malleolusman

keeping it real since 1981
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Mar 5, 2009
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Attendings and practicing physicians out there; What is the level on which we can operate in an emergency situation?

For example, if someone is injured in a MVA? How is the distinction in court made between podiatrist and civilian in assisting someone?

Or if someone experiences a heart attack or anaphylactic shock etc?

What have your experiences been with the above?
 
Oct 11, 2010
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The old time pods may not know much about emergency medicine but the new pods are highy skilled and rotate through ER, gen surgery etc. Many have dealt with codes on the floors.

Pods of today are as well trained or more so than family med docs or IM docs. The emphasis is different. But todays pods and probably yesterdays pods can work up an old guy that keels over.
 

Makati2008

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The old time pods may not know much about emergency medicine but the new pods are highy skilled and rotate through ER, gen surgery etc. Many have dealt with codes on the floors.

Pods of today are as well trained or more so than family med docs or IM docs. The emphasis is different. But todays pods and probably yesterdays pods can work up an old guy that keels over.
Hmmm that maybe a tad suspect...I highly doubt that.
 

hematosis

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Hmmm that maybe a tad suspect...I highly doubt that.
I agree. There is no doubt that pods are trained more(7 years), in the lower extremity, than ANY MD specialty . However, while the newer pod students do 3 year residency and must do rotations in EM, ortho, etc, it is not the entire 3 years. most of the time in residency is spend on lower extremity.
 

Podfather

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The old time pods may not know much about emergency medicine but the new pods are highy skilled and rotate through ER, gen surgery etc. Many have dealt with codes on the floors.

Pods of today are as well trained or more so than family med docs or IM docs. The emphasis is different. But todays pods and probably yesterdays pods can work up an old guy that keels over.
This old time pod (25 years in practice) would be more than happy to go head to head with you on any medical subject. I help train residents and it is a rare event when they blow me away medically. Frankly it surprises me how these mainstreamed people often seem less prepared medically than me and some of my peers both at the start and the end of residency. I think some of it is related to the old timers being under the microscope so much we over compensated when it came to medicine. Do not get me wrong they(todays residents) are bright and certainly their training today is great. I am proud of them and our profession but just love hearing people like you imply senior DPMs are somehow not as good or holding you back. BTW I was one of the first DPMs who was ACLS certified taking the course with the anesthesia residents at a prominent medical school. The course was very intense in the early 80s and some of the anesthesia residents failed. After that I became an instructor for a while and when I started residency, in some of the smaller hospitals, I was often the only or one of a few who had this training. I ran some codes and was asked to respond when one was called.

As to your comment as being as good as a medical specialty. I would agree that a DPM is better than having no one with any any medical training on the scene, And yes I would prefer a DPM with ACLS than say an opthalmologist or a psychiatrist who wasn't ACLS certified helping me in a cardiac arrest. However, when in doubt defer to the MD for training, experience, and perception reasons. The public and a a jury will not understand how a "foot doctor" took over for the MD. There was case involving a DPM in Montana where an EMT was offended and even though the DPM and an ER nurse worked to expedite care after an MVA, the attorney general charged the DPM with practicing medicine without a license. Finally, above all do no harm. Yes CPR and ACLS if you are current, certified, and the most trained on the scene should be delivered but trauma such as MVAs etc should be handled by the experts. Often this may be a paramedic, EMT, or nurse. Egos should be checked whether you are DPM, MD, or DO.
 
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PADPM

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I'm another "old time pod" who will be happy to match wits with any of the new breed on any topic.

I hate to break the news to the "young" docs, but those of us who have been in practice for 20 or 25 years are not "chiropodists" and the emergency room isn't a new invention.

Yes, many actually had the opportunity to have multi year residencies and rotate through ERs, and rotated through general surgery, orthopedic surgery, plastic surgery, etc., etc., just like you. And we often did it without the ability to rely on MRI's, computers, Blackberrys, etc. When we wanted or needed information, we often had to actually pound the pavement, open a book, go to the lab ourself, go to radiology, etc., and didn't have the ability to access everything on a computer screen.

And please don't forget who is usually teaching you, the same doctors who are "old timers".
 
Aug 26, 2010
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And please don't forget who is usually teaching you, the same doctors who are "old timers".
You beat me to it. This is exactly what I had intended on writing as well.
 

Podfather

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I'm another "old time pod" who will be happy to match wits with any of the new breed on any topic.

I hate to break the news to the "young" docs, but those of us who have been in practice for 20 or 25 years are not "chiropodists" and the emergency room isn't a new invention.

Yes, many actually had the opportunity to have multi year residencies and rotate through ERs, and rotated through general surgery, orthopedic surgery, plastic surgery, etc., etc., just like you. And we often did it without the ability to rely on MRI's, computers, Blackberrys, etc. When we wanted or needed information, we often had to actually pound the pavement, open a book, go to the lab ourself, go to radiology, etc., and didn't have the ability to access everything on a computer screen.

And please don't forget who is usually teaching you, the same doctors who are "old timers".
Just today after explaining cellular vs. humoral immunity and bacteriostatic vs bacteriocidal antibiotics to a resident, I said to my partner with a smile "Imagine how smart I would have been with Google in the 80s" LOL Kids................. LOL
 

G0dFather

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Just today after explaining cellular vs. humoral immunity and bacteriostatic vs bacteriocidal antibiotics to a resident, I said to my partner with a smile "Imagine how smart I would have been with Google in the 80s" LOL Kids................. LOL

I dont mean to sound rude , but is it ok for a resident not to know this basic knowledge.. i know we all forget things but still .... or did you go into great depth about these subjects with your resident ?
 
Aug 26, 2010
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I dont mean to sound rude , but is it ok for a resident not to know this basic knowledge.. i know we all forget things but still .... or did you go into great depth about these subjects with your resident ?
For a resident not to know this information is not good at all. Especially if they are in their first year where these things come up on their medical rotations. These things also come up on board exams.

I just helped a student out with some mock interview questions (for the upcoming CASPR interviews) and was amazed that she didn't know the basic trauma classifications she JUST learned. I've been out about ten years and certainly don't use this information daily, but still have the knowledge in my database (brain) through my monthly journal readings.

There are certain things you MUST know as a physician. Even if its at a basic level so that you can either be part of a treatment team or know to where to refer some of your patients.

Edit: I had to look up Cellular vs. Humoral Immunity just to be sure. Thanks for reminding me about it Podfather! I relearned something old which is now new again today. My old brain just doesn't work like it used to lol!
 
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Podfather

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I dont mean to sound rude , but is it ok for a resident not to know this basic knowledge.. i know we all forget things but still .... or did you go into great depth about these subjects with your resident ?
It's not rude. Unfortunately some residents enter residency and are not prepared as much as they should be. The schools have a new approach where they believe a lot of preparation for practice should be deferred to the residencies. They state that all (except next year) graduates now do 3 year residencies and they no longer have to prepare graduates for practice. I would agree that someone starting a program should have basic sciences down but some do not. We also have lost a lot of basic podiatry training. When the education was mainstreamed (overall a good thing) basic common sense podiatry was traded away. Simple things like: give me the differential diagnosis of an nucleated lesion beneath a metatarsal head. Then there were the 2 residents I had a couple of years ago that did not know how to perform basic charting. They wrote orders on the progress notes and didn't know what was supposed to be in a note. When queried both stated they had spent no time writing on charts in a hospital. So yes there unfortunately is a lot of remedial education. Add that to all of the CPME requirements and 3 years is hardly enough.

We do have some good people who do entered prepared and I can usually guess what school a student is from with a few questions (translation there are schools who do a better job).
 
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G0dFather

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Aug 2, 2008
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It's not rude. Unfortunately some residents enter residency and are not prepared as much as they should be. The schools have a new approach where they believe a lot of preparation for practice should be deferred to the residencies. They state that all (except next year) graduates now do 3 year residencies and they no longer have to prepare graduates for practice. I would agree that someone starting a program should have basic sciences down but some do not. We also have lost a lot of basic podiatry training. When the education was mainstreamed (overall a good thing) basic common sense podiatry was traded away. Simple things like: give me the differential diagnosis of an nucleated lesion beneath a metatarsal head. Then there were the 2 residents I had a couple of years ago that did not know how to perform basic charting. They wrote orders on the progress notes and didn't know what was supposed to be in a note. When queried both stated they had spent no time writing on charts in a hospital. So yes there unfortunately is a lot of remedial education. Add that to all of the CPME requirements and 3 years is hardly enough.

We do have some good people who do entered prepared and I can usually guess what school a student is from with a few questions (translation there are schools who do a better job).
Fantastic, thanks for the input!
 

krabmas

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I dont mean to sound rude , but is it ok for a resident not to know this basic knowledge.. i know we all forget things but still .... or did you go into great depth about these subjects with your resident ?
As a resident or an attending it is not imparitive that you know everything.

Are there certain topics that you are expected to know - yes, but sometimes you may forget.

I think it is more important to know what you know, and even more important to know what you don't know and be able to admit it to an attending or patient. As a patient I appreciate and respect the doctor who knows what he/she doesn't know and when to refer.
 

Podfather

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May 10, 2009
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As a resident or an attending it is not imparitive that you know everything.

Are there certain topics that you are expected to know - yes, but sometimes you may forget.

I think it is more important to know what you know, and even more important to know what you don't know and be able to admit it to an attending or patient. As a patient I appreciate and respect the doctor who knows what he/she doesn't know and when to refer.

Yes but bacteriostatic vs. Bacteriocidal? You can not refer everyone.
 
Aug 26, 2010
2,036
10
Not where you think
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Attending Physician
As a resident or an attending it is not imparitive that you know everything.

Are there certain topics that you are expected to know - yes, but sometimes you may forget.

I think it is more important to know what you know, and even more important to know what you don't know and be able to admit it to an attending or patient. As a patient I appreciate and respect the doctor who knows what he/she doesn't know and when to refer.
Let me get this straight. So, Podfather, who has probably been out in practice for what, 20 years or longer? He knows these topics, but someone fresh out of school doesn't? Sorry, you lost me on that one.

I would like to think I'm an averagely intelligent practitioner (maybe not?), but for a student I'm helping with residency interviews to not know the trauma classifications they learned last year, and I can rattle them off 15 years later? That seems a little odd to me.

Forgetting due to lack of use, or not keeping up with the literature is one thing. But fresh out of school not being to answer these basic question is entirely another. My 2 cents...
 

PADPM

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I agree with Krabmas that the best practioners are those who "know what they don't know". And of course after we've been in practice for a few years, it's certainly not possible to remember everything and it's natural that we also forget some of the small details or some of the intricacies of those portions of practice that don't interest us or we don't often treat/see.

In my practice, I don't treat/see a lot of pediatric deformities, therefore I have "forgotten" a lot of details that I used to know or maybe should know.

However, as per Kidsfeet's post, a student or a resident is at a time in his/her training when the information is fresh and when that student/resident is probably at the peak of knowledge and there is really very little excuse to not know the basics. Granted, experience will be the best teacher regarding clinical questions and decisions, but basic academics should be pretty fresh in the minds of students and residents.

But PLEASE don't ask me to recite the Krebs cycle!
 

Podfather

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I agree with Krabmas that the best practioners are those who "know what they don't know". And of course after we've been in practice for a few years, it's certainly not possible to remember everything and it's natural that we also forget some of the small details or some of the intricacies of those portions of practice that don't interest us or we don't often treat/see.

In my practice, I don't treat/see a lot of pediatric deformities, therefore I have "forgotten" a lot of details that I used to know or maybe should know.

However, as per Kidsfeet's post, a student or a resident is at a time in his/her training when the information is fresh and when that student/resident is probably at the peak of knowledge and there is really very little excuse to not know the basics. Granted, experience will be the best teacher regarding clinical questions and decisions, but basic academics should be pretty fresh in the minds of students and residents.

But PLEASE don't ask me to recite the Krebs cycle!
Glucose goes to Glucose 6 phosphate to Glucose 1,6 diphosphate then I'm lost. LOL. Impressed I got to step 3. If this is right.

I agree with the theme that you can't remember everything but PADPM you would know where to go for the answer and would look it up. In the past that meant pulling out a book. Today fresh out of school some residents may not know an answer to something essential. I used to just tell them but now say you really need to know this. About 50% of the time a week later some still do not have the answer. Yes the good ones either know it cold or like you and me look it up.
 

Coastie

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Attendings and practicing physicians out there; What is the level on which we can operate in an emergency situation?

For example, if someone is injured in a MVA? How is the distinction in court made between podiatrist and civilian in assisting someone?

Or if someone experiences a heart attack or anaphylactic shock etc?

What have your experiences been with the above?
:laugh:
:thumbup: Good thread
 

Coastie

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Oct 17, 2005
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The old time pods may not know much about emergency medicine but the new pods are highy skilled and rotate through ER, gen surgery etc. Many have dealt with codes on the floors.

Pods of today are as well trained or more so than family med docs or IM docs. The emphasis is different. But todays pods and probably yesterdays pods can work up an old guy that keels over.
:laugh::laugh::laugh::laugh:
:thumbup: GREAT thread!