by Heather Schafer

After working in the podiatry field for many years, this past year has brought several changes to both my professional and personal life.  That change happens to be diabetes.  I have recently changed offices and am now working for a doctor whose wife is a diabetic educator, and I also have a brother who has been recently diagnosed with the disease.  This has made me increasingly aware of the need for constant diabetic education in our offices.

We all know that diabetes is the leading cause of amputation of the lower limbs, but do we all know that as many of half of these amputations might be prevented through simple but effective foot care practices?  Early identification of foot problems and early intervention to prevent these problems from worsening can often times alleviate many of these amputations.  Good foot care by patients as well as by their podiatrists is an essential part of diabetes management.

What are you doing in your office to help educate your diabetic patients?  Have you contacted your local hospitals and joined forces with their diabetes education department, introducing your office and your interest in their diabetic programs and patients?  As you may also realize, this could also lead to a lot of referrals to your practice that you may not have gotten otherwise.

The doctor that I work for goes to our local hospitals at least once every six months for a “diabetes talk” to all of the recently diagnosed diabetics.  This usually only takes about two hours (at the most) out of his schedule, but the rewards have definitely been great.  We have met some of the most fabulous patients, and the reward of adding these patients to our practice isn’t so bad either!

Take a look at how your office currently handles your diabetic patients.  Do you give each new patient with diabetes (or all of your newly-diagnosed diabetic patients) literature about diabetes and their feet, and about the dos and don’ts of foot care?  Do you set them up for at least an annual check with your office in regards to their diabetes?

Our doctor has trained our medical assistant in exactly what he wants her to be responsible for when it comes to the counseling of our new diabetic patients.  She not only gives them a written “Diabetes and your Feet” brochure (from Krames) but also verbally goes over things with them.  Listed below are some of the things that she goes over with our patients:

1.  “Take care of your diabetes”.  Urges them to work with their health care team to keep their blood sugar within their target range.

2.   “Check the feet every day.  Look for red spots, cuts, swelling and blisters”.  If they can’t see the bottom of their feet, they should use a mirror or have someone help them.

3.   Encourage activity.  Have them plan out a physical activity program with their health care team.

4.   Have them ask their doctor about Medicare coverage for special shoes.

5.  Tell them to wash their feet everyday in warm (not HOT) water.  Instruct them to dry them carefully, especially in between the toes.

6.  Encourage them to keep their skin soft and smooth and to rub a thin coat of skin lotion over the tops and bottoms of their feet, but not in between the toes.

7.  Ask your doctor how they feel about your patients wearing shoes and socks at all times and about telling them never to walk barefoot.  Some doctors’ feelings towards this may be different.

8.  Tell your patients to protect their feet from hot and cold.  “Wear shoes at all times, especially at the beach or on hot pavement.  Test water before submerging the feet, just as if you were bathing a baby”.  Maybe even tell them a horror story from a past patient to let them know that they really can burn their feet without realizing it.

Of course there are always more things that can be said, encouraged and taught to our patients, or other ways your doctor may want these things presented, but maybe if you don’t have anything in place yet for diabetic education for your patients, you can put this on your New Year’s Resolution list to get started for your office in 2005 and……actually do it! 

Heather Schafer

by Gayle S. Johnson

My husband, a photographer, has a little sign that he made and placed on the wall of his darkroom.  He can’t recall the source of the quote he put on it, which reads, “The true scales are internal”.  He says it is a reminder to him that while photography is very much an absolute science there is also a lot that is variable and subjective.  There is a realization that comes from experience, that the technology of times, temperatures and dilutions is tempered by artistic interpretation and intention.

I find that quote’s expression of enlightenment appropriate to the understanding of what certification really means.  A test, any test, is intended to be a benchmark of the facts we may know about a given subject.  No test is perfect and you may recall the historic failure of certain standardized tests to really evaluate aptitude or at least in an equitable way across the population.  Rather than rehash that topic, I would suggest that certification is really a symbol of something deeper and …. internal.  Over the years, I have often said that certification signifies that one has achieved a certain level of competence and knowledgeability.  I have urged podiatric assistants to strive for that symbol of excellence, and urged their employers to encourage them in those efforts.  I have always maintained that this should be a personal goal, a measure of one’s professional growth, not just part of a job description.   

Typical preparation for an exam might be to study material that is likely to be covered in hopes of being able to give correct responses to the questions asked.  The expectation is to get enough correct answers to pass the test, and perhaps actually learn about that subject through the process.  My own experience in preparing for certification was that by studying diligently, we learned far more about each category than was included in the test.  I considered that a positive thing, and the information gained at that time has proved useful even many years later.

Situations arise in the real world that test our abilities to interpret from that acquired pool of knowledge in many different ways than the questions presented on an exam, so that we really do need to “know our stuff”.  There is a definite distinction between what we truly know and what we remember from a few days or hours before.  And certainly knowledge and the certification of that knowledge need to be ongoing and evolving.  A podiatric assistant with many years’ experience doing plaster casting or coding insurance claims is going to excel in those areas, while someone fresh out of school with exposure to the latest computer or other technologies may be able to comprehend things that some others may struggle with.  So a true test must address diverse ranges and levels of experiences.  The real goal and, I believe, the value of certification, is that we fully comprehend the subject matter so that we are able to apply what we have learned to our day-to-day experience. 

I also believe that certification symbolizes something else, an attitude of commitment.  It can represent a commitment to an ideal of professionalism and personal professional growth.  In that regard, certification is a reflection of something inside us, like those internal scales, but alive and changing, not merely the result of a long-ago exam and certificate that we got from a particular entity.  If you seek out knowledge, heed the words of Alexander Pope and “drink deep” from that spring.**  Books are a great resource and starting point, but draw from as many different experiences as you can.  Try to attend seminars when available, resisting the urge to sight-see or shop rather than attend a lecture on some topic you may perceive as sounding boring.  Challenge yourself to return home with new knowledge gained from each speaker.  Aspire to and achieve these things, and trust your internal scales as the true test of your accomplishment.

**
“A little learning is a dangerous thing;
Drink deep, or taste not the Pierian spring:
There shallow draughts intoxicate the brain,
and drinking largely sobers us again. …..”
  -  from “An Essay on Criticism”,  Alexander Pope (1688-1744)

Gayle S. Johnson

by Gayle S. Johnson

Are we listening??  Recently, at least one new patient a week has told me that the podiatrist they had seen previously "just didn't listen to me".  Just as often, we hear of primary physicians who have told them that "It's no big deal" or "It will probably go away on its own", or perhaps referred them for treatment of "X", when their pain comes from "Y".  Each of them told me how their greatest concern about their foot condition was ignored or discounted by the previous practitioner.  While this is not a recent phenomenon, it seems that I have heard such complaints more often lately.  These patients were seeking not only resolution of their problem, but validation that their concern was warranted.

This is somewhat like paying a visit to the mechanic for some brake work, only to be told that you could use a new exhaust system or an alternator or something else that you hadn't noticed at all.  Your immediate concern and the cause of your distress is how your brakes are working, so you don't want that to be brushed aside. 

My experience has been that when the doctor doesn't have the time to fully hear them out, people truly appreciate when the staff will make a point of learning what the patient thinks is their primary issue.  They count on us to help convey that to the doctor, whether our job is gathering information on the phone at the time of scheduling or taking the initial history in the office.  I've learned the wisdom of an early employer's advice: "Never pre-judge a situation".  When there is pressure to act in haste, it is easy to make assumptions about   what seems obvious.  While we all recognize that we must strive for efficiency, we must also remain receptive to what the patients are trying to tell us.

Podiatric assistants serve as advocates for the patients and often as "translators" between them and the doctor.  We can understand what the patient is trying to express, and they will often open up to us with more details about their situation and expectations if they feel we are paying attention.  We need to be sure that the doctor gets the whole story ("She's leaving for a European walking tour next month" or "He's got a marathon coming up") as they consider a treatment plan.  Finally, we can paraphrase and reinforce the doctor's presentation and instructions to help the patient understand the more technical information.   We can add helpful information (pre-approved by the doctor, of course) about keeping dressings or strappings dry; ways to stay non-weight-bearing while performing daily tasks; what and when to eat (or not) while taking medication; placement and timing of heat or cold; and many other details that may otherwise be lost as they try to absorb what the doctor tells them.

In the end, it is all about communication.  Improving our listening skills will help the patients and the practice.

Gayle S. Johnson

Surgical Technologist Registration 
Volume 77

by Mary Wasell, PMAC

The following recently came to our office's attention. We work for a podiatrist who has an ambulatory surgical center (ASC) in addition to the clinic. The back office staff is all trained to circulate and/or scrub in on cases. According to Washington State Department of Health, Health Professions Quality Assurance, "Anyone performing tasks in the surgical setting under the delegation of authority of a licensed health care practitioner must be registered as a Surgical Technologist." This is found in the Revised Code of Washington (RCW) 18.215. You can read the details at: https://fortress.wa.gov/doh/hpqa1/HPS6/Surgical_Technologists/default.htm

Actual forms can be accessed at this link: https://fortress.wa.gov/doh/hpqa1/HPS6/Surgical_Technologists/forms.htm

If you have additional questions, you can call 360-236-4700.

Persons who hold a Registered Nurse, Licensed Practical Nurse or Physician license do not need to register as a Surgical Technologist. Those who are PMACs and have passed the national ASPMA exam, which covers surgical practices, are not exempt. You still have to be registered with the state of Washington.

The requirements are easy. Fill out the registration form, certify that you have seven hours HIV/AIDs education (you needed that to take X-rays) and send your MONEY. The application fee is $50.00 and annual renewal is $125.00. 

This law passed 2-3 years ago as far as I can find out from the Department of Health and it is something that they are now checking to see if ASCs have complied. I thought those of you who work in ASCs might like a "heads-up" if you're not already registered.

Mary Wasell, PMAC
Edmonds Surgery Center, Edmonds, WA