Hello! & Question: In an emergency...

[dallasite]

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Hi guys. First, a short intro: Graduated May '06, was pre-med, working now as a medical devices rep, applying to pod school for next year! I've been stalking this site for a while and many of you have really helped me with my career change. Thank you! =)

My question: A few weekends ago, at a party, a friend slipped and fell on a wine glass. She cut her leg, about a 2 inch laceration, just above the knee. My question is, being aware of the scope of practice of podiatry, how does that factor in with minor "first-aid" in accidents? Assuming I get in, graduate, and become the best clinician ever, would I ever be legally allowed to help with "accidents" like that? Would you just do it (assuming you have the appropriate sterile supplies in office, or where ever) or send her to a hospital to wait for several hours.

Moreover, as an MC/DO/Nurse etc... there are those new laws that require you to help in an emergency situation. Before, those clinicians were hesitant as they didn't want to get sued if something went wrong. Does that also affect podiatrists? What about on the airplane when someone is passing out and they call for a doctor or a nurse. Do you sit there? I would say pods probably know more medicine that the average passenger (or nurse). So help?

So, in the end, could I have stitched up my friend? Helped the passing out passenger on the plane? Prescribe meds for a friend/family (not a paying patient) who's come down with the flu/severe cold? Where do you guys draw the line or what have you been told in school/practice?

Thank you again!

 

[Feli]

...Where do you guys draw the line or what have you been told in school/practice? ...

Uhh, I can only speak for myself, but I'd say I "draw the line" the same place the governing laws do 😉

I know it was just an example, but a small leg scratch is definetly not life-or-death or something most people would risk their license over. If it was a trusted friend who is obviously not going to file litigation or anything on the tiny chance the wound would keloid or get infected, some DPMs might offer to irrigate and sew it in their office. That would be polite rather than sending her to the walk-in ER and to spend $300+ for the same simple skill, but it's a personal judgement call (especially in areas where the required care is not within DPM scope).

As far as the plane/wilderness/desert island scenerio, there are "good samaritan" acts in most areas which will protect you if you are using your skill to assist someone in a dire situation. A piece of glass in a drunk girl's thigh at a party in the middle suburbia just isn't one of those situations lol.

 

[jonwill]

Hi guys. First, a short intro: Graduated May '06, was pre-med, working now as a medical devices rep, applying to pod school for next year! I've been stalking this site for a while and many of you have really helped me with my career change. Thank you! =)

My question: A few weekends ago, at a party, a friend slipped and fell on a wine glass. She cut her leg, about a 2 inch laceration, just above the knee. My question is, being aware of the scope of practice of podiatry, how does that factor in with minor "first-aid" in accidents?

So, in the end, could I have stitched up my friend?

Depends on the state scope. Many states allow treatment of soft tissue up to the thigh. In those states, you'd be perfectly within your scope.

 

[saxifoneforgod]

Prescribe meds for a friend/family (not a paying patient) who's come down with the flu/severe cold? Where do you guys draw the line or what have you been told in school/practice?

Thank you again!

I would also like to know about this particular portion of the OP's question.

 

[cool_vkb]

Many states allow treatment of soft tissue up to the thigh.

when they say Soft tissue upto the thigh. what exactly does it mean. plzzz explain with some sort of example. plzzzzzzzzz.

 

[jonwill]

when they say Soft tissue upto the thigh. what exactly does it mean. plzzz explain with some sort of example. plzzzzzzzzz.

Generally, it means dermatoligical manifestations. One of the main reason the law is in place is to allow pods to take skin grafts from the thigh when needs be.

Concerning writing Rx's for friends and family, I've had pods do it for me and I've seen pods do it. But from a legal standpoint, if something did go wrong, you'd be in huge trouble.

 

[densmore22]

Agreed, judgement call. It's technically unethical to treat a family member, but mom has written me countless scripts for sinus infections (she's an internal med NP) and I think it also depends on the pharmacist who fills the script also. If it's a trusted friend/colleague, shouldn't be a problem, but if you walk into podunk Pharmacy and they question the script, you might get in trouble. I wouldn't be writting for Birth control if I were a pod, but most people aren't going to question an ABO script or even a narc script, but I wouldn't make it a regular practice to be writting out narcs to people, only the occasional "just to get you by this weekend." AND I would make sure it's a good friend or a family member and not just random people in your practice or random people at parties/social events/friends of friends. You'll get a lot of this in your ethics class 1st year, they'll spell it out, but again, there's always exceptions to the rule.

I'd sew up a friend/family member from head to toe, make sure I covered them w/ ABO's, took a quick history, but I would do it for just anybody. I've worked too hard (and eventually it will get to be long too) to have my career thrown away on some butt hole that just wanted money or narcs.

 

[dallasite]

ABO? As in blood? or, I'm assuming-- AntiBiOtic?

 

[densmore22]

My bad, yeah ABO is antibiotic in my lingo. You start to write shorthand when you get here otherwise you spend way too much time writing things out.

 

[JEWmongous]

soft tissue = skin, tendons, muscles, fat, blood vessels, etc
hard=bone

I understand having soft tissue of the lower leg/calf in your state scope of practice allows for skin grafts to be harvested by pods for surgeries (reconstructive, etc). I heard also for treating diabetic ulcers/venous stasis ulcers. Obviously, you won't be doing knee surgery, hip transplants, and the like.

I believe that if your state scope of practice does not allow treatment of soft tissue of the thigh/calf region, you would need an MD/DO surgeon with you in the operating room to harvest the skin graft from the thigh/calf. I even think the pod can do the procedure but its under the "supervision" of an MD/DO surgeon. Seems like its a little annoying with the different state scope of practice laws on this area. Guys, please correct me if I'm wrong on this part.

 

[Dr_Feelgood]

Hi guys. First, a short intro: Graduated May '06, was pre-med, working now as a medical devices rep, applying to pod school for next year! I've been stalking this site for a while and many of you have really helped me with my career change. Thank you! =)

My question: A few weekends ago, at a party, a friend slipped and fell on a wine glass. She cut her leg, about a 2 inch laceration, just above the knee. My question is, being aware of the scope of practice of podiatry, how does that factor in with minor "first-aid" in accidents? Assuming I get in, graduate, and become the best clinician ever, would I ever be legally allowed to help with "accidents" like that? Would you just do it (assuming you have the appropriate sterile supplies in office, or where ever) or send her to a hospital to wait for several hours.

Moreover, as an MC/DO/Nurse etc... there are those new laws that require you to help in an emergency situation. Before, those clinicians were hesitant as they didn't want to get sued if something went wrong. Does that also affect podiatrists? What about on the airplane when someone is passing out and they call for a doctor or a nurse. Do you sit there? I would say pods probably know more medicine that the average passenger (or nurse). So help?

So, in the end, could I have stitched up my friend? Helped the passing out passenger on the plane? Prescribe meds for a friend/family (not a paying patient) who's come down with the flu/severe cold? Where do you guys draw the line or what have you been told in school/practice?

Thank you again!

FYI: Under the Good Sumartian Act, you cannot be legal found guilty if you are helping a person in a emergent situation. So if you are giving CPR or treating a head laceration in an emergent case, scope is through out of the window. Now if you are seeing them as a patient or in the ER (outside of residency), then you must worry about scope.

 

[IlizaRob]

FYI: Under the Good Sumartian Act, you cannot be legal found guilty if you are helping a person in a emergent situation. So if you are giving CPR or treating a head laceration in an emergent case, scope is through out of the window. Now if you are seeing them as a patient or in the ER (outside of residency), then you must worry about scope.

I may be wrong but I thought that only applied to specific health professionals, ie. MD/DO. If joe on the street trys to help someone out who fell 40 feet, then ends up braking the victim's neck, I wonder if Joe is protected, given that he has no medical background whatsoever. I dont know, maybe I should look it up.

 

[krabmas]

Agreed, judgement call. It's technically unethical to treat a family member, but mom has written me countless scripts for sinus infections (she's an internal med NP) and I think it also depends on the pharmacist who fills the script also. If it's a trusted friend/colleague, shouldn't be a problem, but if you walk into podunk Pharmacy and they question the script, you might get in trouble. I wouldn't be writting for Birth control if I were a pod, but most people aren't going to question an ABO script or even a narc script, but I wouldn't make it a regular practice to be writting out narcs to people, only the occasional "just to get you by this weekend." AND I would make sure it's a good friend or a family member and not just random people in your practice or random people at parties/social events/friends of friends. You'll get a lot of this in your ethics class 1st year, they'll spell it out, but again, there's always exceptions to the rule.

I'd sew up a friend/family member from head to toe, make sure I covered them w/ ABO's, took a quick history, but I would do it for just anybody. I've worked too hard (and eventually it will get to be long too) to have my career thrown away on some butt hole that just wanted money or narcs.

It is actually not unethical to treat a family member. It does depend on the circumstance though. surgery and life or limb situations where there is someone else that is just as capable to treat then it is unethical for you to treat an immediate family member.

I have also heard (unsure of truth) that if you do treat a family member (take out an ingrown nail) you cannot bill for it. Has anyone else heard this, or is it completely made up?

 

[Dr_Feelgood]

I may be wrong but I thought that only applied to specific health professionals, ie. MD/DO. If joe on the street trys to help someone out who fell 40 feet, then ends up braking the victim's neck, I wonder if Joe is protected, given that he has no medical background whatsoever. I dont know, maybe I should look it up.

Even Joe Blow is covered, but this is a loaded question. Anyone can sue for any reason, but will they actually win. If Joe is not grossly incompetent (i.e. doing OMM after a guy falls in his head from a height of 20 feet) or if the person was in direct harms way (i.e. Jon doesn't pass his Broadlawns rotation and shows up with a machine gun and Joe pulls Rob's bloody body from harm and aggravates a spinal injury), then the individual is protected from litigation.

The Good Samaritan Act is for anyone anywhere.

 

[Dr_Feelgood]

It is actually not unethical to treat a family member. It does depend on the circumstance though. surgery and life or limb situations where there is someone else that is just as capable to treat then it is unethical for you to treat an immediate family member.

I have also heard (unsure of truth) that if you do treat a family member (take out an ingrown nail) you cannot bill for it. Has anyone else heard this, or is it completely made up?

It is not illegal to treat your family members, nor is it illegal to charge. What is restricted is what drugs a physician can prescribe to a family member.

I try to follow the rule of never mix family and business. Many times physicians will give free care to colleagues family members and expect the same in exchange. This is not illegal either unless you are in different practices and start to cross anti-kick back laws.

 

[densmore22]

It is actually not unethical to treat a family member. It does depend on the circumstance though. surgery and life or limb situations where there is someone else that is just as capable to treat then it is unethical for you to treat an immediate family member.

I have also heard (unsure of truth) that if you do treat a family member (take out an ingrown nail) you cannot bill for it. Has anyone else heard this, or is it completely made up?

I'm not meaning ILLEGAL when I say unethical, I just want to make that distinction because in the medical profession, people often consider them to be synonymous. You really shouldn't treat a family member, but it happens all the time, writting a script for ABO's for a sinus infection to me is no big deal, but managing (for example) a family members blood pressure or diabetes care (beyond giving injections, checking sugars regularly), IMO wouldn't be a good move professionally. I haven't heard if you can bill a family member, that would be sort of funny-ok, well I took out your ingrown toenail, that'll be $150 dad thanks, haha.

 

[Dr_Feelgood]

I'm not meaning ILLEGAL when I say unethical, I just want to make that distinction because in the medical profession, people often consider them to be synonymous. You really shouldn't treat a family member, but it happens all the time, writting a script for ABO's for a sinus infection to me is no big deal, but managing (for example) a family members blood pressure or diabetes care (beyond giving injections, checking sugars regularly), IMO wouldn't be a good move professionally. I haven't heard if you can bill a family member, that would be sort of funny-ok, well I took out your ingrown toenail, that'll be $150 dad thanks, haha.

If you are talking about out of scope practice for family members than that is very illegal and unethical. In scope is legal and billable.

 

[dpmrunner]

I do know a bit about the Meds because my roommate and I had an argument about it a while back. It really goes state to state and ends up being the pharms judgement call in most cases. Many DOs and MDs can write a script and the pharm will think nothing of it although if they really want to they can determine what type of a doc they are.

The majority of states has MD, DO, DPM, and DDS all under the same prescription laws in that they prescribe what they see fit. The difference is that the pharm will much more likely notice a DPM and say something or deny service. There are hardly any laws against it BUT it is against almost every code of ethics for every profession in which case, as was stated, it isn't legally but could just as well be with how they are tied together.

Also, if audited or whatever, when places are checked and there is no office writeup in your chart then insurance companies or whatever start asking questions etc and THAT is where things can get really tricky.

Generally I would say if your close family friend or mom, dad, son whatever need something quick and you know it is minor then sure write out a script as most people do, although I also hear that most of the time you just have your colleague do it and you do it for them. It saves some of the hassle, especially with scrutiny when the drugs are picked up and the same name pops up. Also, common sense, even if a family member needs a certain class of drugs...some are to be avoided and prescribed after a full fledged specialists visit for whatever the condition may be.

 

[purfexshun]

I do know a bit about the Meds because my roommate and I had an argument about it a while back.

Oh was THAT the banging, crashing, and yelling that I heard through the wall that one time?!?

 

[densmore22]

I do know a bit about the Meds because my roommate and I had an argument about it a while back. It really goes state to state and ends up being the pharms judgement call in most cases. Many DOs and MDs can write a script and the pharm will think nothing of it although if they really want to they can determine what type of a doc they are.

The majority of states has MD, DO, DPM, and DDS all under the same prescription laws in that they prescribe what they see fit. The difference is that the pharm will much more likely notice a DPM and say something or deny service. There are hardly any laws against it BUT it is against almost every code of ethics for every profession in which case, as was stated, it isn't legally but could just as well be with how they are tied together.

Also, if audited or whatever, when places are checked and there is no office writeup in your chart then insurance companies or whatever start asking questions etc and THAT is where things can get really tricky.

Generally I would say if your close family friend or mom, dad, son whatever need something quick and you know it is minor then sure write out a script as most people do, although I also hear that most of the time you just have your colleague do it and you do it for them. It saves some of the hassle, especially with scrutiny when the drugs are picked up and the same name pops up. Also, common sense, even if a family member needs a certain class of drugs...some are to be avoided and prescribed after a full fledged specialists visit for whatever the condition may be.

Agreed. I just know from experience, like I stated, my mom has been in the healthcare field for a loooooong time, she has many MD and DO colleagues that I know personally and have asked, one of my best friends is a 4th year Pharmacy student, I know every single doctor in the whole world practicing-basically I know everything, even more than Feelgood, I should really be his mentor.

State to state sounds like is where the differentiation in laws come from, yet another example of something that could be of possible benefit by a national level set of rules.

DPMrunner, we're going riding this weekend too.

 

[Dr_Feelgood]

Agreed. I just know from experience, like I stated, my mom has been in the healthcare field for a loooooong time, she has many MD and DO colleagues that I know personally and have asked, one of my best friends is a 4th year Pharmacy student, I know every single doctor in the whole world practicing-basically I know everything, even more than Feelgood, I should really be his mentor.

State to state sounds like is where the differentiation in laws come from, yet another example of something that could be of possible benefit by a national level set of rules.

DPMrunner, we're going riding this weekend too.

The difference from state to state on prescription are the same for MD/DO/DPM. I am assuming that he is talking about differences in the ability to prescribe to family members. I'm not sure if you guys realize that even antibiotics are a scheduled drug (illegal drug users like them b/c they know you get infections w/ IV drug use). So some states may allow antibiotics but not narcotics.

I also disagree that a pharmacist will balk at a script written by a DPM over s MD/DO. If something is fishy, the only license they care about is their own. It is also tough for any pharmacist to watch for physician's scripting their own family members. Think about if your and was Dr. Johnson, do you think that everyone with the last name of Johnson is going to be questioned? The problem arises when you get audited or if you are reported to the state licensing board.

 

[longstech]

I work at a pharmacy and we input a DPM or an MD etc. into the computer as such so we can identify the difference between prescribers. We had a DPM writing scripts of Ambien for her mom. The pharmacist let her fill it once, and after that when she tried to do it again, he said it was out of her scope of practice. Not to mention, she was also writing numerous scripts of antibiotics (Zithromax) for several people in her family, not the typical antibiotics prescribed by a DPM (and the RPH's were getting really suspicious).

There have been several instances when a DDS has tried to call something in for a friend and it was for something completely outside the scope of what a dentist would "normally" prescribe (like for a cough, etc). The pharmacist has refused to fill those scripts as well.

Pharmacists do look at who prescribes each med they are filling.

 

[Dr_Feelgood]

I work at a pharmacy and we input a DPM or an MD etc. into the computer as such so we can identify the difference between prescribers. We had a DPM writing scripts of Ambien for her mom. The pharmacist let her fill it once, and after that when she tried to do it again, he said it was out of her scope of practice. Not to mention, she was also writing numerous scripts of antibiotics (Zithromax) for several people in her family, not the typical antibiotics prescribed by a DPM (and the RPH's were getting really suspicious).

There have been several instances when a DDS has tried to call something in for a friend and it was for something completely outside the scope of what a dentist would "normally" prescribe (like for a cough, etc). The pharmacist has refused to fill those scripts as well.

Pharmacists do look at who prescribes each med they are filling.

My point was not that they don't look at who and what; it was they do it to cover their own @ss. If a patient came in with a script from a OB-GYN for Flomax, the pharmacist would question that also. Not matter what the credentials, they are worried about themselves and the patient.

FYI: We right for Ambien a lot for short term pain control in patients that don't want narcotics or are just having trouble sleeping. Most drugs are not out of scope for a DPM, it depends on the circumstances. The pharmacist can refuse to fill it, but they should call to ask if they feel their is conflict of interest.

But your example was for his mom, that is a no no even for an MD/DO unless the physician is treating his mother for the condition.