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Hearing from the other side

Posted by Pauline on 6/07/04 at 08:35 (152202)

We often hear claims made about Orthopedic surgeons by our Pods, however, we never get a chance to hear their response. Because of this I took the opportunity to ask Dr. Puzner about his study, the one that Dr. Z posted a while back. Here is his email response to me.

'In spite of your concerns, the qulaity of training for Orthopaedic Surgeons far surpasses the training that a Podiatrist receives. I believe that cream rises to the top. I do not wish to get into a website debate. This article was used to increase the quality of training for Orthopaedic surgeons, who already are better trained than Podiatrists. The Podiatry website was not willing to discuss the sorry state of Podiatric Education, based on THEIR Podiatry 2000 review of their training programs. Should you like to discuss this issue, you may give me a call at 708-216-4993'. mp

Re: Hearing from the other side

Dr. Z on 6/07/04 at 16:08 (152267)

Pauline,
Please give us more information. Who is Dr. Puzner? What article is he talking about that was used to increase the quality of training for orthopedic surgeons, who are already better trained than podiatrists.
Really not sure what Dr. Pulzer is trying to point out.

Re: Hearing from the other side

Pauline on 6/07/04 at 17:04 (152274)

Ops spelled his name wrong. It's Dr. Michael Pinzur M.D. The Orthopedic Surgeon who's study you quoted a while back.

Various statements are often posted about the quality of care from Orthopedic Foot and Ankle specialist on this site. They never have the chance to respond because they don't see the postings. I though it would be nice to get a response directly from him for our readers.

You had asked me to respond but since he was the author of the study quoted it's only fiting that he respond.

He chose to response via email to the letter I sent him. I posted that response. If you or anyone have farther questions as to the educational training provided Orthopedic Surgeons who specialize in Foot and Ankle
or his published study he graciously provided his phone number so anyone can talk to him directly.

Re: Hearing from the other side

Dr. David S. Wander on 6/08/04 at 08:18 (152348)

Pauline,

It is blatantly obvious that your preference for orthopedic surgeons exceeds your preference for podiatrists. It is also intuitively obvious that if you ask a podiatrist, he/she will defend podiatry and if you ask an orthopedic surgeon, he/she will defend orthopedics. Enough is enough. I can inform you that in my area, I do receive referrals from orthopedic surgeons that are not comfortable treating the foot, and I of course refer patients to orthopedic surgeons for problems not relating to the foot and ankle.

As I've stated dozens of times on this forum, there are horrible podiatrists and there are horrible orthopedic surgeons. Being a good doctor involves much more than educational background. Podiatrists have chosen to specialize in the foot and ankle at an earlier point in their career. Orthopedic surgeons that do a foot/ankle fellowship have had excellent training and have chosen to specialize later in their career. BOTH of these professions have the potential to provide excellent care and BOTH of these professions have their share of 'bad apples'.

We can all relate stories of botched surgeries by both professions and most opinions will be based on an individuals personal experiences. I believe that you and Dr. Z are both insulting the educational requirements of both professions. Today's podiatric foot/ankle surgeons have an excellent education as well as several years of post graduate residency training in foot/ankle surgery. Orthopedic surgeons have an excellent education with several years of orthopedic training followed by a fellowship in foot/ankle surgery. The quality of care given is dependent on the individual skills of the surgeon, since BOTH professions receive an excellent education. The bottom line is that if you have a foot/ankle problem, you would be wise to see a podiatric surgeon or orthopedic surgeon specializing in the foot/ankle. Can we finally put this subject to rest?

Re: Hearing from the other side

Pauline on 6/08/04 at 10:08 (152373)

Dr. Wander,
How did I know that you'd be the one to respond? My post was a response to one that Dr. Z posted being critical again of the education and training of Orthopedic surgeons who specialize in Foot and Ankle.

If we want to be frank about this, he has turned heelspurs into a Podiatry advocacy and solicitation site for ESWT namely his group. Both Dr.Z and Dr. Ed openly critize researchers and Orthopedic surgeons for a captured audience in this nice closed arena, knowing that they will get no response from the very people they are critical of.

Does anyone really think that Rachelle Burchbinder or Dr. Manoli would take them to task? Their work and reputation speaks for them. They have no need of heelspurs, but the readers who come to heelspurs do not know these people, nor their work, or their reputations. They form their opinions by what is fed to them.

Dr. Z indicated to us that he's often with Orthopedic Surgeons so my question would be why doesn't he pose his concerns about their level of training, education and their competency to them directly instead of on this site? The answer is simple. He is only interested in forming opinions in readers minds not their response.

I'm glad you posted because hopefully now this subject can be layed to rest. You walk on common ground. It's my hope that the next time a reader ask 'which kind of doctor is best' Dr. Z and I will respond with your answer. This is satisfactory to me. I hope he will copy it down.

'The quality of care given is dependent on the individual skills of the surgeon, since BOTH professions receive an excellent education. The bottom line is that if you have a foot/ankle problem, you would be wise to see a podiatric surgeon or orthopedic surgeon specializing in the foot/ankle'.

Re: Hearing from the other side

Ed Davis, DPM on 6/08/04 at 11:08 (152385)

Pauline:
You have clearly made your preferences known via your posts here. Why do you think that orthopedic surgeons are not coming to this board or site?
Ed

Re: Hearing from the other side

Pauline on 6/08/04 at 11:50 (152391)

I like multiple choice questions.

a. Because they work full time, do hospital rounds, take care of
emergencies, teach, act as expert witnesses, raise families and have
no desire to be famous on heelspurs.

b. Patients seek them out, they don't seek out patients.

c. They don't need the publicity.

d. They would rather treat than debate.

e. All the the above.

The correct answer is 'e'

Re: Hearing from the other side

Dr. Z on 6/08/04 at 11:57 (152395)

You left out they publish ESWT FDA studies showing that ESWT is safe and efficient and should be used for the treatment of Chronic proximal plantar fasciitis. Throw in golf, tennis, and hanging out with Dr. Z

Re: Hearing from the other side

Ed Davis, DPM on 6/08/04 at 13:28 (152415)

Pauline:
I work 90 hours a week so that, I beleive, counts as full time.

Lets face it; there are over 15,000 podiatrists out there and you are hearing from about 2 to 4 max. on this site.

The orthopedic surgeons in my community have billboards -- they seek out patients more aggressively than podiatrists. Some pods are expert witnesses and have families.
Ed

Re: Hearing from the other side

Dr. Z on 6/08/04 at 13:58 (152417)

You are wasting your time Ed. In our area we have orthopedic institutes
paying big bucks for TV , newspaper etc.

Re: Hearing from the other side

Ed Davis, DPM on 6/08/04 at 14:00 (152418)

Dr. Z;
I realize that we are not going to convince Pauline as she has made up her mind. This is a public forum so I am posting to set the record straight for the benefit of the rest of our readers.
Ed

Re: How does one spend their "down" time

Ed Davis, DPM on 6/08/04 at 14:09 (152421)

Usually, I have little down time between patients. Many call their stockbroker, trade stocks online, read journals, play video games. Reading journals is probably the thing that is the most professional.
Dr. Z and I come here and contribute some of our 'down' time to patients with PF.

I think we could get more docs coming here but many are concerned about professional liability. Many don't mind giving advice but don't want to get into debates.

Dr. Z definitely has thick skin and has taught me to thicken mine as it is the only way to be able to hang around here, at times...
Ed

Re: How does one spend their "down" time

Dr. Z on 6/08/04 at 15:08 (152435)

Dr. Ed,

It is so natural for me to use my down time to view this site that I never even think about how much time I spend here. I sure know that you do.
I like people and this is the reason I am really here. I DON'T NEED THE ESWT BUSINESS. Here that Pauline. I don't need the ESWT business. I don't advertize on this site. I will always offer ESWT as a treatment for chronic proximal plantar fasciosis on this site if the situation presents it self and that will not change ! Ed I hope that you will continue to exspress you support for a treatment that is just plain revolutionary. ESWT works !!! , has stood the test of time and when there are so many patients out there demanding insurance coverage only then will it become universally covered
ESWT will stand on its own as a treatment regardless of whether insurance companies become involved.

Re: How does one spend their "down" time

Ed Davis, DPM on 6/08/04 at 18:51 (152455)

David:
It is interesting to note ismst as they are basically moving way past PF and looking at other applications. ESWT is widely accepted in Europe and its efficacy in PF is becoming 'old hat.' The only new papers on this are likely to be US generated since that is where things are being debated ad nauseum.
Ed

Re: Hearing from the other side

Dr. David S. Wander on 6/09/04 at 13:09 (152541)

Pauline,

In your posting you wrote 'How did I know you'd be the one to respond?', regarding my posting. I'm asking how DID you know and why were you confident that I'd respond?

Re: Hearing from the other side

Pauline on 6/09/04 at 20:58 (152605)

Because you are a peacemaker, a diplomat, and a person of character.

Re: Hearing from the other side

Ed Davis, DPM on 6/09/04 at 21:56 (152615)

'Both Dr.Z and Dr. Ed openly critize researchers and Orthopedic surgeons for a captured audience in this nice closed arena, knowing that they will get no response from the very people they are critical of.'

Pauline: Dr. Z and I have only needed to come to defense of podiatric physicians when you launch an attack. As far as researchers; there are thousands whom we respect. I would be happy to hear a response from Dr. Buchbinder on this board. She has written flawed, biased research which has been used as a 'tool' by some in the insurance industry to deny legitimate treatment so I will take her to task here or ANY forum.
Ed

Re: Hearing from the other side

Pauline on 6/09/04 at 22:24 (152619)

Dr. Ed,
If you want a response from Dr. Buchbinder don't wait for her to respond in this forum because that will never happen. There is this thing called professional protocol where by professionals respond in formal medical forums and or published letters to the editors of medical journels etc.

If you really wanted to discuss material with her you'd have made the contact already. What I see here is all talk and no action.

If I can find her address soooooooo can you. She has responded to me, but I made it happen. I didn't just talk about it. Email her or snail mail her and you'll get a response or drag yourself to the next professional meeting where she will be and talk to her in person.

Make the effort and you'll have success, but from what I see that isn't really your goal.

Some people make things happen, others just spin their wheels.

Even Dr. Rompe suggest that you and Dr. Z formally write to the publication as he did. Sooooooooooo what's holding you back?

You have the power to solve your own problem. Time to get off the pot.

Re: Hearing from the other side

Pauline on 6/09/04 at 23:16 (152623)

Dr. Ed,
Here is Dr. Wander's answer. I think it's great. Why not copy it and if the question comes up again use it.

'The quality of care given is dependent on the individual skills of the surgeon, since BOTH professions receive an excellent education. The bottom line is that if you have a foot/ankle problem, you would be wise to see a podiatric surgeon or orthopedic surgeon specializing in the foot/ankle. Can we finally put this subject to rest?'
Posted to Category: Ask the Foot Doctors

Re: Hearing from the other side

Ed Davis, DPM on 6/10/04 at 00:34 (152624)

Pauline:
I have responded to her paper in a number of venues- you do not know where I speak or write - I am a teacher to residents.. I am clincian, not a professional author -- I have done more than my share statements. I am not going to write her a letter just to make you happy.
Ed

Re: Hearing from the other side

Dr. David S. Wander on 6/10/04 at 07:48 (152627)

Pauline,

Thanks for the kind words, they are appreciated. The bottom line is that there are enough skilled podiatrists and foot/ankle orthopedists to assure that patients are well treated, and there are enough patients with foot/ankle pathology to keep both professions busy.

Re: Hearing from the other side

Pauline on 6/10/04 at 13:24 (152659)

Your letter writing isn't for my benefit. It's for yours. You're the one seeking answers from her. I got my questions answered.

You have an abundance of time to tell us that she isn't qualified but you have yet to discuss her qualifications to publish on ESWT with her personally. It's not answers from her you seek about her work, and her qualifications as it relates to ESWT. If it were you'd have had them by now.

From your collection of posts we know that you are everything to everyone from teacher, and doctor to volunteer. To that end it should be very simple for someone one with your experience, background and credentials to get the answers you seek from one researcher if you really want them.

If you really want to talk to her she's a phone call or email away. She's not difficult to reach.

Re: Hearing from the other side

Dr. Z on 6/10/04 at 13:58 (152664)

I just got off the phone with her. She told me she was very sorry but would try to do a better job in her next article. I ask her when that was and she told me she would have to contact her insurance carrrier to see if they would cover another publiication by her. Some kind of pre-certication rules.
Seriously this dialogue between you and Dr. Ed could go on and on . It is very boring to me so it must be very boring to the board.
The proper place for this discussion is at the level of the journal editorial responses. Will this resolve the problem?. Maybe if you have hundreds of responses. I doubt it
The way to resolve insurance issues is in front of a judge or mediation. This is best handled by a patient who really is the subcriber and pays the premium costs.
So I say we end this discussion on this specific topic What do you think??

Re: It's a shame...

lurker on 6/10/04 at 22:31 (152704)

that this message board is used more for debate than treatment. Look through these pages and see how many posters' questions have been ignored while messages like this one are receiving multiple replies. You have ALL lost your focus here and these continual fights have no meaningful value. I'm sure there are many lurkers who are reading these childish threads from the sidelines while trying to glean meaningful information to deal with their pain. It is admirable that any drs post here and whether you may agree with them or not, please allow them to utilize their time wisely and help as many people as possible. We are all intelligent enough to do further research and discern whether advice given or treatments recommended are for us. This is the first & last time I will ever post here.

Re: It's a shame...

Pauline on 6/10/04 at 23:00 (152706)

You've got to do what you feel is best.