What a joke

[PADPM]

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I saw this news clip on the podiatry management website. This is a complete joke, and one reason some people may laugh at our profession. I consider this an embarrassment.

The doctor has trademarked a procedure based on his "innovative" idea of placing the incision for a bunionectomy on the medial aspect of the foot, something that has been done by podiatrists and orthopedists for many, many years.

I have no problem with him telling patients that he believes that placement of the incision at that area will result in a more cosmetically appealing incision, but for him to say that he pioneered or invented that procedure or idea is simply misleading and fraudulent.

NY Podiatrist Develops New Cosmetic Approach to Bunion Procedure​

In the past, bunion removal was considered a functional foot procedure necessary to relieve the chronic pain bunions cause. According to Dr. Emanuel Sergi, a Manhattan podiatrist, today’s patients are also concerned with the overall look of their feet. In addition to eliminating the pain caused by bunions, there is an emphasis on making feet more cosmetically appealing. Sergi has developed a new procedure dsigned to produce both functional and cosmetic improvement.
Dr. Emanuel Sergi
Slimline Bunion Surgery™ provides patients with a better cosmetic outcome because it results in significantly less scarring than other techniques. Most traditional bunion removal techniques use a dorsal incision, resulting in permanent visible scarring on the top of the foot. During Slimline Bunion Surgery™, Dr. Sergi removes the bunion through a medial incision. According to Dr. Sergi, "A medial incision, which is an incision on the inside of the foot, results in fine to almost no scarring."

Source: GlobeNewswire [8/8/11]

 

[jonwill]

I saw this news clip on the podiatry management website. This is a complete joke, and one reason some people may laugh at our profession. I consider this an embarrassment.

The doctor has trademarked a procedure based on his "innovative" idea of placing the incision for a bunionectomy on the medial aspect of the foot, something that has been done by podiatrists and orthopedists for many, many years.

I have no problem with him telling patients that he believes that placement of the incision at that area will result in a more cosmetically appealing incision, but for him to say that he pioneered or invented that procedure or idea is simply misleading and fraudulent.

NY Podiatrist Develops New Cosmetic Approach to Bunion Procedure​

In the past, bunion removal was considered a functional foot procedure necessary to relieve the chronic pain bunions cause. According to Dr. Emanuel Sergi, a Manhattan podiatrist, today’s patients are also concerned with the overall look of their feet. In addition to eliminating the pain caused by bunions, there is an emphasis on making feet more cosmetically appealing. Sergi has developed a new procedure dsigned to produce both functional and cosmetic improvement.
Dr. Emanuel Sergi
Slimline Bunion Surgery™ provides patients with a better cosmetic outcome because it results in significantly less scarring than other techniques. Most traditional bunion removal techniques use a dorsal incision, resulting in permanent visible scarring on the top of the foot. During Slimline Bunion Surgery™, Dr. Sergi removes the bunion through a medial incision. According to Dr. Sergi, "A medial incision, which is an incision on the inside of the foot, results in fine to almost no scarring."

Source: GlobeNewswire [8/8/11]

Yea, I was well trained on the medial incision in residency. I had a handful of attendings that did it. A couple guys were actually doing hammertoes through a medial incision.

 

[PADPM]

Our Dean of clinical sciences talked to us about this the other day. Stating how pods in NYC and CA are turning more to cosmetic podiatry procedures to make $$$. She obviously discouraged us from ever practicing this way but my question is how do these pods get away with this? How do they get away with altering normal surgical procedures, promoting them as new cosmetic wonders, and make loads of cash off people without being penalized by the law? Is it really that simple to prey on people's insecurities, call a procedure elective, and have these patients pay completely out of pocket?

It's not the fact that these docs get patients to pay out of pocket that bothers me. That's a concious decison a patient has made. And if a bunion isn't painful or a hammertoe isn't painful, etc., it really isn't covered by insurance. Insurance does not pay for cosmetic surgery, so the doctor has every right to charge a patient for the procedure(s).

Performing cosmetic surgery is another moral/ethical decision that you will have to make when you graduate. The ABPS, ACFAS and even the Orhopedic Foot & Ankle Society have stated their policies about cosmetic foot surgery and advise against this practice.

However, my primary "beef" with this doctor isn't his decision to perform cosmetic foot surgery or to charge patients for surgery. My problem is that he is basically frauding patients and the public by claiming to pioneer or develop a procedure that has been performed by most podiatric and orthopedic surgeons for many, many years.

Doctors like this simply nauseate me. They are legends in their own mind and have contributed NOTHING to our profession or any profession. They are simply great marketers who love to deceive the public by attempting to embelish their own credentials, and most of the time these doctors have very unimpressive credentials.

It's no different than me making my bunion incision with an 11 blade instead of the traditional 15 or 10 blade and telling everyone I've innovated a new surgical approach/technique.

Trademarking a new name for a bunionectomy/osteotomy we all perform on a regular basis. This guy's a joke........ a bad joke.

 

[PADPM]

Yea, I was well trained on the medial incision in residency. I had a handful of attendings that did it. A couple guys were actually doing hammertoes through a medial incision.

Exactly. Medial incisions have been used for quite some time for bunionectomies and hammertoe repairs at an attempt to eliminate dorsal scarring. Nothing new and certainly not developed by this clown in New York.

 

[Podfather]

Exactly. Medial incisions have been used for quite some time for bunionectomies and hammertoe repairs at an attempt to eliminate dorsal scarring. Nothing new and certainly not developed by this clown in New York.

Moy (get it) of the same.

 

[jonwill]

Moy (get it) of the same.

See what he did there

 

[PADPM]

Moy (get it) of the same.

Ha, I get it. My favorite part of his website is where there is an area to find a surgeon in your area. When you click on it there is a comment that he ATTEMPTED to train doctors in other states, but can not refer you to anyone else, because he is the only one that can perform this type of procedure, etc., etc.

I've visited the site, and his results look nice, but here's another guy who certainly didn't reinvent the wheel. He's performing bunionectomies with osteotomies and screw fixation like everyone else. I just don't have his marketing skills or advertising budget.....YET!

Keep tuned, I'm working on a bunion clinic with a drive thru window. You pick your procedure from the first column, pick the site of your incision from the next column, pick the type of hardware, etc., then pay at the first window, and stick your foot out and everything is taken care of at window # 2.

I'm working on names;

1) Bunion King (HAV it your way)

2) Hack in the Box...............................

 

[347932]

Bunion King (HAV it your way)

This!👍👍

 

[zane870]

Ha, I get it. My favorite part of his website is where there is an area to find a surgeon in your area. When you click on it there is a comment that he ATTEMPTED to train doctors in other states, but can not refer you to anyone else, because he is the only one that can perform this type of procedure, etc., etc.

I've visited the site, and his results look nice, but here's another guy who certainly didn't reinvent the wheel. He's performing bunionectomies with osteotomies and screw fixation like everyone else. I just don't have his marketing skills or advertising budget.....YET!

Keep tuned, I'm working on a bunion clinic with a drive thru window. You pick your procedure from the first column, pick the site of your incision from the next column, pick the type of hardware, etc., then pay at the first window, and stick your foot out and everything is taken care of at window # 2.

I'm working on names;

1) Bunion King (HAV it your way)

2) Hack in the Box...............................

Maybe by the time I get out of school, you will have your new drive through clinic up and running and you will be needing some extra help😀

 

[zane870]

I have ZERO problem with a doctor promoting cosmetic surgery or even basing their practice on it. I do have a problem with somebody not giving credit where credit is due or claiming they have reinvented the wheel as others have already said. It makes you look foolish to your professional community and can make patients distrust you if they ever find out the truth. But if the doc is bringing in cash money hand over fist then he may not give a rat's you know what.

 

[347932]

I have ZERO problem with a doctor promoting cosmetic surgery or even basing their practice on it. I do have a problem with somebody not giving credit where credit is due or claiming they have reinvented the wheel as others have already said. It makes you look foolish to your professional community and can make patients distrust you if they ever find out the truth. But if the doc is bringing in cash money hand over fist then he may not give a rat's you know what.

The problem with "cosmetic" foot surgery, is there is nothing really cosmetic about it. Having a toe amputated for fashion reasons, doesn't make your foot look any better.

Amputating or "shortening" toes so your client can fit into pointy, high heel shoes is just plain unethical in my book. There is no way you can adequately explain the long term sequela of this by any stretch. Good luck with that if it ever goes really sour on those high class clients of yours. Use at your own risk!

 

[zane870]

The problem with "cosmetic" foot surgery, is there is nothing really cosmetic about it. Having a toe amputated for fashion reasons, doesn't make your foot look any better.

Amputating or "shortening" toes so your client can fit into pointy, high heel shoes is just plain unethical in my book. There is no way you can adequately explain the long term sequela of this by any stretch. Good luck with that if it ever goes really sour on those high class clients of yours. Use at your own risk!

We are in agreement here. I'm just a student so I have no idea what my future holds but I don't figure I'll ever be in the business of cosmetic foot surgery. There are vain folks out there that are willing to pay big bucks to achieve the look they want and there will be doctors that come forward and fill that desire. Breast augmentations, tummy tucks, rhinoplasty, and the like are good examples.

 

[Podfather]

The problem with "cosmetic" foot surgery, is there is nothing really cosmetic about it. Having a toe amputated for fashion reasons, doesn't make your foot look any better.

Amputating or "shortening" toes so your client can fit into pointy, high heel shoes is just plain unethical in my book. There is no way you can adequately explain the long term sequela of this by any stretch. Good luck with that if it ever goes really sour on those high class clients of yours. Use at your own risk!

Agreed. Also the psychological profile of a person who would have a toe amputated to fit in a shoe makes the hair stand up on the back of my neck. God forbid if the shoe doesn't fit. Imagine explaining to a jury of your peers (not the patients since most would not consider doing what they did) what you did and why. Next they will be told how much you were paid, the patient will claim they can't walk because they are off balance (a common old wives tale), and since the amputation their significant other will not make love to them. It would be easier to explain doing surgery on the wrong foot. LOL

 

[dtrack22]

If I end up using a more medial incision for bunionectomies and/or hammertoes (for example) I would definitely market my "cosmetic" approach to these procedures. Putting on my website, facebook page, twitter account, etc. that I use surgical techniques that minimize scarring for "cosmetic" purposes is completely ethical and in many cases (see Women) going to bring in some patients...IMO

I agree 100% with PADPM that touting something as new/revolutionary, when it isn't, is bush league. And I agree with Kidsfeet that true "cosmetic surgery" (cutting without pathology so you can fit into those Jimmy Choos) of the foot is unethical.

But some Podiatrists will continue to perform unnecessary procedures if it means $$$ or notoriety (I'm also talking about some Pods who do 1-2 TARs/wk)...guess you just have to treat your patients right, live your own life and not worry too much about the yahoo's out there practicing

 

[Podfather]

If I end up using a more medial incision for bunionectomies and/or hammertoes (for example) I would definitely market my "cosmetic" approach to these procedures. Putting on my website, facebook page, twitter account, etc. that I use surgical techniques that minimize scarring for "cosmetic" purposes is completely ethical and in many cases (see Women) going to bring in some patients...IMO

I agree 100% with PADPM that touting something as new/revolutionary, when it isn't, is bush league. And I agree with Kidsfeet that true "cosmetic surgery" (cutting without pathology so you can fit into those Jimmy Choos) of the foot is unethical.

But some Podiatrists will continue to perform unnecessary procedures if it means $$$ or notoriety (I'm also talking about some Pods who do 1-2 TARs/wk)...guess you just have to treat your patients right, live your own life and not worry too much about the yahoo's out there practicing

There is a difference in performing surgeries to minimize scarring and to be cosmetically pleasing versus performing cosmetic surgery. I mean in some a subcutaneous closure, incision placement, and other traditional techniques may produce the former. Once you state you are doing cosmetic surgery of the foot, IMO that raises the bar, attracts a different patient population (yes some with neurosis), and generally higher expectations. The cosmetic surgeon who takes say 650 dollars from an insurer now charges 2,000 dollars (for the same procedure) when it's "cosmetic". Higher fees for the same procedure may be unethical and break the rules with some insurers but at the very least implies IMO a better outcome.

Add to the above many tout "special techniques" they invented, special training (often a weekend course), and unique skills (a la Moy). IMO another issue is if there indeed is cosmetic surgery of the foot it is being hijacked by some with less training/experience and some of the less than ethical DPMs much like MIS was. There were/are minimal incision techniques that were/are viable choices but because this was hijacked by some sleazy untrained DPMs in the 1980s it still carries a negative image.

Remember underpromise/overproduce and your patients will be happy and you can stay out of court. The term cosmetic IMO already breaks that rule. As someone who has done many surgeries over the last 24-26 years I can say sh.. happens and God forbid it happens on someone who thought they were having surgery for a pretty foot or to wear crazy shoes.

 

[dtrack22]

Once you state you are doing cosmetic surgery of the foot, IMO that raises the bar, attracts a different patient population (yes some with neurosis), and generally higher expectations. The cosmetic surgeon who takes say 650 dollars from an insurer now charges 2,000 dollars (for the same procedure) when it's "cosmetic". Higher fees for the same procedure may be unethical and break the rules with some insurers but at the very least implies IMO a better outcome.

It is definitely a slippery slope, but ultimately it is the Dr.'s decision to overcharge because they are doing a "cosmetic procedure". That is very different for performing a procedure when indicated and simply marketing your incision and suturing as cosmetically appealing. It is also the Dr.'s choice to do the procedure or not. Even a plastic surgeon turns down pts with unrealistic expectations (the neurotic), why can't a pod do the same after the consult?

Add to the above many tout "special techniques" they invented, special training (often a weekend course), and unique skills (a la Moy). IMO another issue is if there indeed is cosmetic surgery of the foot it is being hijacked by some with less training/experience and some of the less than ethical DPMs much like MIS was. There were/are minimal incision techniques that were/are viable choices but because this was hijacked by some sleazy untrained DPMs in the 1980s it still carries a negative image.

From what I've read/seen in regards to the Moy's of the world, you are absolutely correct in terms of the connotations associated with the word "cosmetic" in the Podiatry world.

Remember underpromise/overproduce and your patients will be happy and you can stay out of court.

I understand the underpromise/overproduce train of thought, but all of the literature says that patients do not generally go to court over poor outcomes. A majority of patients who like their physician/surgeon (as a person) will not sue. Meaning, if you actually take your time with people, don't rush office visits, give thorough explanations of dx and tx options, are generally nice, and have a courteous and professional office staff, then you can have complications and not end up in court. From what I've read on here, a practice like PADPMs would be a good example. I don't expect him to divulge litigation info but I would bet that practice is better than most even though I'm sure they have complications just like everyone else.

I know a lot of my above opinion is due to athletics in college. I would never dream of telling a coach that I probably wasn't going to catch a ball and then watch his face light up when I did...but medicine is a whole 'nother beast. It's a confidence (borderline cocky) attitude that you had to have to play at that level...something I have to work on 😀

 

[Podfather]

It is definitely a slippery slope, but ultimately it is the Dr.'s decision to overcharge because they are doing a "cosmetic procedure". That is very different for performing a procedure when indicated and simply marketing your incision and suturing as cosmetically appealing. It is also the Dr.'s choice to do the procedure or not. Even a plastic surgeon turns down pts with unrealistic expectations (the neurotic), why can't a pod do the same after the consult?



From what I've read/seen in regards to the Moy's of the world, you are absolutely correct in terms of the connotations associated with the word "cosmetic" in the Podiatry world.



I understand the underpromise/overproduce train of thought, but all of the literature says that patients do not generally go to court over poor outcomes. A majority of patients who like their physician/surgeon (as a person) will not sue. Meaning, if you actually take your time with people, don't rush office visits, give thorough explanations of dx and tx options, are generally nice, and have a courteous and professional office staff, then you can have complications and not end up in court. From what I've read on here, a practice like PADPMs would be a good example. I don't expect him to divulge litigation info but I would bet that practice is better than most even though I'm sure they have complications just like everyone else.

I know a lot of my above opinion is due to athletics in college. I would never dream of telling a coach that I probably wasn't going to catch a ball and then watch his face light up when I did...but medicine is a whole 'nother beast. It's a confidence (borderline cocky) attitude that you had to have to play at that level...something I have to work on 😀

Yes you are correct it is the physician's decision to choose their practice style, charges, etc as long as they follow laws and contracts they signed with insurers. It is also their obligation to give patients the appropriate informed consent and treat them ethically.

I have done a lot of expert witness testimony for the defense. Yes there is sometimes a breakdown in the communication between the patient and the doctor, a comment by an uncaring staff, or simply a balance on a bill that instigated the lawsuit. Sometimes it is a poor outcome that was not the result of negligence.

However, many suits are the result of a poor informed consent, unrealistic expectations of the patient, and an aggressive surgeon who cuts first and asks questions later. Some docs have the I can do this so it needs to be done attitude and in the 5 minutes they spent with the patient didn't realize there was no way the patient could be off weightbearing with 5 children and no support network or the patient has mental instability. Cosmetic unfortunately implies perfection. People who are having aggressive surgery to fit in a shoe or to fix their "ugly toes" smells of issues. Cosmetic foot procedures have no long term studies to demonstrate long term success or even patient satisfaction.

I am not saying you can't do it but one had better beware of the potential risks. The cosmetic people I have met are all about the money and less about the science.

 

[Feli]

Well, the guy is trying to make a living, but there are much deeper undertones than just greed or showmanship. Private practice will trend more and more towards concierge. That means docs are salesmen.... many already are, and you picked a good example. Can smart people see through it? Yep, they get a referral, not a flyer or yellow pages or internet ad for a professional service. However, that's assuming they care for their body and are smart people.

Most prople just aren't that smart or self respecting when they come to their body, and they'll probably learn their lesson when they receive subpar medical care. That's why board cert and hospital privileging and license hearings exist, but we all know the system's not 100%. There are some real greedy, lazy, or otherwise bad apples out there in every career field. I think we are all adult enough to know that, much like any profession, not all doctors are good doctors... you really have to do your homework. It will only get worse with the bad economy and a lower and lower % of the population actually working to support a higher and higher % of the American population whose laziness our govt decisions enable.

IMO, medicine in 20-30yrs will be in one of two roads:
1 - most docs will work for hospital systems (who have their own health plans and control those pts, and they keep buying up private practices+docs)
2 -the few docs who remain in private practice as we know it will take cash only (concierge med)

The govt plan (ObamaCare) won't be able to afford the private practice docs, so they will bargain with hospitals, who will take the meager pay in exchange for the pts (and to avoid the bad PR of being "cold hearted" by refusing the indigent). The problem is that it's malignant... disability pay, MedicAid, etc just snowball on the population fast. Why would anyone want to buy insurance when their neighbor, sister, etc have it basically free (aka through the hard earned tax $ of others)?

The social services are malignant. Once the govt decided to enter education, welfare, health care, etc etc... there's no getting them out (at least not anytime soon). People get dependent, and if you try to take it away and make them independent and self sufficient once again, you will have a riot on your hands - sometimes literally. Sad but true.

 

[that1guyfromFL]

something I have to work on 😀

Uh, ya think?

 

[dtrack22]

Once I'm off the juice I'm sure it'll calm down...