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Podiatric Physicians: Essential to Insuring Comprehensive, Coordinated, and Collaborative Care Especially in the Elderly Community
April 21, 2018

Leonard A. Levy, DPM, MPH

Professor Emeritus, Nova Southeastern University

Dr. Kiran C. Patel College of Osteopathic Medicine

 

Charimedes or Temperance, a play written by Plato in 380 BCE, includes the following statement: “ {A}s you ought not to attempt to cure the eyes without the head, or the head without the body, so neither ought you to attempt to cure the body without the Soul. And this … is the reason why the cure of many diseases is unknown to the physicians of Hellas (i.e., Greece), because they disregard the whole, which ought to be studied also, for the part can never be well unless the whole is well.” Plato, not knowing anything about podiatric medicine, could certainly have used the profession as an example of what he was espousing. The profession with all of its progress in the last 100 years including its adoption of the title podiatric physician, too often in practice perceives itself as essentially practitioners who prevent, diagnose, and treat problems of the pedal extremity. Indeed that is a valuable and essential set of health care services and should not be denigrated. However, podiatric medicine’s potential has yet to be fully perceived as an integral part of medical practice, not yet holding the same license as physicians from such specialties as otorhinolaryngology, ophthalmology, and orthopedics.

Perhaps the aging of the population of the nation provides the key for podiatric medicine to achieve that recognition, facilitating its integration into the mainstream of health care. Between 2012 and 2050, the United States will experience considerable growth in its older population. In 2050, the population aged 65 and over is projected to be 83.7 million, almost double the estimated population of 43.1 million in 2012. By 2030, 20.3 percent of U.S. residents are projected to be 65 years of age and over, compared with 13.7 percent in 2012. As a result it can be projected that the prevalence of chronic disease will likely also increase considerably because of the vulnerability of the older population as well as the continued increase in the conversion of acute diseases to becoming chronic. (1) This includes the major increase in the population of people with diabetes, cardiovascular disease, and osteoarthritis.

This provides podiatric medicine with the opportunity to become a major part of continuous, comprehensive, and collaborative health care. Whether a first visit or follow-up visit, all podiatric patients, particularly the elderly, should have included in their physical examination blood pressure determination, assessment of the patient’s gait, overall skin color, ability to communicate, and a determination of whether they are complying with directions provided by other members of the health care team. Since podiatric physicians often see their patients more frequently than other physicians especially in those who require monthly or semimonthly nail care, they are in a position to participate as an essential component of the process of continuous care. For example, a patient who is being treated for hypertension and is identified by the podiatric physician to have dangerously high blood pressure could be sent to their primary care physician, perhaps averting a serious complication. It is not enough to take ones blood pressure at the first visit to the podiatric physician. By routinely doing so at every visit the DPM becomes truly part of the process of comprehensive, collaborative, and continuous care. Indeed there can be little doubt that if such management existed throughout the podiatric medical community, the profession’s essential role will be recognized by both healthcare providers and the general public.

Reference

1. Ortman J, Victoria A, Velkoff, V, and Hogan H . An aging nation: The older population in the United States. Estimates and Projections Current Population Reports Issued May 2014 P25-1140, United States Census Bureau.

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