Can podiatrists handle basic internal medicin issues?

[MysteryDiagnosis]

So if a podiatric patient presents to the office for some regarding their lower extremety but have diabetes or a bronchitis or whatever, can the podiatrist prescribe them insulin or antibiotics

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[heybrother]

Legally, podiatry's scope varies state to state, but why would you want to. This isn't a backdoor path to being an internist. This is its own unique field that will provide you with a knowledge set that in my experience - few other medical professionals have. It has value and you will have plenty of other ways to help people and satisfy your professional interests. Having completed school and residency, would you have the mental capacity - sure, nurses with far less training are apparently taking over urgent cares across the country. You will complete some variation of an internal medicine rotation - residents experience managing systemic issues will vary. But again, why would you want to. Toss a referral to the people who manage this 20 times a day. My time with other MD specialists is that they happily treat within their area of expertise and refer the rest on.

 

[dyk343]

I frequently medically manage patients in the perioperative (hospitalized) setting all the time. I have no problem managing a relatively uncomplicated diabetic patient's insulin while hospitalized (continuing basal insulin + starting a sliding scale is not rocket science). If they are a brittle diabetic or with severe comorbidities I will get a medicine consult as they know it best.

I don't think any of us would Rx antibiotics to treat pneumonia (bronchitis as you put it). That would be a medicine consult as that's not our place.

 

[hematosis]

no

 

[I post PRN]

I think why would you want to is the best answer to this question. Ha

 

[Creflo]

Sometimes you do need to get involved in medicine. I'm managing a delayed union and ran pth, calcium, vitamin d labs. They returned slightly abnormal so I ordered a bone density scan to see if it supports the abnormality. Now the results are in, I will turn over to medicine. Where I work the patient has been somewhat ignored by primary care, so I had to step in and do these things to justify further workup. Other times you may need to manage anti coagulation therapy when immobilizing a patient with a hypercoagulability disorder or history of blood clot. I would never get into medicine issues that don't relate to the foot /ankle.

 

[FootAndAnkle]

So if a podiatric patient presents to the office for some regarding their lower extremety but have diabetes or a bronchitis or whatever, can the podiatrist prescribe them insulin or antibiotics

You could prescribe the medications, but it would be a bad idea as this would be outside of your scope and be indefensible if something went wrong. You can manage basic things like insulin if you have an inpatient and are the primary service without a consult to medicine or endocrinology. Your patients deserve excellent, well-qualified care, so just as others here have said, it's in everyone's best interest to recognize the purview of other physicians just as they recognize and value yours.

 

[hematosis]

In some hospitals Podiatry is a primary admit service (I think some VA hospitals, Medstar ?). In that case, they will admit from the ED or clinic any patient with F/A pathology (Open fracture, DFU, etc) that meets admission criteria. Being the admitting team, they'll have to do a full H/P, start and dose their medication and any complications as an inpatient. So for example, for the Diabetes question, you can restart their outpatient insulin regimen or if they are on an oral like metformin, u can start sliding scale, prandial, nph, based on weight, etc, etc. But even so, I imagine you'll have to consult medicine if things get too crazy. Sometimes even medicine won't manage them and defer to Endocrine.

As a resident, my program was a consult team but we were able to admit healthy patients. Admitting and managing co morbidities was my least favorite part of residency.

Work within your scope. Don't try to be a hero.

 

[GypsyHummus]

I remember asking the podiatrist I shadowed that before and she said she would "medically manage" if the patient was asking for a specific type of surgery and was a high risk patient, then she would do some light (I mean very very superficial) diabetic and weight management.

Honestly, as a pod, why would you want to? One of the attractive things about this profession is not having to deal with all that other stuff and focus on fixing the problem.

 

[AttackNME]

The great thing about medically managing your own diabetic foot infections is that they can be complicated in terms of discharge course, wounds may turn south pretty quickly and being the podiatrist you can delay or expedite discharge plans based on your expertise. Usually these types of patients end up on podiatry service if they are admitted primarily for a foot infection. If they are in DKA, in septic shock, they will be admitted to the ICU and medicine will take care of it until they are stable for the floor and then you can take over. If they are stable and admitted for just the foot infection, and is having some postop chest pain, as a podiatrist you can do a quick assessment, order stat EKG, troponins, chest xray if you suspect pulmonary issues in ddx, and call cardiology, or you can just call cardiology and ask them what to order. If they develop AKI, you can again do an assessment ask about hx of obstruction/bph, order PVR, follow the Cr, if you feeling fancy order a fena, hold nephrotoxic drugs, hold ACEI and any other htn meds that affect the afferent tubules of the kidneys which I'm not remembering, and then consult nephrology. OR you can just call them and ask them what to do. If they develop a swollen scrotum... you get the picture.. evaluate, then consult urology. You're not alone, medicine would be doing the same thing, evaluate what you can, start a workup based on what you know or are comfortable with, and then consult the appropriate service, they're available as a resource and you are not expected to know everything, but you should do at least the most basic workup based on what you do know. Same for outpatient problems, only I would lean towards deferring to their PCP rather than refer directly to the specialist. Unless it's ortho related stuff then I would evaluate, order appropriate workup/imaging, then refer.

 

[podoloco]

Dr Wenstrup was on the scene at today's shooting in VA, unfortunately it's necessary to say which one. Needless to say, he did not hesitate to jump into action and help save his injured colleague.
Rep. Brad Wenstrup tended to wounds in congressional baseball shooting - CNN.com

 

[GypsyHummus]

And now podiatrists can be heroes.

Dr Wenstrup was on the scene at today's shooting in VA, unfortunately it's necessary to say which one. Needless to say, he did not hesitate to jump into action and help save his injured colleague.
Rep. Brad Wenstrup tended to wounds in congressional baseball shooting - CNN.com