Mark et al
The issues you raise are ones which a National Health Service will have to
address sooner or later and are much bigger than just podiatric care. This
morning I listened to the ex Sec of State for Health suggesting that we
should change the rights of patients by giviong them in the next Labour
maifesto a legal right to demand the treatment of their choice and under
strict time constraints. Failure would give them rights of redress in the
courts.
This is all one way traffic. For example how long are the rest of us
expected to provide expanding care services for those who self damage by
smoking and then expect care on demand. Such rights must be supported by
obligations on the part of patients.
I know a local vascular team that will not treat varicose veins in smokers
because the recurrence rate is greater than 50% in such situations, would
you feel this to be wrong? I would see it as sensible planning.
In podiatric care nail cutting for the infirm who can not manage for
themselves is defined in the UK as social not medical care. It is generally
supported in Scotland but not England, although the issue that raised all
this calls that Scottish policy into doubt. It may well be best provided
under the aegis of podiatry but not, I would suggest, necessarily by a
graduate podiatrist. An assistant grade may be suitable.
If the nails are pathologic and the patient declines treatment then it is
not clear that the NHS does have a duty to do something else. Maybe it
should and maybe not. Marks analogy about oncology is flawed since terminal
care has largely been taken by the hospice movement who are associated but
not run by the NHS.
If the NHS is to be required to provide services under a legal obligation
then we had all better be prepared to take a deep breath and make some
painful decisions about the extent and timing of such services.
Under present arrangements many podiatry depts would find the greater part
of the budget being spent in settling damages and legal fees and providing
even less care.
"Your shoes are just too small Mrs Smith thats why you have toe ulcers with
infection."
"You listen to me young man, I will wear what I like and you will treat me
twice a week or I will sue you!"
Food for thought
Ralph Graham
Consultant Podiatrist
Witham, Essex, UK
-----Original Message-----
From: A group for the academic discussion of current issues in podiatry
[mailto:[log in to unmask]]On Behalf Of Mark Russell
Sent: 02 March 2004 10:06 AM
To: [log in to unmask]
Subject: Re: Toenail Maintenance
Akbal,
You wrote:
"I am glad to see that you are now thinking about this issue. What makes you
think that this person is going to have problems with healing times?
If it ain't broke then why is this chap seeing a podiatrist? He has painful
involuted nails from what I understand, personally I don't see why he should
be kept in pain just to give a podiatrist a set of nails to cut."
I think it comes down to patient choice. For example; I have cancer. My
oncologist advises that an operation is neccessary to remove the tumor. If
I don't proceed, I will die. If I do then the chances are I might make a
good recovery. If I decide not to proceed with surgery, would you expect my
consultant to withdraw palliative care and leave me to seek medication from
the private sector? He may advise surgery, but in the end it is my choice
and the consequences of that choice is my own responsibility.
None of us know the particular circumstances of the gentleman in the
Highlands. I suspect that he does have pathology and that the offer of
surgery was made in his best interests. He has the right to refuse
treatment. The question is therefore, should the alternative to surgery -
palliative care- be withdrawn?
You (and Mr Wylie if I read him accurately) raised an entirely different
aspect - the removal of healthy toenails as an alternative to providing a
routine nail service for the elderly and infirm. I think you may find that
few would support such a move. As a profession we can advise what we think
is best for our patients. They still retain the right to choose. That
should never change.
Best wishes
Mark Russell
-----------------------------------------------------------------
This message was distributed by the Podiatry JISCmail list server
All opinions and assertions contained in this message are those of
the original author. The listowner(s) and the JISCmail service take
no responsibility for the content.
to leave the Podiatry email list send a message containing the text
leave podiatry
to [log in to unmask]
Please visit http://www.jiscmail.ac.uk for any further information
-----------------------------------------------------------------
-----------------------------------------------------------------
This message was distributed by the Podiatry JISCmail list server
All opinions and assertions contained in this message are those of
the original author. The listowner(s) and the JISCmail service take
no responsibility for the content.
to leave the Podiatry email list send a message containing the text
leave podiatry
to [log in to unmask]
Please visit http://www.jiscmail.ac.uk for any further information
-----------------------------------------------------------------
|
