by Mayo J. Galindo Jr., MD
Several years ago, the State Podiatry Board attempted to expand the scope of practice by redefining the foot. They suggested that the “foot” includes contiguous structures. Technically, this would imply that since the gastrocnemius muscle crosses the knee, a podiatrist could do knee arthroscopy and total knee replacements. The Texas Attorney General ruled against the podiatry board, which initiated a lawsuit. In 2005, a lower court ruled in favor of the podiatrists.
I testified before the Podiatry Board that one can legislate a janitor to do neurosurgery; however, it does not mean that the janitor is capable of performing neurosurgery (my apologies to janitors). My fellow at the time testified that during his tenure as Chief Resident at the University of Texas Health Science Center in San Antonio, podiatry residents under his supervision were neither qualified nor trained to do certain procedures they requested.
This court ruling has resulted in confusion on the part of Hospital Creden-tialing Committees. Even by their own admission, podiatrists do not have a uniform residency program, as do ortho-paedic surgeons. Podiatrists attend podiatry school, all of which are private. Podiatry school is somewhat similar to medical school, but they do not and have not delivered babies, cared for sick children, rescued a patient from diabetic ketoacidosis or a hypertensive crisis. They do not deal with polytrauma victims in their training.
At the conclusion of podiatry school, they take no national board exams as do physicians. Their residency training is variable and can include one, two or three years of isolated foot surgery. This may qualify them for forefoot, midfoot or hindfoot privileges, according to the way most hospitals group podiatric privileges. Their residencies are not overseen by the Accreditation Council for Graduate Medical Education. The burden of proof is on the individual podiatrist to show that he or she is capable of performing the requested procedures.
As many physicians are aware, an orthopedic surgeon who specializes in foot and ankle surgery has had four years of medical school, one year of internship, four years of an orthopedic residency and for those of us who specialize in foot and ankle surgery, an additional year of fellowship in the subspecialty discipline. The level of training clearly is different between the podiatric discipline and the orthopedic discipline.
As physicians, we strive to provide the utmost in care for our patients. However, it is difficult enough in most cases to achieve a satisfactory result in the eyes of the patient. Nothing is ever perfect in nature. All of us who perform surgery have complications. A now-deceased general surgeon once said to me, “If you do lousy work, you will get lousy results all the time. However, if you do excellent work — the best anyone can do, you will get lousy results some of the time.”
Dealing with complications separates surgeons from renegade podiatrists. I am an adamant believer that if a surgeon cannot deal with surgical complications he or she may face, they should not be performing that particular procedure.
As Clint Eastwood said, “A man has got to know his limitations.”
Unfortunately, those of us who practice subspecialty foot and ankle surgery are seeing a number of complications caused by podiatrists who ventured outside their realm of training with disastrous, life changing problems for their patients. This is not to say all podiatrists venture beyond their training. I work on a daily basis with conscientious and legitimate podiatric practitioners who truly care for the welfare of their patients and refer when appropriate. If you are a family practitioner and admit or sponsor a patient for a podiatrist, you are the responsible party. The same is true for anesthesiologists when they are in the operating room doing anesthesia for a podiatrist.
If you are a referring internist or family practitioner, what level of medical expertise do you wish for your patients to have? The referrals we make reflect on all of us. No matter what professional or paraprofessional group medical people belong to, the ultimate goal should be to protect and do no harm to our patients.
Mayo J. Galindo, Jr., MD is a Board Certified Orthopaedic Surgeon in private practice since 1986. Dr. Galindo is a member of the San Antonio Orthopedic Group and part
of the Foot and Ankle Section. Dr. Galindo says his greatest accomplishment in life has been becoming a grandfather.
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