What are some things you've refused to do?

[Sweatshirt]

A patient comes to you with a foot and ankle problem. It's within your scope of practice, but you elect not to do anything. You either refer out, or just tell the patient sorry I can't/don't want to do anything

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[air bud]

I am a year and a half out. I already refer out anybody I deem to be a Trainwreck waiting to happen. Its not worth it to me. I refer to a great doctor who is well trained.

 

[NatCh]

I no longer do anything that has to do with diabetes. No nails, no ulcers, no shoes, no insoles, no thanks.

 

[spo01]

I am a year and a half out. I already refer out anybody I deem to be a Trainwreck waiting to happen. Its not worth it to me. I refer to a great doctor who is well trained.

As a 2nd year attending it is amazing how my mindset has changed. When I was a 4th year student I lived for surgery and I almost chose my residency so I could train under Dr. Dror Paley to learn limb lengthening. I was all about that stuff and I was damn good at it. But boy have I changed. Last week I had a patient that needed a lapidus done. The old me would jump at this situation, but the patient had a history of fibromyalgia and difficulty healing, not to mention they have a history of being a non-compliant jerk. I simply referred it to one of the hundreds of doctors in the area who don't mind doing it. I am referring more and more surgical cases out and to be honest I may do away with surgery all together. My biggest factor is simple, and to some people it maybe superficial, but to me it's all about risk vs reward/money. Some people get off at the complexity of cases. It makes them feel like a doctor, a surgeon, yah! But to me, when I do a bunion and I get reimbursed a measly $300-400 and follow up with them for free for 90 days, I simply tell myself "wtf?". Bob at the mechanic store across the street gets $500 for 20 minutes to repair my car, here I am with 10 years of schooling and a 3 year surgical residency getting crap reimbursement and high stress. Bottom line: For ME, it's just not worth it. And I won't stand for it and I adjust my life accordingly.

I guess what I'm trying to say is there is absolutely nothing wrong with referring out, BUT, you need to ask yourself what kind of doctor do you want to be. Do you want to be the big shot who one day people will refer the complex cases to YOU. If so, then you need to take those kind of cases. Or do you just want to do your 9-5 job, avoid headaches, and get a decent paycheck and focus on other things perhaps outside hobbies and family. This is the beauty of podiatry. Even with all the set backs and lows people complain about, podiatry is one of the best fields you can get into because of this ability to choose what you want to do and how involved you want to be. You want to do complex surgeries, lecture at prestigious universities, be the go-to person for complex foot and ankle problems at your hospitals, you can do it. Likewise, if you want to clip nails at nursing homes all day, you can.

 

[NatCh]

I've become more direct about refusing to write for opioids. Now we can pull up prescribing history for any patient, and if someone shows a history of having received 1200 hydrocodone from eight different providers over the past twelve months I'll show them their history.

 

[NatCh]

But boy have I changed. Last week I had a patient that needed a lapidus done. The old me would jump at this situation, but the patient had a history of fibromyalgia and difficulty healing, not to mention they have a history of being a non-compliant jerk. I simply referred it to one of the hundreds of doctors in the area who don't mind doing it.

It's funny how after you've had to deal with a few difficult patients you learn when to listen to that inner voice telling you to pass. I recently had a patient who was a dark cloud. She was one of those who when you see their name on the schedule you cringe. When I told her that I didn't want to do her surgery she did not like that at all. She stormed out and slammed the door, ending the consultation prematurely, but it was a great relief.

 

[NatCh]

Clever. But then that patient gets royally pissed and goes to the internet to give you a 1/5 star rating and tells the world what a hack/criminal you are. But you can’t respond because that would be a HIPAA violation. Medicine sucks.

True. I try not to worry myself too much about my internet reviews though, as long as I feel I'm doing the right thing. I recently had someone (I'm not sure who it even was) who posted on the internet that I'm "not fit to practice," which I'll admit hurt a little bit, but overall my ratings are 5/5. I hope that people see the overall ratings and realize that low ratings are outliers, and that anyone who is of the personality to pay more attention to one bad rating rather than the bulk high ratings will go elsewhere anyway.

 

[NatCh]

I wanted to add this: I was just out in the woods on a trail run during which I came across a patient who’s a well-known ultra-distance runner. As we passed each other he shouted out, “My favorite podiatrist!” Interactions like these keep me motivated.

 

[ksp2276]

As a 2nd year attending it is amazing how my mindset has changed. When I was a 4th year student I lived for surgery and I almost chose my residency so I could train under Dr. Dror Paley to learn limb lengthening. I was all about that stuff and I was damn good at it. But boy have I changed. Last week I had a patient that needed a lapidus done. The old me would jump at this situation, but the patient had a history of fibromyalgia and difficulty healing, not to mention they have a history of being a non-compliant jerk. I simply referred it to one of the hundreds of doctors in the area who don't mind doing it. I am referring more and more surgical cases out and to be honest I may do away with surgery all together. My biggest factor is simple, and to some people it maybe superficial, but to me it's all about risk vs reward/money. Some people get off at the complexity of cases. It makes them feel like a doctor, a surgeon, yah! But to me, when I do a bunion and I get reimbursed a measly $300-400 and follow up with them for free for 90 days, I simply tell myself "wtf?". Bob at the mechanic store across the street gets $500 for 20 minutes to repair my car, here I am with 10 years of schooling and a 3 year surgical residency getting crap reimbursement and high stress. Bottom line: For ME, it's just not worth it. And I won't stand for it and I adjust my life accordingly.

I guess what I'm trying to say is there is absolutely nothing wrong with referring out, BUT, you need to ask yourself what kind of doctor do you want to be. Do you want to be the big shot who one day people will refer the complex cases to YOU. If so, then you need to take those kind of cases. Or do you just want to do your 9-5 job, avoid headaches, and get a decent paycheck and focus on other things perhaps outside hobbies and family. This is the beauty of podiatry. Even with all the set backs and lows people complain about, podiatry is one of the best fields you can get into because of this ability to choose what you want to do and how involved you want to be. You want to do complex surgeries, lecture at prestigious universities, be the go-to person for complex foot and ankle problems at your hospitals, you can do it. Likewise, if you want to clip nails at nursing homes all day, you can.

I feel EXACTLY the same way. However I am grateful that for the residency training in that I have ...a certain set of skills.... to destroy the bad guy bunnies, tackle the trauma, and wrestle the , I don.t have anything that starts with a W

 

[heybrother]

True. I try not to worry myself too much about my internet reviews though, as long as I feel I'm doing the right thing. I recently had someone (I'm not sure who it even was) who posted on the internet that I'm "not fit to practice," which I'll admit hurt a little bit, but overall my ratings are 5/5. I hope that people see the overall ratings and realize that low ratings are outliers, and that anyone who is of the personality to pay more attention to one bad rating rather than the bulk high ratings will go elsewhere anyway.

Internet reviews don't seem to be a big thing in my area. My program director has been at the same location for a long time, sees a very large number of patients per day, and has less than 10 reviews on the front page review sites. Is that a bigger part of your experience on the west coast?

 

[dtrack22]

I feel EXACTLY the same way. However I am grateful that for the residency training in that I have ...a certain set of skills.... to destroy the bad guy bunnies, tackle the trauma, and wrestle the , I don.t have anything that starts with a W

You’re a podiatrist...wounds?

 

[AttackNME]

I feel EXACTLY the same way. However I am grateful that for the residency training in that I have ...a certain set of skills.... to destroy the bad guy bunnies, tackle the trauma, and wrestle the , I don.t have anything that starts with a W

I love my wife, never gonna give her up.

 

[NatCh]

Internet reviews don't seem to be a big thing in my area. My program director has been at the same location for a long time, sees a very large number of patients per day, and has less than 10 reviews on the front page review sites. Is that a bigger part of your experience on the west coast?

It has some effect on my practice. Most of my new patients come from word of mouth and physician referrals but we’ve also seen a large number of self-referrals via web search, so having a good google rating seems to have at least some importance. When you look up a business you’ve never been to you often do a search, right? Then you’ll probably gravitate towards the ones with multiple reviews at the top of page one versus those on page two without any reviews, or those that have consistently bad reviews. Therefore I’d say it matters some.

 

[tracheatoedoc]

When I was practicing Podiatry, I was reluctant to get involved in a wound care case. If you came into my office with an ulcer, poorly managed diabetes, and poor circulation, it was a direct referral back to primary care. Let them sort it out. I remember a woman who came in with really poor circulation, and needed routine foot care. I didn't want to touch her, but I treated her but didn't recommend any further treatment. She came back in about a year, and in the interval, she had gone to someone else who cut her while doing routine foot care, and she ended up with a BKA. I was very nervous treating her remaining foot, and told her so.

 

[Adam Smasher]

While I pride myself on going the extra mile for patients in need, I have some boundaries:

I don't prescribe narcotics for patiens who are not immediate postops of mine

I don't prescribe diabetic shoes for people I'm pretty sure will never ulcerate, and I've gotten to be good at figuring out who never will.

If it's Friday afternoon, and my schedule is booked, and you call me requesting a same day appt, and I haven't operated on you recently, I'm not seeing you. Go to the ER or wait til Monday morning

If you call me and leave a message like "I would like to talk to you" or "I have some questions" I am not returning your call. My EHR gives you the ability to e-mail me, so use that feature or schedule an appt.

If you are in a wheelchair and cannot be troubled to at the very least put your feet up on the exam chair for me to examine/treat you, you will need to seek care elsewhere. I am not going to crawl on my hands and knees for the privilege of trimming your nails.

 

[ExperiencedDPM]

True. I try not to worry myself too much about my internet reviews though, as long as I feel I'm doing the right thing. I recently had someone (I'm not sure who it even was) who posted on the internet that I'm "not fit to practice," which I'll admit hurt a little bit, but overall my ratings are 5/5. I hope that people see the overall ratings and realize that low ratings are outliers, and that anyone who is of the personality to pay more attention to one bad rating rather than the bulk high ratings will go elsewhere anyway.

Sorry, I couldn’t help but post that review.

 

[NatCh]

Sorry, I couldn’t help but post that review.

I KNEW IT!

 

[Pronation]

When I was practicing Podiatry, I was reluctant to get involved in a wound care case. If you came into my office with an ulcer, poorly managed diabetes, and poor circulation, it was a direct referral back to primary care. Let them sort it out. I remember a woman who came in with really poor circulation, and needed routine foot care. I didn't want to touch her, but I treated her but didn't recommend any further treatment. She came back in about a year, and in the interval, she had gone to someone else who cut her while doing routine foot care, and she ended up with a BKA. I was very nervous treating her remaining foot, and told her so.

One should never take good circulation for granite.

 

[Weirdy]

One should never take good circulation for granite.

Just had a patient who verbatim asked for big toenail transplants. Can't even make this up. Reminded me of you.

 

[NatCh]

One should never take good circulation for granite.

Rock solid advice there. 👍🏼

 

[NatCh]

If you call me and leave a message like "I would like to talk to you" or "I have some questions" I am not returning your call.

Oh god, that's like my least favorite message. I mostly get that from the type A endurance athlete crowd. One asked if they could have my personal cell number "so I can text you in case I think of any questions while I'm out training." Ummmm... how about HELL NO? I'm not your coach.

 

[ExperiencedDPM]

Oh god, that's like my least favorite message. I mostly get that from the type A endurance athlete crowd. One asked if they could have my personal cell number "so I can text you in case I think of any questions while I'm out training." Ummmm... how about HELL NO? I'm not your coach.

Damn, that’s the attitude that makes you unfit to practice. I may need to report this to the authorities. Again.

 

[NatCh]

Damn, that’s the attitude that makes you unfit to practice. I may need to report this to the authorities. Again.

Ha! Tell them I said hi.

 

[DYK343]

I dont understand how Drs give out their private cell number. I just cant do it. I work so many hours.

Once Im home Im home. I am with the family and relaxing. Last thing I want is an onslaught of calls and texts.

Gotta leave work at work and home is my home. They dont mix.

I gave my number out once and I got text messages every hour for abour a month. Then every holiday a happy holiday call. No thanks. Im not your friend. Its a business relationship.

 

[air bud]

I dont understand how Drs give out their private cell number. I just cant do it. I work so many hours.

Once Im home Im home. I am with the family and relaxing. Last thing I want is an onslaught of calls and texts.

Gotta leave work at work and home is my home. They dont mix.

I gave my number out once and I got text messages every hour for abour a month. Then every holiday a happy holiday call. No thanks. Im not your friend. Its a business relationship.

I give all (most) elective surgery patients my cell phone number. Keeps my screw ups under the radar and people from knowing my biznass.

 

[NatCh]

I give all (most) elective surgery patients my cell phone number. Keeps my screw ups under the radar and people from knowing my biznass.

If a patient calls, our office line can forward to the cell of the doctor on call. It's better than having a patient call me when I'm out of town on vacation and leaving a voicemail saying they think have an infection or whatever. I call patients using the Doximity app (displays as my practice name rather than my name).

Edit: The Doximity app also has a secure read-only text feature that conceals your cell number.

 

[DYK343]

If a patient calls, our office line can forward to the cell of the doctor on call. It's better than having a patient call me when I'm out of town on vacation and leaving a voicemail saying they think have an infection or whatever. I call patients using the Doximity app (displays as my practice name rather than my name).

Edit: The Doximity app also has a secure read-only text feature that conceals your cell number.

I prefer the weekend stew method and call office on Monday.

 

[DYK343]

Also I moved from an extraordinarily healthy area to a fairly unhealthy area.

So many of my patients (~30%) are in wheel chairs (with a laundry list of medical problems) and cant transfer to the exam chair.

I dont have the greatest back courtesy of my mother's genetics. Its fine and I can get down on my hands/knees still but its not great and wont get better with time. At some point I have to start refusing care. I dont know the legality behind refusing care to someone in a wheelchair. That sounds messy legally.

I should move back to my old gig. Its just the hours worked there that killed me. They already reached out and said they would hire me back again because they need their workhorse mule back lol. 80 hours a week easy. It paid decent tho.

 

[Shiyuan]

Also I moved from an extraordinarily healthy area to a fairly unhealthy area.

So many of my patients (~30%) are in wheel chairs (with a laundry list of medical problems) and cant transfer to the exam chair.

I dont have the greatest back courtesy of my mother's genetics. Its fine and I can get down on my hands/knees still but its not great and wont get better with time. At some point I have to start refusing care. I dont know the legality behind refusing care to someone in a wheelchair. That sounds messy legally.

I should move back to my old gig. Its just the hours worked there that killed me. They already reached out and said they would hire me back again because they need their workhorse mule back lol. 80 hours a week easy. It paid decent tho.

80 hrs!?? WTF. No way. Say goodbye to your family.

EDIT: Agree on “backbreaker” patients. The absolute worst.

 

[DYK343]

80 hrs!?? WTF. No way. Say goodbye to your family.

EDIT: Agree on “backbreaker” patients. The absolute worst.

I made a huge nest egg. Financially im doing great. But it nearly killed me. Burned out so hard.

It was just that golden carrot at the end of the day.... every day.

 

[NatCh]

Also I moved from an extraordinarily healthy area to a fairly unhealthy area.

So many of my patients (~30%) are in wheel chairs (with a laundry list of medical problems) and cant transfer to the exam chair.

I dont have the greatest back courtesy of my mother's genetics. Its fine and I can get down on my hands/knees still but its not great and wont get better with time. At some point I have to start refusing care. I dont know the legality behind refusing care to someone in a wheelchair. That sounds messy legally.

I should move back to my old gig. Its just the hours worked there that killed me. They already reached out and said they would hire me back again because they need their workhorse mule back lol. 80 hours a week easy. It paid decent tho.

Roll up in your own wheelchair

 

[Shiyuan]

Roll up in your own wheelchair

 

[NatCh]

I dont have the greatest back courtesy of my mother's genetics. Its fine and I can get down on my hands/knees still but its not great and wont get better with time. At some point I have to start refusing care. I dont know the legality behind refusing care to someone in a wheelchair. That sounds messy legally.

Seriously though, if you work for someone else you could try asking for your own accommodations to save your back. Let Human Resources know that when you have to stoop down to trim toenails it kills your back and see what solutions they come up with.

 

[pod squad]

Seriously though, if you work for someone else you could try asking for your own accommodations to save your back. Let Human Resources know that when you have to stoop down to trim toenails it kills your back and see what solutions they come up with.

HR's solution: you should have studied harder in college and gone MD/DO, now get back on the floor *cracks whip*

 

[NatCh]

HR's solution: you should have studied harder in college and gone MD/DO, now get back on the floor *cracks whip*

Labor lawyer tiiiiiiiime

 

[PatchAdamsFan]

I kid you not, my boss in my first job in PP had one of those "under car rollers" that they would use for wheelchair nail patients. Very amusing to see.

 

[NatCh]

I kid you not, my boss in my first job in PP had one of those "under car rollers" that they would use for wheelchair nail patients. Very amusing to see.

Install a hydraulic lift

 

[Pronation]

Install a hydraulic lift

This actually seems like a reasonable apparatus for a total toenail replacement surgeon to have

 

[Nard_Dog]

Also I moved from an extraordinarily healthy area to a fairly unhealthy area.

So many of my patients (~30%) are in wheel chairs (with a laundry list of medical problems) and cant transfer to the exam chair.

I dont have the greatest back courtesy of my mother's genetics. Its fine and I can get down on my hands/knees still but its not great and wont get better with time. At some point I have to start refusing care. I dont know the legality behind refusing care to someone in a wheelchair. That sounds messy legally.

I should move back to my old gig. Its just the hours worked there that killed me. They already reached out and said they would hire me back again because they need their workhorse mule back lol. 80 hours a week easy. It paid decent tho.

Keep doing it. Claim long term disability. Retire from podiatry. Enjoy your life.