A number of interesting points have been raised regarding diabetes and the involvement of podiatry. I agree with the concept that diabetes education often fails to achieve the patient response required no matter the level of intellect involved. We all know the details of lack of compliance, self-efficacy and any other fancy name one wishes to use in association with diabetes education. We have recently had discussion on U/G education which I think we would all agree requires review, based on what the profession really wants in the future, assuming of course the profession actually knows or has given any thought to the future. I, and others, over time, have used the fact we produce a graduate who can practice in the community as a "beginning practitioner" or phrases of a similar ilk. The problem with that philosophy is that many graduates may decide that that level is quite sufficient for the rest of their career and in many cases it may well be the case.
We have discussed how podiatry needs to develop in areas of specialization to demonstrate our expertise and to allow practitioners to study at P/G level to acquire those skills.  The day has long gone when, within our own profession, we claim to be sports medicine, biomechanics, diabetes etc, experts without demonstrating to the general health population we have the credentials to back it up. Maybe if we did, governments may take us a little more seriously in determining policy.
Just to hopefully stimulate discussion or criticism, I would suggest the following with regard to diabetes education.  I would ask the question as to why podiatrists feel they should be involved in educating the diabetic patient in all aspects of foot care, particularly in a hospital or community health clinic environment? In most multi disciplinary clinics there are diabetes educators employed to "educate' patients. Podiatrists should only be involved with the severe cases and the education associated with dealing with the presenting problem. The diabetes educator should be responsible for educating the other patients. I accept the rules are somewhat different in private practice. My experience of diabetes education both here in Australia and in Singapore is that the old term of diabetes "NURSE" educator has gone and it is now professionally non specific, indeed several podiatrists have been credentialed in that area.
If podiatry is to be seen as having greater involvement in diabetic care maybe we should be thinking laterally and try to bring diabetes education under our wing. Let podiatry, in association with other health professionals, train the diabetes educators as an offshoot of our education programs. We can utilize the professional skills required of nutritionists, physicians etc but we retain ownership of the program and confer the academic award. This may also be the case in other areas of podiatry involvement. As with most professions we have to lose the mind set of we do everything when it comes to foot care. Why not adopt a philosophy of we do all the foot care at a level for which we have been trained but we have others trained, by us, to support our work in particular environments.
I accept the premise of one contributor who said podiatrists will choose their area of interest and work environment. I only ask the question as to whether as a profession we are happy to accept areas of interest in which to practice or are we willing to take the tougher approach and say, by all means choose, but, if in an area deemed one of specialization, you will require further study and qualification to demonstrate your "interest" is based on additional training at a higher level. Other professions do, so why not podiatry?  The point of all this, lets think outside what we currently have and consider areas we can develop, retain ownership of, and demonstrate professional expansion based on education. If we fail to do so, as usual someone else will and we will be left wondering what might have been.  Alan

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