Memes of Podiatry

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diabeticfootdr said:
How do you do a complete H&P?
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Hospital doesn’t let me. Well, some do, some don’t. The ones that do - I get PCP or MD/DO clearance.

I literally have to get transferred to different surgery centers or hospitals just because MDs and DOs don’t feel comfortable clearing my peds matrixectomies under anesthesia. It’s not just a DPM issue.
 
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air bud said:
Our schools and residencies can't even do a good job teaching us about a foot.... And you're worried about a heart?
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Ok, but you never document an H&P? I’m just asking. You send every patient for a PCP appointment within 30 days of surgery?

What about a patient that had “clearance” 35 days before surgery?
 
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I know it's a TOS violation to talk seriously in the meme thread, but is there a source that says and H&P isn't an H&P unless you listen to the patient's heart and lungs?

Because I've gotten back some really lazy H&Ps from some PCPs in the area that were obviously templated "S1, S2, RRR." In residency and podiatry school, I watched IM/EM attendings do the most insincere 2 second long cardiopulmonary auscultations. I'm not saying stethoscopes don't still have a role in healthcare, I'm just saying I don't know we're accomplishing beyond ticking off some administrative box.

P.S. I tried to make a meme of this, it came out bad so I scrapped it, sorry
 
That thing is real btw (Link)

Even the especially anal places I’ve operated at, which even make their own H&P templates, only ever asked for a single system physical exam. Never been an issue.
 
I almost cannot believe what im reading lol. I am unaware of anywhere in this country where it is standard of care for a podiatrist to do a "complete" H&P with heart & lung exam, nor to do a preoperative risk assessment. Nobody does that. Ortho at my hospital (or any hospital ive ever had priveleges at) doesn't do it.
 
Flip-flop-flerpity said:
I almost cannot believe what im reading lol. I am unaware of anywhere in this country where it is standard of care for a podiatrist to do a "complete" H&P with heart & lung exam, nor to do a preoperative risk assessment. Nobody does that. Ortho at my hospital (or any hospital ive ever had priveleges at) doesn't do it.
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I do all my surgery patient's H&Ps. For both hospital and surgery center.
 
Flip-flop-flerpity said:
I almost cannot believe what im reading lol. I am unaware of anywhere in this country where it is standard of care for a podiatrist to do a "complete" H&P with heart & lung exam, nor to do a preoperative risk assessment. Nobody does that. Ortho at my hospital (or any hospital ive ever had priveleges at) doesn't do it.
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After reading some of the garbage H&Ps I have gotten from a lot of PCPs, I started doing my own preop H&P for some patients. It helps with scheduling, because many times coordinating that PCP visit around the surgery isn't feasible. Also it saves the patient because some insurances don't cover a "preop clearance." I focus on things that have the strongest bearing on their surgery, not reporting their heart sounds. And yes, I've been criticized for doing this here, idgaf.
 
Flip-flop-flerpity said:
I almost cannot believe what im reading lol. I am unaware of anywhere in this country where it is standard of care for a podiatrist to do a "complete" H&P with heart & lung exam, nor to do a preoperative risk assessment. Nobody does that. Ortho at my hospital (or any hospital ive ever had priveleges at) doesn't do it.
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Those are 2 different things.

A complete preoperative H&P within 30 days of surgery is a CMS and TJC standard. Then an "H&P update" must be performed and documented if the complete H&P was not performed in the last 24 hours. That could be, but is not necessarily the same as, a preoperative risk assessment.

Individual patient circumstances drive the decision for how thorough the preoperative risk assessment is. A 24-year-old healthy female with a bunion or an 19-year-old healthy male with an ankle fracture would not require anything more than this complete H&P performed by the podiatrist (or orthopedic surgeon).

But we encounter frequently a medically-complicated patient who either had a recent inpatient stay and complete work-up, or a complete outpatient work-up (cardiac or general) that is slightly older than 30 days. In that case, if there are no changes in the patient's condition, it is not the standard of care to repeat the work-up just because it 35 days old. It is appropriate for the surgeon (regardless of specialty) to perform and document the complete H&P to comply with the CMS and TJS standards. And yes, ortho does this too.
 
Adam Smasher said:
After reading some of the garbage H&Ps I have gotten from a lot of PCPs, I started doing my own preop H&P for some patients. It helps with scheduling, because many times coordinating that PCP visit around the surgery isn't feasible. Also it saves the patient because some insurances don't cover a "preop clearance." I focus on things that have the strongest bearing on their surgery, not reporting their heart sounds. And yes, I've been criticized for doing this here, idgaf.
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Yes, and some hospitals (like mine) has "required elements" to be considered an H&P (like a heart and lung assessment). If there is an element missing, it doesn't count for the CMS/TJC 30-day standard and has to be repeated by the surgeon.

It sounds ridiculous, but sometimes a PCP's H&P is missing a specific heading like HPI. Then it must be repeated just so the paperwork is in compliance.
 
Flip-flop-flerpity said:
I almost cannot believe what im reading lol. I am unaware of anywhere in this country where it is standard of care for a podiatrist to do a "complete" H&P with heart & lung exam, nor to do a preoperative risk assessment. Nobody does that. Ortho at my hospital (or any hospital ive ever had priveleges at) doesn't do it.
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Specialists often don't "clear" per se, usually the work up done by PCP or other specialties has worked up the patient enough, and a full H&P has been done somewhere. Almost all surgical notes somewhere before procedure will have a one or two liner from the surgeon showing they at least discussed/considered patient factors affecting risk of surgery "patient has CVD, DM2, OSA, will..." which medicolegally functions as a preoperative risk assessment. If there is some bigger issue that needs more like uncontrolled DM they might write "patient referred to PCP for glucose management prior to procedure. The riskier the procedure the more is done/you'll see reflected.

So I argue those things are in place, just not always done in an overt or long form manner (unlike an internist admission H&P).

My guess is that a lot of what ortho does is low risk enough you don't see it done as more than the terse surgical one liner.
it's not major heart surgery or transplant surgery. Also insurance can drive the work up (like transplant patients). Although my understanding is even ortho, any surgery, looks that for CYA and SOC there are things in the chart covering bases.
 
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Adam Smasher said:
I know it's a TOS violation to talk seriously in the meme thread, but is there a source that says and H&P isn't an H&P unless you listen to the patient's heart and lungs?

Because I've gotten back some really lazy H&Ps from some PCPs in the area that were obviously templated "S1, S2, RRR." In residency and podiatry school, I watched IM/EM attendings do the most insincere 2 second long cardiopulmonary auscultations. I'm not saying stethoscopes don't still have a role in healthcare, I'm just saying I don't know we're accomplishing beyond ticking off some administrative box.

P.S. I tried to make a meme of this, it came out bad so I scrapped it, sorry
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You're right it's a box tick when done insincerely, but the idea is that arguably the heart is the most important system and also from a medicolegal standpoint, CYA, it makes sense to do.

It makes the patient feel like you did an exam, they expect it (they can't really gauge what/how much exam is necessary), it's "doctorly" to them.

The patient will often remember if you did/didn't, in a lawsuit the jury of their peers will think you're negligent if you didn't, period. Same reasoning.

The heart it's easy to catch/miss things, again it's bad if you miss something obvious in court, if they die of a subtle findings well you tried. Since heart stuff is a top cause of death...CYA.

Lastly, there is a good amount of PE and for billing I can claim in honesty just by looking at patient, pressing their belly, squeezing their ankles (general, head and neck, derm, abdominal, gross neural, peripheral) so if I toss in the big important thing I can't do without equipment, I've hit it all. Again, court.

My training would say, no the **** you can't do a full H&P without doing/documenting a heart exam. Period. Whether that for real medical reasons or CYA.

Pods is its own world, maybe you guys aren't lawsuit magnets like EM. MDs, at least PCPs and EM situations (not all, like optho) have to do it, period.
 
Crayola227 said:
The patient will often remember if you did/didn't, in a lawsuit the jury of their peers will think you're negligent if you didn't, period. Same reasoning.
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Sorry, no, I will not fall for scare tactics. If you're going to bring up medical legal risk, then you've got to be prepared to discuss causal pathways between "failure to auscultate" and whatever harm could happen to a patient. I am not being pedantic. The plaintiff's loss needs to have resulted from the defendant's negligence. The most common reason pods get sued is because of chronic postop pain/deformity after elective surgery. Is the plaintiff's counsel seriously going to argue "because Dr Smasher failed to identify the S3 heart sound, the bunionectomy went on to nonunion"

And obviously if someone dies on the operating table yeah that cardiac w/u probably mattered. But you have to be smart about who you indicate for surgery anyway. If they've got chronic disease or haven't seen their pcp in years or are generally just crazy, I'm not doing the h&p!
 
Not technically a meme, but reality is equally weird.

Guys, we are out of business. Podiatry was fun while it lasted.
We cannot compete with this... but at least ortho's outta biz too.
"Fractured ankle 17 years of pain, pain is gone... feet and ankle, pain is gone"
It's all on a poster I ran into going to a restaurant tonight:

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(and yeah, that's my reflection in the window... don't say I'm doxxing me!)
 
Feli said:
Not technically a meme, but reality is equally weird.

Guys, we are out of business. Podiatry was fun while it lasted.
We cannot compete with this... but at least ortho's outta biz too.
"Fractured ankle 17 years of pain, pain is gone... feet and ankle, pain is gone"
It's all on a poster I ran into going to a restaurant tonight:

.

View attachment 407129

(and yeah, that's my reflection in the window... don't say I'm doxxing me!)
Click to expand...
I see the same claims for vibrating foot pads and tv neuropathy cures
 
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