Opthomologist or Podiatrist? who knows diabetes more? :-)

[cool_vkb]

I met a 2nd yr Optho resident today. We had a great conversation on so many topics and then finally it came to diabetes. the question was "Who knows or handles Diabetics more? ".

Before i go futher, i would like to add that these are his personal views. he does not represent or speak for the entire opthomology board or any other organization. it was a friendly conversation. so please lets not make it a thread war or anything else

He claimed Opthos are undisputed kings when it comes to handling diabetic related Eye pathologies. They are no endocrinologists or internists but they know their stuff and if it comes to saving the eye they will happily over look the PCPs medical plan and take over the patient and prescribe or do whatever is needed. He said DPMs cant even prescribe for the whole body so there is no way they can ever intervene for the welfare of their patient. they are on the mercy of the primary doc and accoridng to him it can get very risky because if the patients diabetes is not in control then no matter what we do at the foot . its never gonna work. now this was his version. im sure he has his ignorances and defects.

Since my School houses the famed CLEAR institute it was very hard for me to believe what he was saying. I mean common people we deal with diabetic ulcers every single day. i think we deal or know more abt them . be it basic nail care for diabetics, wound management , debridement , amputations or limb salvage. Diabetics form a very huge percentage of our clients.

Can the residents/pods share their views on the topic.

---

Members don't see this ad.

 

[PMSIII]

I met a 2nd yr Optho resident. We had a great conversation on so many topics and then finally it came to diabetes. the question was "Who knows or handles Diabetics more? ".

well he claimed Opthos are undisputed kings when it comes to handling diabetic related pathologies. They are no endocrinologists or internists but they know their stuff and if it comes to saving the eye they will happily over look the PCPs medical plan and take over the patient and prescribe or do whatever is needed.

Since my School houses the famed CLEAR institute it was very hard for me to believe what he was saying. I mean common people we deal with diabetic ulcers every single day. i think we deal or know more abt them then anybody else. be it basic nail care for diabetics, wound management , debridement , amputations or limb salvage. Diabetics form a very huge percentage of our clients.

Can the residents/pods share their views on the topic.

Well for starters we do not have clients, we have patients. Second, diabetic patients also represent a fair portion of an opthomologist's practice. I don't think its fair to assess who out of both groups necessarily knows more about the pathology because both clinicians need to know everything about diabetes for proper patient care - period. No one can argue the clinical manifestations in the eye, as well as those occuring in the lower extremity. I would hope for the sake of the patients that both groups know everything that has to do with diabetes - pathology, manifestations, medications.

 

[sapna]

I agree that Opthos are undisputed kings when it comes to handling diabetic related Eye pathologies.

I also believe that podiatrists are, similarly, undisputed kings when it comes to handling diabetic related foot/LE pathologies.

Foot and ankle orthos probably are pretty darn good, but then so are optometrists. I think it's pretty hard to draw a clear line between optometrists/opthamologists and orthos/podiatrists with this issue. There will be some ortho's better than some pod's and vice versa.

HAving said that, the whole discussion is kind of stupid. Who would you expect to know eye pathologies better than an opthamologist. It's like, would you go to a cardiologist for a neurological problem? Stupid. I certainly would never go to a podiatrist for eye problems nor would i go to the best opthamologist in the world for foot problems.

 

[Podmeister]

The endocrinologist knows more about diabetes than both the opthalmologist and podiatrist combined so end of story.

 

[sapna]

The endocrinologist knows more about diabetes than both the opthalmologist and podiatrist combined so end of story.

of course. but the debate can exist when it comes to diabetes effects on specific body parts like the eye/foot etc.

managing diabetes = endocrinologist.
managing retinopathy secondary to diabetes = opthamologist.
managing non-healing ulcer secondary to diabetes = podiatrist

 

[Pinkertinkle]

it's ophthalmologist

 

[KingJ]

well no ****... of course Opthomologists are the undisputed kings of diabetic eye problems... im sure they are the undisputed kings of anything related to the eye.... its common sense... they specialize in treating eye disorders...

and guess what? podiatrists are undisputed kings of anything located below the knee.. because thats their speciality. i mean come on.

oh and your eye doc is completely wrong about what a podiatrist and prescribe, i have shadowed 3 podiatrists here in Nevada, I asked all of them about prescriptions and they all said pretty much the same thing: they can legally prescribe any drug which is in the best interest of their patient, but they don't usually stray outside of common pod drugs.. just as how a Opthomologist probably isnt going to prescribe you heart meds, neither is a Podiatrist...

 

[Feli]

There's really nothing wrong with what he said, but the part implied regarding an optho possibly trumping the patient's PCP, IM, endo, etc is just not accurate. They are a consult service, if anything they make "recommendations," just as a consulted pod could. You would lose consults pretty darn fast if you went around cancelling or drastically changing the meds and/or care plan the referring doc had chosen. These kind of pre-med or early MS ego battles are kinda funny.

The endocrinologist knows more about diabetes than both the opthalmologist and podiatrist combined so end of story.

Exactly^^ Endo and/or IM are definitely the captain of the ship when it comes to managing the diabetics overall disease.

Optho, pod, vascular, plastics, ortho, nephro, etc etc are just part of the team and specialty consults for their respective areas of expertise. However, they often detect early changes which give clues that the disease is advancing... or they sometimes even diagnose the disease initially in patients who neglect to visit PCPs regularly.

 

[NatCh]

...they will happily over look the PCPs medical plan and take over the patient...

It's hard to believe any PCP would want or need Ophthalmology to "take over" general medical management.

It's hard to believe any Ophthalmologist in practice would want to "take over" general medical care of any patient.

 

[Foot Doc]

they do eyes, we do feet....problem solved

 

[Feli]

It's hard to believe any PCP would want or need Ophthalmology to "take over" general medical management.

It's hard to believe any Ophthalmologist in practice would want to "take over" general medical care of any patient.

Yep^, and it'd equally true if you replace "opthalmologist" with "podiatric surgeon." Few specialists want to spend time doing general medical care tasks that there are IM/FP/etc docs who are paid to do that and are undoubtedly better/faster at it.

I still don't really understand the mindset of some DPMs and/or their residents/program wanting to be the primary admitting doc and medically managing inpatients. Not only does it take up a ton of your time, nobody can make the convincing argument that any surgical specialist is equal/better at medically managing their inpatients who have many comorbidities than the IM team would be (aside from maybe the rare exception of some very tough trauma surg, OB/gyn, or neurotrauma cases). From my limited experience, ortho, ENT, plastics, optho, etc etc all seem happy to co-admit or just be the consulting service on their surgical inpatients and then sign off fairly soon after their procedure appears to have gone well. It gives them time to see and help more patients since they aren't bogged down with comprehensive medical management and piles of paperwork that IM is almost invariably better and more efficient at.

Clearing your own pts for surgery as a DPM or tweaking a med list as needed? Ok, but I'd be perfectly content letting medicine/ICU docs do what they are the most trained for and stick to what I'll be most trained for.

 

[NatCh]

Yep^, and it'd equally true if you replace "opthalmologist" with "podiatric surgeon."

I still don't really understand the idea of some DPMs and/or their residents/program wanting to be the primary admitting doc and medically managing inpatients. Not only does it take up a ton of your time, nobody can make the convincing argument that any surgical specialist is equal/better at medically managing their inpatients who have many comorbidities than the IM team would be (aside from maybe the rare exception of some very tough trauma surg, OB/gyn, or neurotrauma cases). From my limited experience, ortho, ENT, plastics, optho, etc etc all seem happy to co-admit or just be the consulting service on their surgical inpatients and then sign off fairly soon after their procedure appears to have gone well. It gives them time to help more patients since they aren't bogged down with comprehensive medical management and piles of paperwork that IM is almost invariably better and more efficient at.

Clearing your own pts for surgery as a DPM or tweaking a med list as needed? Ok, but I'd be perfectly content letting medicine/ICU docs do what they are the most trained for and stick to what I'll be most trained for.

Agreed. The only time/place where it's preferable to have our own admitting privileges is in ASA I or ASA II outpatient cases with minimal or no medical issues. It saves the patient time and money by being able to admit directly to the surgery center or hospital rather than make them see another doctor before surgery. Otherwise, I think it's good to keep the PCP in the loop for medical, legal, and practice management reasons.

 

[Podmeister]

He claimed Opthos are undisputed kings when it comes to handling diabetic related Eye pathologies. They are no endocrinologists or internists but they know their stuff and if it comes to saving the eye they will happily over look the PCPs medical plan and take over the patient and prescribe or do whatever is needed. He said DPMs cant even prescribe for the whole body so there is no way they can ever intervene for the welfare of their patient. they are on the mercy of the primary doc and accoridng to him it can get very risky because if the patients diabetes is not in control then no matter what we do at the foot . its never gonna work. now this was his version. im sure he has his ignorances and defects.

.

In theory, the ophthalmologist cited in your example has the medical legal right to prescribe whatever is needed for the diabetic patient, but in reality or real practice, no surgical specialist would want to take over the medical management of a chronic condition, especially when the patient already has a primary care physician (PCP). By doing so would only tick off the PCP and adversely affect one's relationship down the line. Just last month, one of the PCP in my group referred a patient for a cardiology consultation, and later discovered that certain non-cardiology related medications were altered by the cardiologist. Well, guess what…no more referrals to that particular cardiologist. Is it fair? Is it right? Well, that's the medical world that we live in where turf wars are not uncommon. ..so get use to it and don't bite the hand that feeds you.

If you are worried about the diabetic patient's uncontrolled blood sugar level which might affect his or her foot healing potential, then simply pick up the phone, speak to the PCP directly and express your concerns. When treating the diabetic population, communication is key and requires a multi-disciplinary team approach. As podiatrists, we are apart of that team so never be afraid to speak up.

 

[Meibomian SxN]

I met a 2nd yr Optho resident today. We had a great conversation on so many topics and then finally it came to diabetes. the question was "Who knows or handles Diabetics more? ".

He claimed Opthos are undisputed kings when it comes to handling diabetic related Eye pathologies. They are no endocrinologists or internists but they know their stuff and if it comes to saving the eye they will happily over look the PCPs medical plan and take over the patient and prescribe or do whatever is needed. He said DPMs cant even prescribe for the whole body so there is no way they can ever intervene for the welfare of their patient. they are on the mercy of the primary doc and accoridng to him it can get very risky because if the patients diabetes is not in control then no matter what we do at the foot . its never gonna work. now this was his version. im sure he has his ignorances and defects.

Since my School houses the famed CLEAR institute it was very hard for me to believe what he was saying. I mean common people we deal with diabetic ulcers every single day. i think we deal or know more abt them . be it basic nail care for diabetics, wound management , debridement , amputations or limb salvage. Diabetics form a very huge percentage of our clients.

Can the residents/pods share their views on the topic.

1) The "2nd yr resident is just that, a resident. Very eager but no real wrold experience yet. I do not know of any ophthalmologist that would screw with a Px's diabetic/heart/thyroid meds unless they are crazy! Its not difficult to Rx Lipitor drugs, but the problem occurs when the diabetes has an adverse systemic effect and the patient goes into renal failure. That's when the ophthalmologist would be fried....

2) As already stated, Ophthalmologist/Optometrist are the go to person for diabetic ocular manifestations. That's why PCPs, endocrinologist etc HAVE to send the diabetic patient for a annual medical eye exam. The PCP knows more systemic knowledge about diabetes but not eyes. Same can be said about a dentist and diabetic manifestations in the mouth.

3) MDs can prescribe for the whole body but trust me when I tell you that the Pharmacist ultimately fills the Rx and they generally question out of scope meds (I know from experience with trying to Rx myself cough syrup as a eye doctor lol)!

 

[whiskers]

Usually the person who knows the most about something is the same person who has applied them the most towards that goal.

It has very little relation to profession.

If you want to learn about diabetes as a lay person and read a bunch of books and take a few classes, you may know more than either a pod or opth.

It's a silly question without any merit IMO.