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the infamous brown shopping bag

Posted by Ed Davis, DPM on 11/06/01 at 21:34 (064280)

I think Richard, Dr. Z and others have seen the infamous shopping bag.
The poor patient walks in with a shopping bag filled with shoes, devices, gadgets, pads, supports---often several hundred dollars worth of stuff and occasionally running into the thousands. Not all the stuff in the bag is useless, sometimes it just has not been used properly. Some of the items may be costly devices with little efficacy.

It is now our duty to go through the bag, explain to the patient what everything is and what it does and does not do and what we really need to do to treat their PF. About 45 minutes have gone by, we are running late and the next few patients are irate, wondering why the heck doctors cannot seem to run on time. If they only knew about the brown shopping bag.
Ed

Re: but it spawned a whole profession

elliott on 11/06/01 at 23:24 (064287)

Following shoulder surgery last year, I had an old, legendary PT (he handled the Baltimore Colts in the glory days of Unitas; Dorothy Hamill showed up late to see him during one of my scheduled appts, and guess which one of us had to wait? :-)). He loves to talk and reminisce. He said that as the running boom took off and the injuries followed, DPMs soon realized that they could capitalize on injured runners looking for a sympathetic ear. The orthos just didn't have the time or patience to deal with the infamous brown bag, and so sports DPMs filled the gap. The runner would take out all the failed running shoes, orthotics, pads, tape, etc., and explain to the DPM exactly why they all failed. Said runner could talk for hours if you'd let him, but always needed at least 45 minutes. Tough for the DPM to make a living. But cure one runner, and 30 of his friends will flock to that DPM (of course, each runner needing his own 45 minutes). As a (sadly former) runner, I can sympathise with them. If we could just explain to the DPM exactly why every device in the brown paper bag failed, the DPM would gain the exact insight needed to offer a fix. :-) Even if you don't believe that, we do! :-)

Re: the infamous brown shopping bag

Barbara TX on 11/07/01 at 09:52 (064298)

Dr. Ed - every chronic condition has its own brown shopping bag. In fact, my bag is full of expensive useless wigets given to me exclusively by podiatrists, fully certified by the American Podiatric Association, and hand-picked by the descriminating BabsTX! Add to that a shelf full of useless pills, many of them with serious side effects.

I know the brown bag is frustrating for doctors, but they themselves create it, and out of necessity. Even if podiatric medicine did have a standard protocol for treating PF (currently there is none as far as I can tell), I still think that part of the art of medicine is that process of combing through the brown bag and taking that time to listen to the patient's history. In fact, the brown bag IS the patient's history!

Only one of my four medical doctors, three of them podiatrists, took the time to look into my brown bag. They just kept adding to it. So, I commend you for even taking a peek in the brown bag - most don't even look. And your patients should realize that you're late because you are a compassionate doctor. B.

Re: the infamous brown shopping bag

D.Thomas on 11/07/01 at 10:47 (064303)

Dr. Ed,

What is your patient load a week? I am just wondering. The excellent Pod I finally found pushes 150 a week. You can tell sometimes when he is having a hard day, but he never limits his time with you to keep on time. He is a class act like yourself and makes sure each patient gets 100%. I know your patients appreciate that even if you run late sometimes. I don't care at all that mine runs late becuase I know he will give 100% of his attention when he arrives. And that is all I ask.

I have to admit that it is very cool when you establish a good working relationship with a good doctor. I have improved so much in the last few weeks becuase of him, and believe me I am truly grateful for finding him.

Re: the infamous brown shopping bag

Beverly on 11/07/01 at 13:36 (064312)

I used to drag my brown bag to the doctor's office. Then, it dawned on me that he didn't know nearly as much about shoe choices as I did, and not being the orthodist, it didn't utilize my time well to show failed orthodics.

I did find it helpful to drag the brown paper bag to orthodist's office when contemplating new orthodics, because I wanted to show what had helped and what had been a total waste of money. Also, I discovered that a good orthodics maker is more up on shoe choices anyway than most of the doctors.

And the orthodist was far more patient as I did 'show and tell.'

Beverly

Re: the infamous brown shopping bag

JudyS on 11/07/01 at 14:02 (064316)

My docs didn't even look in my brown paper bag - even though every item in it had been provided by or prescribed by them!

Re: the infamous brown shopping bag

Glenn X on 11/07/01 at 15:59 (064328)

D Thomas: This is nicely said. I have that very 100%-of-attention experience every time I'm treated at Dr. Ed's office. And there's always a lot of other stuff going on there.

Quality care is remembered long after incidental waiting time is forgotten.

Re: protocol and flow chart

Ed Davis, DPM on 11/08/01 at 15:59 (064435)

The 'official' protocol and flow chart for plantar fasciitis published by the ACFAS was supposed to have been published by now----I will call them tommorrow morning to see what is up.
Ed

Re: "famous" not "infamous"

Ed Davis, DPM on 11/08/01 at 16:02 (064437)

I guess I should have called it the 'famous' brown shopping bag.
Ed

Re: the infamous brown shopping bag

BG CPed on 11/18/01 at 10:04 (064939)

2X that Dr Ed. I get about 5 of those per week. I understand they have been through the mill and are very cautious about getting it again. The ones that have a bag full of flimsy heels, easy spirits, and keds that are all size 6 narrow and they measure an 8 wide. Then you get the death stare when you suggest that the shoes are a BIG part of the problem. How many times do you hear 'nonsense I have been a size 6 aa since I was in high school.

Those shoes are known as foot girdles. Dr Ed it shows you take time with your pt to let them go thru it most guys would cut them off and not go over shoes and that is part of the problem. That is also why they have accumulated a bag full of devices and still wear terrible shoes and STILL have pain. There are also many pt with selective hearing, with them I will tell them if you are not willing to listen AND throw out the bad shoes then I am not going to waste my time or their money.

Too many folks doing orthotics just hand them to the patient and give little or no instructions which is a large part of the problem

Re: the infamous brown shopping bag

Ed Davis, DPM on 11/26/01 at 16:40 (065317)

A classmate of mine once remarked that he wanted nothing to do with shoes, arguing that psychiatrists do not deal with hats. Probably an extreme attititude but one that cannot be ignored. One that is changing for the better seriously but slowly through the years.
Ed

Re: the infamous brown shopping bag

BGCPed on 11/26/01 at 22:35 (065364)

Good point. As we know shoes can and do contribute to many foot problems. I had another one in today. Made me sit and watch her take out 1 heel after another, put it on and stand, then ask me 'what about this one' After a few pair I said if they are all slip ons and heels the orthotics are not going to work. They were also 1 1/2 size too small.

Half way thru explaining that she needed to switch to athletic shoe to get it under control, she pulled out another pair of heels put them on and stood up 'what about these' I told her to pretend those shoes dont exist anymore. She said ' but your making orthotics for these, i dont wear anything else' (I am not making this up) I traced her bare foot on paper then put her shoe over it to illustrate how her footshape eclipsed her shoe.

She then tried to put less wt on it and curled her toes back asking me to 'trace it again' At that point I said you are obviously not ready to go on a shoe diet and I understand, call back when you are ready to deal with this problem. Patients like that make me wish I worked in an auto plant

Re: but it spawned a whole profession

elliott on 11/06/01 at 23:24 (064287)

Following shoulder surgery last year, I had an old, legendary PT (he handled the Baltimore Colts in the glory days of Unitas; Dorothy Hamill showed up late to see him during one of my scheduled appts, and guess which one of us had to wait? :-)). He loves to talk and reminisce. He said that as the running boom took off and the injuries followed, DPMs soon realized that they could capitalize on injured runners looking for a sympathetic ear. The orthos just didn't have the time or patience to deal with the infamous brown bag, and so sports DPMs filled the gap. The runner would take out all the failed running shoes, orthotics, pads, tape, etc., and explain to the DPM exactly why they all failed. Said runner could talk for hours if you'd let him, but always needed at least 45 minutes. Tough for the DPM to make a living. But cure one runner, and 30 of his friends will flock to that DPM (of course, each runner needing his own 45 minutes). As a (sadly former) runner, I can sympathise with them. If we could just explain to the DPM exactly why every device in the brown paper bag failed, the DPM would gain the exact insight needed to offer a fix. :-) Even if you don't believe that, we do! :-)

Re: the infamous brown shopping bag

Barbara TX on 11/07/01 at 09:52 (064298)

Dr. Ed - every chronic condition has its own brown shopping bag. In fact, my bag is full of expensive useless wigets given to me exclusively by podiatrists, fully certified by the American Podiatric Association, and hand-picked by the descriminating BabsTX! Add to that a shelf full of useless pills, many of them with serious side effects.

I know the brown bag is frustrating for doctors, but they themselves create it, and out of necessity. Even if podiatric medicine did have a standard protocol for treating PF (currently there is none as far as I can tell), I still think that part of the art of medicine is that process of combing through the brown bag and taking that time to listen to the patient's history. In fact, the brown bag IS the patient's history!

Only one of my four medical doctors, three of them podiatrists, took the time to look into my brown bag. They just kept adding to it. So, I commend you for even taking a peek in the brown bag - most don't even look. And your patients should realize that you're late because you are a compassionate doctor. B.

Re: the infamous brown shopping bag

D.Thomas on 11/07/01 at 10:47 (064303)

Dr. Ed,

What is your patient load a week? I am just wondering. The excellent Pod I finally found pushes 150 a week. You can tell sometimes when he is having a hard day, but he never limits his time with you to keep on time. He is a class act like yourself and makes sure each patient gets 100%. I know your patients appreciate that even if you run late sometimes. I don't care at all that mine runs late becuase I know he will give 100% of his attention when he arrives. And that is all I ask.

I have to admit that it is very cool when you establish a good working relationship with a good doctor. I have improved so much in the last few weeks becuase of him, and believe me I am truly grateful for finding him.

Re: the infamous brown shopping bag

Beverly on 11/07/01 at 13:36 (064312)

I used to drag my brown bag to the doctor's office. Then, it dawned on me that he didn't know nearly as much about shoe choices as I did, and not being the orthodist, it didn't utilize my time well to show failed orthodics.

I did find it helpful to drag the brown paper bag to orthodist's office when contemplating new orthodics, because I wanted to show what had helped and what had been a total waste of money. Also, I discovered that a good orthodics maker is more up on shoe choices anyway than most of the doctors.

And the orthodist was far more patient as I did 'show and tell.'

Beverly

Re: the infamous brown shopping bag

JudyS on 11/07/01 at 14:02 (064316)

My docs didn't even look in my brown paper bag - even though every item in it had been provided by or prescribed by them!

Re: the infamous brown shopping bag

Glenn X on 11/07/01 at 15:59 (064328)

D Thomas: This is nicely said. I have that very 100%-of-attention experience every time I'm treated at Dr. Ed's office. And there's always a lot of other stuff going on there.

Quality care is remembered long after incidental waiting time is forgotten.

Re: protocol and flow chart

Ed Davis, DPM on 11/08/01 at 15:59 (064435)

The 'official' protocol and flow chart for plantar fasciitis published by the ACFAS was supposed to have been published by now----I will call them tommorrow morning to see what is up.
Ed

Re: "famous" not "infamous"

Ed Davis, DPM on 11/08/01 at 16:02 (064437)

I guess I should have called it the 'famous' brown shopping bag.
Ed

Re: the infamous brown shopping bag

BG CPed on 11/18/01 at 10:04 (064939)

2X that Dr Ed. I get about 5 of those per week. I understand they have been through the mill and are very cautious about getting it again. The ones that have a bag full of flimsy heels, easy spirits, and keds that are all size 6 narrow and they measure an 8 wide. Then you get the death stare when you suggest that the shoes are a BIG part of the problem. How many times do you hear 'nonsense I have been a size 6 aa since I was in high school.

Those shoes are known as foot girdles. Dr Ed it shows you take time with your pt to let them go thru it most guys would cut them off and not go over shoes and that is part of the problem. That is also why they have accumulated a bag full of devices and still wear terrible shoes and STILL have pain. There are also many pt with selective hearing, with them I will tell them if you are not willing to listen AND throw out the bad shoes then I am not going to waste my time or their money.

Too many folks doing orthotics just hand them to the patient and give little or no instructions which is a large part of the problem

Re: the infamous brown shopping bag

Ed Davis, DPM on 11/26/01 at 16:40 (065317)

A classmate of mine once remarked that he wanted nothing to do with shoes, arguing that psychiatrists do not deal with hats. Probably an extreme attititude but one that cannot be ignored. One that is changing for the better seriously but slowly through the years.
Ed

Re: the infamous brown shopping bag

BGCPed on 11/26/01 at 22:35 (065364)

Good point. As we know shoes can and do contribute to many foot problems. I had another one in today. Made me sit and watch her take out 1 heel after another, put it on and stand, then ask me 'what about this one' After a few pair I said if they are all slip ons and heels the orthotics are not going to work. They were also 1 1/2 size too small.

Half way thru explaining that she needed to switch to athletic shoe to get it under control, she pulled out another pair of heels put them on and stood up 'what about these' I told her to pretend those shoes dont exist anymore. She said ' but your making orthotics for these, i dont wear anything else' (I am not making this up) I traced her bare foot on paper then put her shoe over it to illustrate how her footshape eclipsed her shoe.

She then tried to put less wt on it and curled her toes back asking me to 'trace it again' At that point I said you are obviously not ready to go on a shoe diet and I understand, call back when you are ready to deal with this problem. Patients like that make me wish I worked in an auto plant