Microscopes?

[dpmPOD]

Does anyone use a microscope in podiatry? I've had certain professors of mine stress the importance of doing KOH to confirm tinea etc., but never see anyone actually doing it in my school clinic or during my shadowing experiences. It seems underutilized. Is it not a billable procedure to perform or something?

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[Feli]

You send those tests to a path lab. There's no need for a microscope in the clinic.

 

[dpmPOD]

I just don't see the real need to send a KOH out to path. It is fairly straight forward and a positive test is rather obvious. Seems like something we could easily and quickly do ourselves.

 

[Podfather]

Yes but the expense and lack of reimbursement makes it un-necessary. After histology you can sell your microscope to another student. You could also do other laboratory tests and even your own path reports but these are better sent out. In a non-related area you could also make your own orthoses (some do) but most send these out as well.

 

[Feli]

...something we could easily and quickly do ourselves.

Time is money.

As podfather said, you have to evaluate how much you get paid for each service, consider the time + equip cost of the service, estimate the avg volume of that service you are providing, and think about the patient expectations. You then can ultimately decide if it's better to do each service yourself, hire an employee to do it for you in the office, hire an associate, or send the service out altogether. This applies to basically everything... from diabetic shoes to account collections to nail care to vascular testing to billing/coding to orthotics casting to marketing to physical therapy to collections.

 

[NatCh]

I've seen a ccouple of practices that have their own microscope and dermatophyte test medium (DTM) setups, but I think most just send it out. More accurately, I think most docs just diagnose based on clinical signs and symptoms then treat without doing the KOH.

 

[krabmas]

I've seen a ccouple of practices that have their own microscope and dermatophyte test medium (DTM) setups, but I think most just send it out. More accurately, I think most docs just diagnose based on clinical signs and symptoms then treat without doing the KOH.

my director does his own DTM.

 

[g squared 23]

We have a clinician who does his own KOH's for tinea and teaches our students how to as well. He doesn't get reimbursed because it requires further certification which he isn't interested in: he just likes to do them for fun. If it's something you're interested in, then pursuing the certification would be worth it. However, it is far from a cost effective use of your time for your practice (unless you're only seeing 5 patients/day and have the time)

 

[NatCh]

my director does his own DTM.

I'm kind of curious as to how many docs still do DTM's for onychomycosis. It used to be necessary for insurance coverage of Lamisil (formerly $1200/90 days), but now that generic Terbinafine is as low as $4/month I don't know how many folks bother running it through insurance pharmacy benefits any more when the pay-out-of-pocket cost is less than the co-pay.

"Good medicine" would entail getting a positive lab confirmation of onychomycosis on every last toenail before treating, but then there's "the real world" where sometimes you just go on clinical experience (after having seen your 40,000th fungal nail).