I'm curious about that, because still several hospitals in my area won't accept a DPM H&P, and require MD to perform it. Which is perfectly fine with me, because spreading out liability is always ok in my book.
Concur... I am in support of DPMs
not doing H&Ps (besides in residency, when on med/surg off rotations). I think it's better for the patients and the facility if we have PCPs do it. We don't have the training and certainly don't have the volume.
I have obviously worked and taken cases to places that let DPMs do H&P... and others that do not.
The main reasoning for facilities blocking us is simply liability. I've seen this a few times; one of my hospitals is now having podiatrists no longer do H&P (after decades of podiatrists doing H&Ps). Well, dentists also... but no dentists do surgery here presently. The reason is twofold:
- JHACO ("...The H & P must be completed and documented by a qualified and privileged physician or other qualified licensed practitioner privileged to do so in accordance with state law and organizational policy. Other qualified licensed practitioners could include nurse practitioners and physician assistants. ...")
- Podiatrists were crashing off the guard rails (doing H&P for "clearing" fairly sick pts, doing surgery poorly and/or taking way too long to the point pts would admit post-op due to pain and/or prolonged anesthesia issues)
It's a gray area with JHACO for podiatry H&Ps in the link above, so most facilities won't allow it for simply that reason. With JHACO, it has to fit all of the above reqs (state allows it, facility allows it, "...
Dentist or Podiatrist is only authorized to perform aspects of the History and Physical that are applicable to either Dentistry or Podiatry." If I were on the hospital bylaws, I absolutely wouldn't take the chance - particularly if there had been problems with podiatry H&Ps and outcomes recently.
Personally, I could care less if we do them. I will do H&P occasionally for ASA 1 or ASA 2 surgery pts who don't have a PCP and have a time-sensitive issue (trauma... any significant infection would be inpt with H&P already), but that is just to expedite the surgery. It's not because I'm good at them or for ego or billing. I think that DPM doing H&P (even "easy" ones) situation is sub-optimal (we don't know what we don't know), but I do it a few times per year, if facility allows it (mostly just to avoid admitting a healthy patient just to push an Achilles or ORIF or whatever injury surgery quick). I won't do the H&P at all on sick pts (ASA 3+) or longer/complicated surgery cases or elective stuff for any reason... those get H&P by a qualified PCP or admit the pt for inpt surgery.
At the end of the day, it's our job to have a good working relationship with the PCPs. They are the lifeblood of your practice, especially if you're in PP (most of us are). It's best to have the pre-op patient see them and know they're having surgery, get them a visit, follow the proper protocols. It's also considerate to anesthesia to have proper workup and tests done by someone other than the podiatrist doing the surgery, who is marginally trained and biased to get the surgery going and done.
The podiatry "foot and ankle surgeon" pretending to listen to lungs and filling out a form to push a long surgery on complicated patient is not safe from many standpoints - including their own medicolegal risk, the facility, and of course the patient.
...at the end of the day, H&Ps are just like ankle surgery and some complicated surgeries: you want to log them, but some facilities won't give you privileges for them regardless. They don't care if you have a million logged... per their bylaws, DPMs don't do those at the hospital/facility.
🙂
