The New York Guide to seeing a Podiatrist
Most people give very little thought to podiatry. Unless and until you need one, you may never have considered the fact that podiatrists exist. You can't be blamed – this industry operates in a silo of sorts, outside the scope of typical medical practice, and you can't be blamed for not paying attention.
But say you are at a stage where you need to see a podiatrist. There are some questions you should ask along the way to help ensure that you're receiving the appropriate care and treatment.
Before the initial appointment
Before you ever see a podiatrist, you should stop and ask why. Why are you seeing a podiatrist rather than, say, an orthopedic surgeon?
Is your condition severe? If so, you may wish to consider seeing an Orthopedic Surgeon. Generally speaking an orthopedic surgeon with a specialty in foot/ankle procedures will have more experience with complex surgeries and their potential risks.
Have you tried talking with my general doctor? Are there easy alternatives that may provide some help/relief (like shoe supports, different shoes, etc.)?
Finally, before you go see a podiatrist, be sure that you actually need to see one. This may seem obvious, but we have seen many people who received terrible podiatry care when in reality they may have been better suited with some other form of treatment for their foot problems.
If you are determined to see a podiatrist, who will you see, and how will you know that they are okay?
Unfortunately, because of the nature of the field of podiatry there is not a terribly significant amount of information available to help you determine who is good and who is bad.
You can look online, of course, and look at reviews from current and former patients. These may provide some insight into the skill level of the podiatrist.
You can also ask your current physician for a referral, but keep in mind that referring physicians often have very little actual knowledge about the skill level of the podiatrist to whom they are referring you. In fact, in many cases the physician will simply refer the patient to the one or two podiatrists they've actually heard of.
Finally, you can check to see if the podiatrist has ever been sued or has ever been subject to disciplinary action. The New York State Department of Education, Office of the Professions, has a website that publishes information about podiatry discipline. You can find that here. (ADD LINK).
At the initial appointment
You've made the decision to seek medical attention from a podiatrist for a foot problem; and you've done your homework (to the extent possible) to confirm that the podiatrist whom you've decided to see is qualified. Now what?
The initial podiatry appointment is, in hindsight, often the most critical. For the patient, it presents the opportunity to finally get some answers, but it also puts the patient in the critical position of having to ask all the right questions.
Generally speaking, many poor podiatry surgeries happen shortly after the first appointment, so it's critical that you ask the right questions during that first visit. (NOTE: If you are able to bring a family member or close friend to the appointment, do so. It is often quite helpful to have a second set of eyes/ears in the room whenever dealing with a medical issue). In no specific order, they are:
1) What are the possible causes of the issue that I'm having? It's not always a simple answer, and it's critical that the podiatrist consider and rule out other potential problems before making a final determination.
2) What tools/factors are you considering in determining what is wrong with my foot? At a bare minimum, the podiatrist will likely take x-rays of your foot. This can help them determine positioning of the foot, as well as the presence or absence of arthritis (often used as a justification for surgery). How many and at what angles is another important question, however. We have seen multiple instances of a podiatrist performing surgery on a foot based upon insufficient x-rays confirming the need for the surgery in the first place.
3) What conservative, non-surgical options are available, and should I be considering those? Many podiatrists who do surgery like to do surgery. It's often the most interesting part of their job, and in some cases the reality is that it is also the most financially lucrative, meaning that they will earn more money by performing surgery than by giving you an orthotic shoe insert. This certainly does not apply to everyone in the field, but it's a reality that cannot be ignored.
4) What are the risks associated with this particular procedure? Don't be fooled by a statement such as “we're just going to scrape some bone,” or “this is a very simple procedure.” The fact is that anytime you have surgery you face very real risks. These include everything from pain to increased risk for infection to the possibility that the surgery makes the condition worse and will require follow up surgery. And it's important to understand that before any surgery you will be asked to sign a consent form which indicates that you've been told about these risks, so the best thing you can do for yourself is to ask about them early on.
5) How many times have you performed the procedure you're recommending, and how many patients have had difficulty following the procedure? Don't be embarrassed to ask. You would not want to have brain surgery from a surgeon who has never operated on the brain. Similarly, you don't want to put your ability to walk in the hands of someone who has never actually seen this problem before. Similarly, if a particular procedure has a significant likelihood of causing long term issues/problems, you'll want to know that and consider it in deciding whether to move forward.
6) Who will be performing the surgery? The podiatrist, a resident, or someone else? Who will be assisting and who will be present in the room?
7) Would you mind if I got a second opinion? It's amazing how many people are afraid of insulting someone they just met. This podiatrist is (generally) not a family member. They are a professional who you've gone to for help with a problem. If their proposed remedy is something that you need to think about, or talk to someone else about, do not for a moment feel awkward about that. Also, asking the podiatrist if they are okay with you getting a second opinion is a good test. If they become upset or are resistant – run. There's no place for an ego that large in medicine (or law), and such a response is a major red flag.
Prior to Surgery
If you have decided to move forward with podiatry surgery, your work is still not done. It remains very important that you take proactive steps to ensure that you are 1) receiving the correct treatment, and only that treatment; and 2) that you acknowledge and consent to only that treatment.
On the day before or day of the surgery you will likely be asked to sign some additional forms. If you have not already signed the consent form, the podiatrist (or, more likely, a nurse) will hand you the form and ask you to sign it. Be sure that you read it, and that it clearly states exactly what procedure is being performed.
An all too common practice in podiatry is to have the patient execute a blank consent form, only to have the podiatrist go back, after surgery, and “fill in the blanks”. This is not only improper, but it completely undermines the entire reason for the consent form in the first place. The podiatrist has an obligation to provide you with a detailed explanation of the upcoming surgery, and to ensure that you understand.
In many cases, the post-surgical period is one of the most critical. Often the bones in the foot must be set in a position to allow for optimal healing. If the toes are not positioned properly, the foot may heal in an incorrect position, often causing the patient more difficulty than they had prior to surgery and in many cases requiring surgical repair. The podiatrist should also be watching for signs that things did not go well, which include excessive swelling or pain.
Unfortunately, all too often podiatry records are completely lacking when it comes to post-surgical care. We routinely see post-surgical records which are clearly “copied and pasted,” and reflect the exact same notes for several visits in a row. This is not acceptable.
Once again, after surgery you must be your own advocate. If you have pain or discomfort you must document it to the podiatrist. If it continues, come back and complain again, and ask for x-rays. Keep a journal, reflecting your complaints, and include photographs of the foot. If at all possible, bring a friend or family member to the appointment to account for what you are saying and what was said in response. Finally, if the podiatrist shrugs off or completely ignores your complaints (“this is just normal healing”) go get a second opinion. If the problems are severe, consider calling an orthopedic surgeon to look at your foot.
What to do if things go wrong
More than ever, it is crucial that patients act as their own advocates. Medicine (including podiatry) has become such a rushed business that patients routinely feel that their needs are being ignored. By knowing the right questions to ask from the outset, you may help prevent a lifetime of pain in the end.
Remember, if things go wrong, we're here to help.
If things do not go as planned, contact us today. We're happy to help.