Paul
I'll try to make this the last comment on this subject. There are
plenty of articles done in Peer Reviewed Journals that are for lack of a
better phrase, "are just shit!" I respect your view and your point, but
that doesn't change the point that just because it hasn't been "Journaled,"
doesn't mean it doesn't work.
Bruce
----- Original Message -----
From: "Paul Bowles" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, February 15, 2002 5:10 PM
Subject: Re: Orthotic Abuse by Podiatrists
> Tony stated,,
>
> "Do you feel that it is fairer to prescribe orthoses that may resolve the
> patient`s complaint in a couple of visits, and last for a long period, or
to
> use another avenue .eg. ultrasound twice a week at a cost per
consultation."
>
> With all due respect Tony, I feel you are straying from the initial
> posting - in response to you point above, the word "MAY" is a very
poignant
> point. You have no proof that orthoses are any better at curing foot pain
> than ultrasound is. I am assuming you are referring to soft tissue
> inflammatory related conditions when we talk about this. Don't get m
wrong
> I understand where you are coming from mechanically - but my initial point
> remains - you have no proof that orthoses are doing NO HARM long term.
You
> can find several peer reviewed papers on the benefits of theraputic
> ultrasound in several well respected journals - medical, physio, chiro and
> the likes. I can't seem to find a peer reviewed paper supporting the use
of
> orthoses in biomechanically related conditions, and more importantly I
> cannot find a peer reviewed paper that tells me they will do NO HARM to
the
> patient in the long term.
>
> Again, don't take this the wrong way, I utilise orthoses when I need to as
a
> last possible resort - but my initial argument concerned Pods who knew
> NOTHING else but to prescribe orthoses - and most of them did not know WHY
> they were doing it.
>
> The bottom line is USE CAUTION - I wonder what we will find in 50 years
from
> now in research regarding orthotic use?
>
> Respectfully,
>
>
>
> Paul Bowles
>
>
>
>
> ----- Original Message -----
> From: "tony" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Saturday, February 16, 2002 3:58 AM
> Subject: Re: Orthotic Abuse by Podiatrists
>
>
> > Paul,
> > In regard to the over prescription of orthoses, I am sure there are
> > individuals, and not just podiatrists who are out to make a profit.
> > However, the patient is also a consumer and has the choice to go
elsewhere
> > if unhappy with the service provided. I currently work in the NHS and
> > prescribe a fair amount of orthoses, as well as employing other
> modalities.
> > There is no profit, however , if a private practitioner chooses to
charge
> a
> > certain price for his orthoses, that is for that individual to decide
and
> > for the consumer to make an "informed" decision.I have patients request
> > specific orthoses, not because they are functionally better, but look
> better
> > and are prepared to pay for them!
> > I also believe that there are practitioners that use other treatment
> > modalities, that could be questionable in regard of cost.
> > Do you feel that it is fairer to prescibe orthoses that may resolve the
> > patient`s complaint in a couple of visits, and last for a long period,
or
> to
> > use another avenue .eg. ultrasound twice a week at a cost per
> consultation.
> > This is for the practitioner to decide with the patient, there will
always
> > be inequalities in cost, in most cases the consumer has a choice
> > regards
> > Tony Achilles
> > ----- Original Message -----
> > From: "Paul Bowles" <[log in to unmask]>
> > To: <[log in to unmask]>
> > Sent: Friday, February 15, 2002 7:36 AM
> > Subject: Re: Orthotic Abuse by Podiatrists
> >
> >
> > > Andrew and others,
> > >
> > > You are not the only one it freightens mate, it scares the living
> > daylights
> > > out of me and that is why I choose to speak up. I agree with this
> comment
> > > whole heartedly but unfortunately this is the nature of the beast.
> > >
> > > Tony stated:
> > >
> > > "How does it - that makes no sense? None of us (I think) work for
> charity,
> > > so there has to be some profit in working, somewhere. If you are in
> > private
> > > practice Paul, and I assume from your sentiments that you *don't* make
> any
> > > profit from the provision of foot orthoses and orthomechanical
> treatment,
> > > then how do you survive and pay the bills?"
> > >
> > > Thats not what I stated Tony. I was simply implying that some
> Podiatrists
> > > have an extreme overtendency to overprescribe foot orthoses for NO
> > APPARENT
> > > REASON - hence the motives of profit need to be questioned. I made no
> > > mention of charity work, and I am well aware of the bills and
outgoings
> > > associated with MY private practice. I survive rather well and am
> always
> > > booked at least a few weeks in advance, and I do not believe in
> > > overprescription - hence point proved I do not rely on orthoses to pay
> my
> > > bills and survive. That is not to that I do not prescribe them, I do
> when
> > I
> > > deem it necessary.
> > >
> > > Tony cont'd:
> > >
> > > " Do you derive any profit from seeing somebody to remove a plain old
> run
> > of
> > > the mill corn, after all consumables and normal overheads are
accounted
> > > for?"
> > >
> > > Um, the answer to that is yes.
> > >
> > > Cont'd:
> > >
> > > "Where do you draw the line? Is making *any* profit from providing a
> > service
> > > unacceptable?"
> > >
> > > No - making a profit is not unacceptable - you get paid for the
service
> > you
> > > provide, that is how the world goes around. But can I ask you a few
> > > questions Tony? How much do you charge for a pair of orthoses?
> Assuming
> > > you are in Australia, it should cost you around $120 with full covers
> and
> > > soft tissue supplementations from the lab. I'm betting you sell them
to
> > > your patients for AT LEAST double that probably more. So I raise the
> > issue
> > > once again for you - why do you deserve to make over 100% profit on
> > > something you put in a cardboard box and send away? Why not charge
the
> > > patient $150 - making orthoses much more affordable to lower socio
> > economic
> > > areas ofd the community who require them (if they are so good!)
Surely
> > you
> > > make profit from your consultations, or do you do that for CHARITY?
> > >
> > > This rule of course does not apply to those podiatrists who
manufacture
> > > their own orthoses with their own hands. It is a time consuming
> activity
> > > which takes a few hours to complete - hence the payment.
> > >
> > > Jeff also stated:
> > >
> > > "I think when it comes to podiatrists who over prescribe orthoses, you
> may
> > > be attempting to make the exception appear like the rule. It also
> appears
> > > to me from your comments that you do not recognize the same beneficial
> > > qualities of orthoses as some of your colleagues."
> > >
> > > I don't know about that Jeff - the Podiatrists I see who prescribe
> > orthotics
> > > usually have no idea WHY they are doing it - again it scares the
living
> > hell
> > > out of me, especially considering we have NO long term evidence to
> support
> > > their safe use. Once again your arguments falls down due to the point
> > that
> > > YOU do not believe that I recognise the beneficial qualities of
> orthoses -
> > > maybe you do not recognise my qualifications as a Podiatrist either?
I
> > > recognise the potential benefits Jeff, do you recognise the potential
> > harm?
> > >
> > > Jeff also stated:
> > >
> > > "I have no problem with your position which I'm sure is honest and
based
> > on
> > > your experiences and personal perspective. But other podiatrists may
> have
> > > different experiences than you, and may find orthoses to have a
broader
> > > application."
> > >
> > > Sure agreed, this may be the case, especially I believe in people such
> as
> > > Kevin who have a wealth of experience using them - but that does not
> mean
> > he
> > > is correct in all he does. As Daryl Phillips stated a few days ago -
"
> > This
> > > then begs the question as to what you define as an 'experienced'
> > > practitioner? Could it be one who makes the same mistakes regularly by
> > only
> > > using orthotics or using them when they are not indicated but
regularly
> > > believes they are. That makes someone experienced. Not good, but
> > > experienced."
> > >
> > > Jeff I see so many patients who complain to be about MULTIPLE pairs of
> > > orthoses that have been forced upon them year after year - surely this
> is
> > > not coincidence or simple misdiagnosis? The reason patients pusrchase
> > them
> > > is that patients go to someone for help and they belive what they are
> told
> > > by that so called experienced person. I cannot tell you the amount of
> > times
> > > collegues have commented to me regarding how they SELL their
orthoses -
> > all
> > > the little "tricks of the trade". Patients even comment to me that
they
> > > were SOLD their orthotics and not given them. Until we actually
> > understand
> > > HOW they work, the only application that orthoses have is BROAD!
> > >
> > > To put an end to my comments regarding this thread - because it really
> is
> > > getting old - if there was a national inquiry by the ACCC into the use
> of
> > > orthoses i'm sure alot of Podiatrists/Physio's and Chiro's would be in
> > > trouble :)
> > >
> > >
> > > Regards
> > >
> > >
> > > Paul Bowles
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > ----- Original Message -----
> > > From: "Andrew Tindall" <[log in to unmask]>
> > > To: <[log in to unmask]>
> > > Sent: Tuesday, February 12, 2002 10:19 PM
> > > Subject: Re: Orthotic Abuse by Podiatrists
> > >
> > >
> > > > Dear all,
> > > >
> > > > Well, a very interesting debate!
> > > >
> > > > Going back to Simon's original posting, and drawing on the issue of
> > > competence, I doubt (knowing where Simon stands)that the physios he
> refers
> > > to, were complaining about HIM overprescribing orthoses! They were
> > probably
> > > refering to a host of others.
> > > >
> > > > Now, what I am about to say refers to NONE of the regular (or even
> > > irregular) contributors to this mailbase.
> > > >
> > > > There are many many podiatrists out there who prescribe orthoses
> > > inappropriately, or because they do not fully understand what they are
> > > doing. I know of someone who qualified and within a few months had
set
> up
> > > private practice calling herself and expert in biomechanics. This was
> > > certainly news to her lecturers judging by their comments on her
> > abilitiesvs
> > > her claims.
> > > >
> > > > I know of many people who would hold up their hand and say they know
> > very
> > > little about biomechanics, and yet they will prescribe orthoses. What
> > > verges more on incompetence - getting something wrong or doing
anything
> > > knowing full well you don't know what you are doing? These people
will
> > look
> > > at a biomechanics case and wonder about it, and say 'coo, look, they
> > > overpronate, I'd better do an orthosis' and away they go with often a
> poor
> > > cast, an an arbitary 4 degree rearfoot wedge without any thought about
> why
> > > the patient pronates in the first place, or what relevence it has to
the
> > > condition they are presenting with.
> > > >
> > > > You may think I'm am being cynical, but this is what I have seen,
and
> it
> > > frightens me.
> > > >
> > > > Andrew
> > > >
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