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04/16/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Anyone Can be a Victim of Employee Theft


From: Name Withheld (MA)


 


I just spent a lovely morning in court having to deal with an employee who stole nearly $13,000 from me over a period of four years, beginning in 2008. The original court date was April 9, 2014. At that time, the thief was given the opportunity to pay restitution during a period of probation, or go to jail. I agreed with the district attorney to allow her to pay restitution and not have a criminal record or any jail time. Was this a mistake? This morning, I appeared before the judge asking why, after four years, full restitution has still not been made. According to the original agreement, full restitution should’ve been paid at the end of one year. 


 


Believe it or not, all of us are at risk for this above scenario. I never thought I would be. It happens more often than you think. Please, please consider that you could be a victim yourself. There are many ways to prevent what happened to me. Please take the steps necessary and don’t let this happen to you. 


 


Name Withheld (MA)

Other messages in this thread:


12/06/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Marc A. Benard, DPM


 



Kudos to Dr. Belli. I’m happy to read that he, as well as others, have been motivated to provide international humanitarian foot and ankle care. For those of you who have not yet had the opportunity or motivation, I urge you consider it. Indeed, it can be life-altering for both the patient, the patient’s family, and for you. 


 


I’ve been co-director for the Baja Project for Crippled Children for many years (aka Operation Footprint) and my enthusiasm has never waned. I literally had an epiphany in 1977 when,...


 


Editor's note: Dr. Benard's extended-length letter can be read here


12/06/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Vladimir Gertsik, DPM


 


SCFE does not occur in infants. It is a disease of older kids and adolescents. Perhaps there is a hip dislocation? 


 


Vladimir Gertsik, DPM, Brooklyn, NY 

12/04/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert Scott Steinberg, DPM


 


Dr. Shavelson talks about a more patient-friendly, evidenced-based paradigm. As for the patient-friendly part, I have been doing that for all the years I have been in practice, by sparing my patients an ego-based showing-off of my biomechanical knowledge, choosing instead to have the devices I dispense speak for themselves. And... FYI, I am closely following everything Dr. Kevin Kirby publishes about biomechanics. I don't agree with everything, but he is consistent, and presents all his reasoning behind his newer theories.  


 


Robert Scott Steinberg, DPM, Schaumburg, IL

12/03/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Time to Develop Consensus Biomechanical Protocols


From: Dennis Shavelson DPM


 


I published a short white paper years ago entitled “The Tower of Biomechanics” where I imagined a forum that put together many different lower extremity biomechanical theories to show that biomechanically-oriented DPMs agree 90% of the time. For example, Dr. Phillips and I agree 90% of the time when debating biomechanics. I replaced his time-consuming measurements and pedobariograph technology with a simple, quick, and effective open and closed chain evaluation.


 


Biomechanics would flourish if we developed consensus terminology, examination, treatment, and presentation protocols. This would allow interested professionals to offer patients foundation stability, support, strength, symmetry, and balance with a promise for a more comfortable, injury free, upgraded quality of life.


 


As Drs. Schuster, Root, and Dananberg did for biomechanics years ago, we need to unite behind a new common vocabulary that replaces the poorly evidenced subtalar neutral, rearfoot varus, pronated, acquired flatfoot with a more patient-friendly, clinically relevant, presentable, evidence-based paradigm. 


 


Dennis Shavelson DPM, NY, NY

11/30/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Keith L. Gurnick, DPM


 


For my first 20-25 years in private practice, I always wore a full-length lab coat, nice slacks and nice dress shirt, and a nice tie in the office on days when patients were scheduled. I often got compliments on my ties, but mostly when I would wear the flashy silk ones, like the Zegna or Hermes ties. I always felt confined and hot wearing the tie and somewhat restricted wearing the lab coat, but it seemed like the proper thing to do, especially since I was younger and this was at a time when our profession was not as generally understood and respected as it has become today by patients and... 


 


Editor's note: Dr. Gurnick's extended-length letter can be read here

11/30/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From:  Charles Morelli, DPM


 


When I first got into practice 28 years ago, I wore slacks, a dress shirt, tie, a new lab coat and $200 shoes. After the first year seeing my dry-cleaning bill soar into the thousands of dollars, I quickly changed how I dressed. If I was a primary care physician who did nothing more than check my blood pressure, listen to my lungs, look in my ears, etc., and then call in his nurse to do everything else, I too might dress in a shirt, tie, and a lab coat. In my practice as with many of us, I am continually exposed to not only wounds and bodily fluids, but also things like.. 


 


Editor's note: Dr. Morelli's extended-length letter can be read here.

11/28/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Elliot Udell, DPM


 


Look at some of the panels on CNN, Fox News, and MSNBC. Some of the men wear ties and others do not. That's enough for me. I take the most comfortable way out and do not wear ties at all anymore. I just hope that they never do a survey showing that doctors with tuxedos make more money because that will never happen in my office in my lifetime.


 


Elliot Udell, DPM, Hicksville, NY

11/28/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Neil H Hecht, DPM


 



I thought “BBE”, i.e. “bare below the elbow” had been adopted as appropriate infectious disease prevention protocol in many places, especially in the UK. Wouldn’t that apply to our offices as well?


 


From MDLinx November 14, 2018: Neckties: Yet another reason to forego the necktie: Studies have shown that neckties and other items of clothing quickly become contaminated with bugs such as MRSA and C. difficile.


 


Worries about clothing contamination have fueled a new policy in the UK National Health Service hospitals banning neckties and jackets. Healthcare workers engaged in direct patient care are, instead, required to wear re-processable garments.


 


Neil H Hecht, DPM, Tarzana, CA


11/28/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C



From: Spencer F. Dubov, DPM


 



In response to Dr. Smith’s article concerning proper attire in the office, it has always been my view and experience of 55 years in practice, especially running courses in “Practice Administration”, that proper business attire sends a positive message to your patients of respect for them, yourself, and your profession. Wearing a white lab coat requires a business shirt and tie, or surgical scrubs. Nothing short of that is acceptable. When you visit a lawyer, his dress code is a suit and tie. Why would anyone want to present with a lesser appearance as a podiatric physician? The key is to “Dress for Success!” 


 


Spencer F. Dubov, DPM (Retired), Naples, FL


11/21/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Has Evidence-Based Medicine Gone Too Far?


From: Al Musella, DPM


 


I was at a cancer conference recently and there was a discussion on how we moved too far to the "evidence-based medicine" camp and lost all common sense. A doctor at the meeting (Brian Alexander. MD) presented this funny abstract: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials


 


Objectives: To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.


Design: Systematic review of randomized controlled trials.


Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate Internet sites and citation lists.


Study selection: Studies showing the effects of using a parachute during free fall.


Main outcome measure: Death or major trauma, defined as an injury severity score > 15.


Results: We were unable to identify any randomized controlled trials of parachute intervention.


Conclusions: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence-based medicine have criticized the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence-based medicine organized and participated in a double-blind, randomized, placebo-controlled, cross-over trial of the parachute.


 


Al Musella, DPM, Hewlett, NY

11/13/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Ed Davis, DPM


 


The lack of studies on this subject may be due, in part, to it being classified as a “rare” disease.  I am not sure if it is really that rare. Diagnosis codes may be used to track disease entities and there is no unique code for Ledderhose disease.


 


I have been using serial ultrasound-guided injections of hyaluronidase mixed with triamcinolone acetonide for about 20 years with very good results. I would be happy to share my protocol with any interested podiatrist.


 


Ed Davis, DPM, San Antonio, TX 

11/12/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Allen Jacobs, DPM


 


Injectable collagenase may be helpful for plantar fibromatosis, although neither robust nor long-term studies are available for reference. My personal approach is as follows:


 


1. Confirm the diagnosis with MRI, ultrasound, or percutaneous needle biopsy prior to treatment;


2. Daily BID application of a compounded mixture of 5% lidocaine, 5% diclofenac, and 15% verapamil (EBM);


3. Stretching of the plantar fascia (night splint and/or active stretch);


4. Avoidance of hard insoles or rigid orthotics. 


 


My experience (for many years) with the utilization of this technique for non-aggressive type fibromatosis has been nothing short of excellent.


 


Allen Jacobs, DPM, St. Louis, MO

11/09/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Ira Baum, DPM


 


I cannot speak to the use of collegenase, but I will share a technique that I used with a high degree of success. First, let me define success. Resolving a plantar fibroma via any injection technique is rare. However, reducing the size of the fibroma to resolve symptoms is what I  consider success. Having said that, the needling technique is as follows: Block anesthetize around the target lesion. Once anesthetized, with great care, using a 20 g needle, needle the lesion multiple times until it is palpably soft and reduced in size and depth. Finally, inject the lesion with an acetate type of steroid. Then place a mild, almost a venous heart-like compression dressing.


 


Inform patients that they may have discomfort and black and blue around the area for several days. I also suggest a very soft insole and a follow-up visit in 7 days. It may take several weeks to see the final result. Take great care (inform the patient of the risks) when needling the depth of the lesion to prevent injury to the medial proper digital nerve and a potential future rupture of the medial band of the PF.  


 


Ira Baum, DPM, Naples, FL

11/08/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Allen Jacobs, DPM


 


It is not appropriate to willfully misrepresent facts to a patient. Tell the patient the truth. You are paid less for multiple procedures performed concurrently. You are not willing to accept the reduced payments. The patient should be made to understand that you utilize the same degree of care, time, cost, and expertise for each procedure. 


 


If you are found negligent in the performance of a second or third procedure, I do not believe the jury award or settlement by the carrier is reduced 25 or 50 or 75 percent. Just tell the patient the truth. Misrepresentation is always unethical regardless of any well-intentioned reasons for doing so.


 


Allen Jacobs, DPM, St. Louis, MO

11/07/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Cynthia S. Ferrelli, DPM


 


I really don’t see how we can afford to do multiple procedures and still stay in business. I only do one procedure at a time. For instance, when performing a matrixectomy, I tell the patient that we need to see how the area heals, how they react to the anesthesia and phenol, how they heal before I will perform this on another toe. Most patients accept that without issue. If they don’t come back for the other toe, I don’t feel like I have lost out, because another patient needing the procedure is right behind them. We don't not get paid enough as it is for procedures; therefore, I am not willing to accept 50% for an additional procedure.


 


Cynthia S. Ferrelli, DPM, Buffalo, NY

11/02/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Elliot Udell, DPM


 


I feel Dr. Borreggine's frustration and anger when a patient walks out of the door and never pays his or her bill and, in some cases, has no intention of ever paying it. We had one patient who not only told me that the check would be in the mail, but he took a whole bunch of foot creams and never paid for them either. I physically and emotionally write off these cases by saying to myself that I took an oath to be a healer and that money is secondary.


 


What got me really angry was when that patient who never paid for the visit nor the foot creams popped up in my office a month later demanding that I give him a copy of the x-rays so that he can go to another doctor. Legally, I had to give him his records and x-rays. I suspect he probably travels from doctor to doctor doing the same thing.


 


Elliot Udell, DPM, Hicksville, NY

11/02/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Charles Morelli, DPM


 



With total respect for Dr. Borreggine, I am surprised that question is still being debated. With the exception of those who only take cash and do not contract with any insurers, the business of medicine and the times have certainly changed from what we all were accustomed to. They changed years ago.


 


Many will give examples of going to the store and asking to only pay 80% for their groceries, while others will comment on shopping at the mall and asking the lady (sorry "person") at checkout if they can pay when they come back to shop again in 2-3 months or they will suggest...


 


Editor's note: Dr. Morelli's extended-length letter can be read here.


11/01/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Collecting Fees Upfront


From: Joseph Borreggine, DPM


 


This is a worsening quandary day by day in my office: collecting fees upfront from the patient when services are rendered. The old adage says, “It is easier to collect money from the front door than it is from the back door.” But, with ever increasing deductibles into the $5-10K range, many of the medical services and minor surgical in-office services are not usually covered by an insurance carrier until the deductible is met. 


 


In this day and age, you would think the patient would be more educated about their benefits, but alas, they are not. They are ignorant in thinking that the “co-pay” is their only responsibility and the rest will be...


 


Editor's note: Dr. Borreggine's extended-length letter can be read here.

10/31/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: PICA, Name Withheld


 


Providers may or may not charge for copies and supplies necessary to copy depending upon the stipulations in the contract with payors. PICA recommends that you check your contract with the payor to determine if you can charge for charts being requested for audits.


 


PICA


 


I have gotten requests from Ciox a few times. On one occasion, I sent them an invoice of $25/chart for around ten charts. They did send a check. More recently, they requested four charts. I again sent an invoice but have not heard back from them. This was a few months ago. Still waiting. Did not send charts. I don’t want to give erroneous information but I believe a practitioner is entitled to get paid for this before sending chart requests. 


 


Name Withheld 

10/25/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Brian Kiel, DPM


 


We use Dragon Medical and it does an excellent job of accuracy at normal to fast talking. It also learns new words. For accuracy's sake, I read on the screen as I type and I am able to pick up any discrepancies . 


 


Brian Kiel, DPM, Memphis, TN

10/25/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Charles Morelli, DPM


 




I have been using this program for close to 20 years now. I'm actually writing this message while using Dragon voice dictation. I am not going to reread this, or by going to correct mistakes. Voice dictation has made during my nodes remarkably simple although I've had to correct mistakes on occasion especially when trying to dictate patient's names and using other medical terms that are far into the per gram. You are able to recognize that word so that the mistakes I made the future. What I've chosen to do is just not voiced dictate names but typed in manually. Has been a great asset to my practice, writing notes and doing anything that one would normally have to type


 


Here's what I just learned about the new version of Dragon I just...



 


Editor's notes: Dr. Morelli's extended-length letter can be read here. This note has NOT been edited and has been written exclusively with Dragon Voice dictation. 


10/16/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Dragon Voice Dictation


From: Ira Meyers, DPM


 


Every once in a while, someone has a question regarding voice dictation. I have been using Dragon Dictate for 10 years. Up until recently, I found the program to be fair. I recently upgraded to Medical Version 4 and I am pleasantly shocked how well it works. If you have been holding off waiting for an almost perfect dictation program, now is the time. 


 


Ira Meyers, DPM, Huntingdon Valley, PA

10/03/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Warren Joseph, DPM


 



I feel your pain! We were getting our insurance through my wife’s teaching job at a University. After she left the position, we have been on COBRA, which ran out September 30!  We have been looking for decent coverage for months. We found a reasonable “Short Term” catastrophic plan, which will only cover us for 3 months which started today. In the “Marketplace”, the best we could do was a BC/BS PPO Bronze plan at $1,900/mo and a $15,000 out-of-pocket deductible! Of course, there is only one provider, Independence Blue Shield. We hear that come Nov. 1 when Open Enrollment begins, 2 more insurers will enter the fray so maybe, just maybe, there will be some competition. 


 


So, I can’t help you with any suggestions; but I can commiserate. I too would love to hear from anyone who may have some thoughts on obtaining coverage.


 


Warren Joseph, DPM, Hatboro, PA


10/03/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Alicia Ericksen, DPM


 


I'm responding to Dr. Mark Stempler's concern with obtaining affordable health insurance for his family. My family was in the exact same predicament, with similar premium and deductible; absolutely unaffordable. We took a leap and became members of a bill sharing network. A few of my colleagues and patients have done this. There are several out there, and we found the right fit for us.  It has honestly been the best decision, and I cannot foresee making exorbitant payments to a health insurance company ever again.   


 


Alicia Ericksen, DPM, Seneca, NE

09/26/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Richard Adams, DPM


 


I have been using a scribe in my clinic for about three years. The benefits of a scribe are many. The benefits of a virtual scribe include one less body in an already cramped exam room, no necessity to purchase equipment, and no additional employee on your payroll. 


 


The downside of a virtual scribe involves occasional, but rare, IT concerns. In my opinion, if you choose the correct virtual provider, you will be very pleased. 


 


Richard Adams, DPM, Granbury, TX
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