The author reflects upon his experiences within podiatric medical education and shares his thoughts about the directions podiatric medical education should take before the end of the century. The author envisions a collaborative effort between the practitioners and educators within the profession in areas such as curriculum, research, academic health science centers, accreditation, and other important issues. The author calls for an education system relevant to and tested upon the anvil of patient care.
A 2004 survey of US adults found that 19% had experienced foot problems at work at some time. As a result, 38% reported lost productivity and 28% missed time at work. Younger, less educated male workers were more likely to suffer from foot problems. The percentage of the total population surveyed who missed time at work owing to foot problems was 5.4% in 2004. In a previous survey conducted in 2000, the corresponding percentage was 6.6%. (J Am Podiatr Med Assoc 94(6): 604–607, 2004)
Background: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk factors of chronic pain and debilitating injury. Screening has the potential to identify people at risk that may otherwise go unrecognized. This quality improvement project (QIP) aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center. Methods: A suicide risk screening QIP was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. Following training for all staff, patients ages 18 years and older were screened for suicide risk with the Ask Suicide-Screening Questions (ASQ) as standard of care. Clinic staff were surveyed about their opinions of screening. Results: Ninety-four percent of patients (442/470) agreed to be screened for suicide risk and nine patients (2%; 9/442) screened non-acute positive; zero for acute risk. The majority of clinic staff reported that they found screening acceptable, felt comfortable working with patients who have suicidal thoughts, and thought screening for suicide risk was clinically useful. Conclusions: Suicide risk screening was successfully implemented in an outpatient podiatry clinic. Screening with the ASQ provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision-making and leading to improved overall care for podiatry patients.
The coronavirus disease of 2019 pandemic is driving significant change in the health-care system and disrupting the best practices for diabetic limb preservation, leaving large numbers of patients without care. Patients with diabetes and foot ulcers are at increased risk for infections, hospitalization, amputations, and death. Podiatric care is associated with fewer diabetes-related amputations, emergency room visits, hospitalizations, length-of-stay, and costs. However, podiatrists must mobilize and adopt the new paradigm of shifts away from hospital care to community-based care. Implementing the proposed Pandemic Diabetic Foot Triage System, in-home visits, higher acuity office visits, telemedicine, and remote patient monitoring can help podiatrists manage patients while reducing the coronavirus disease of 2019 risk. The goal of podiatrists during the pandemic is to reduce the burden on the health-care system by keeping diabetic foot and wound patients safe, functional, and at home.