Bob

They just don’t get it, these medics and orthopods, do they? After Ralph
went to great lengths on these pages the other month, to explain the
realities of NHS titles, I’ve been telling our colleagues in the medical
profession that they should be sensible now and realise the consultant
debate has been lost and podiatric surgery is unstoppable in its
ascendancy. “Be reasonable”, I say to them, “and reason will prevail.” I’m
not sure whether they’re paying much attention though.

Some years back I ran a company that provided, amongst other things,
management consultancy and locum services for private practice and the
National Health. It was a private company and operated on a contractual
basis. From the outset I used the term ‘consultant’ instead of ‘director’
or ‘proprietor’ or ‘chief executive’ as I thought it more appropriate for
the type of work I was engaged in. This was a mistake. Although there are
no legal barriers to using the term ‘consultant’ from a private company’s
point of view, I should have realised that it would ruffle more than a few
feathers within the parochial environs of the NHS. It did. Without being
made aware of the fact, I found out twelve months later that an alert
notice had been registered against my name and although this was removed
(with an apology from the Trust Chief Executive), it highlighted to me the
depth of feeling held by those who attain this title in the public health
sphere. Of course I should have known better but it was a genuine mistake
and I apologised for any misunderstanding I caused. The Trust also
apologised – they had ignored Department of Health procedures by issuing
the notice without informing the individual (me) and legally they were in
a precarious position. It was a salutary lesson for all concerned -
especially for me, as it was a fellow podiatrist – not an orthopaedic
consultant - who instigated the notice on behalf of the Trust.

I recount this tale to illustrate how emotions can run high over
territorial encroachment – in this case between two chiropodists; one a
general practitioner and the other a podiatric surgeon. But it is not just
with the term ‘consultant’ that friction is produced between these two
entities. I know of one NHS podiatry department whose staff were at
loggerheads with the local podiatric surgeon who insisted they call
themselves chiropodists (as opposed to podiatrists), with predictable
hostility all round as a result. What never ceases to amaze me however, is
the annoyance from certain quarters of the podiatric profession directed
at our colleagues in orthopaedics, when the latter takes umbrage at the
use of terms such as ‘consultant’ and ‘physician’ by podiatrists. I would
suspect that the vast majority of (registered) podiatrists are a little
more than unhappy regarding the ascendancy of the ‘independent trained’
practitioner which has given them parity of registration with the HPC. Why
should we expect orthopaedic consultants to feel any different towards
podiatric surgeons?

Unfortunately I can’t see any reasonableness prevailing on either side.
Reading through both podiatric and orthopaedic literature, both ‘camps’
appear to be intransigent with the result that these issues are set to be
with us for some time yet. Podiatry will continue to make use of political
expediency and the RCS will do their utmost to make life difficult at the
sharp end. Personally, I’m not sure why those podiatrists with a desire to
perform invasive surgery don’t go back to university and undertake the
same course of study as their medical counterparts, but no doubt someone
will enlighten me otherwise. I also wonder how much time is devoted to the
podiatric surgery problem by the principal professional body in relation
to general podiatric practice given that there are less than
200 ‘surgeons’ against some 8,500 general practitioners. Is the ratio of
resources devoted to each aspect of practice comparable?

What is regrettable is the impasse we seem to be heading for. I have no
doubt that podiatrists can and do make good foot and ankle surgeons but
what could otherwise be a natural progression is being hindered by a
flawed set-up during training. Perhaps one solution is to disband the
terms ‘podiatric surgeon’ and ‘orthopaedic surgeon’ [in relation to foot
surgery] and introduce ‘foot and ankle surgeon’ instead. As for training,
shouldn’t all surgeons progress from the same platform? That is, after
all, what we demand from the unregistered practitioner after 2005 in our
own profession.

Yours sincerely

Mark Russell

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