podiatry and diabetic feet go hand and hand. I don't think you can avoid diabetic patients.
 
Diabetics and feet are like sandwiches and bread. U can technically have a sandwich with no bread, but it just isn't the same.
 
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Diabetics and feet are like sandwiches and bread. U can technically have a sandwich with no bread, but it just isn't the same.
Double Down sandwich from KFC. The best thing since sliced bread.

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I have worked in podiatry for 7 years. 80% of the patients are medicare age diabetic routine foot care. The other 20% are wounds/injuries. I have worked in three states, for a total of 13 different podiatrists, so I speak from experience. On an average day of 40 patients (per doc) we see about 5-10 wounds. When I first started in podiatry I was grossed out, gangrene is a smell that you can never un-smell, believe me. Now I don't even think twice, there are still some things that gross me out, but I'm not nearly as bad as I once was. I started out wanting to run out of the room, but I got better with each wound and each smell. As a resident you will be doing all wound work, trust me on that. All of my podiatrists make their residents see all their wound/amputation patients. You will get better, it just takes time and exposure. It's not as bad as you think! If you want to avoid diabetic patients, pursue a career in ortho. Otherwise you will miss out on 80% of your patients as a podiatrist. Good luck.
 
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80% of the patients are medicare age diabetic routine foot care. The other 20% are wounds/injuries.

If you want to avoid diabetic patients, pursue a career in ortho. Otherwise you will miss out on 80% of your patients as a podiatrist. Good luck.

Although I agree that diabetic patients make up a big portion of many podiatrists practice, the statements above are pretty broad. It sounds like the doctors you have worked with have had a routine care focus. Out of the practicing podiatrists on this forum, I don't think that any of us have a practice that is close to what you describe. Although I do see my fair share of diabetic patients, I don't see anywhere near 80% routine care on my worst day.
 
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