ORTHOPAEDIC SURGEON OR OPERATIVE PODIATRIST?

Abstract

Introduction: In 2005, 88 patients (19M/69 F, mean age 55) initially referred by their GP to a Consultant Orthopaedic Surgeon were seen by an Operative Podiatrist as a waiting list initiative. The mean delay between GP referral and clinic appointment was 632 days. The majority of patients were listed for a surgical procedure. The podiatrist left the Trust before any listed surgery was performed. The cohort was subsequently reviewed by a Consultant Orthopaedic Surgeon prior to surgical intervention, creating a unique opportunity to compare podiatric and orthopaedic input in one patient group

Materials & Methods: Casenotes and clinic correspondence were identified by merging clinic datasets & retrieved in 86/88 cases. Medical records and documentation of peripheral vascular status were examined as a standard of care. Correlation of surgical decision making was examined qualitatively

Results: Circulatory status was found to be documented in 0/58 (0%) records available for patients seen by the podiatrist and 70/74 (95%) seen by the orthopaedic surgeon respectively. Vascular investigation or referral was initiated by the orthopaedic surgeon in 8 patients listed for surgery by the podiatrist. The listed procedure was postponed or cancelled by the orthopaedic surgeon in a further 11 patients (5 medically unfit for listed surgery, 4 treated conservatively & 2 unable to obtain valid consent). No written or dictated contemporaneous records were made for 23/88 (26%) of index podiatric consultations. Clinically significant drug history was documented by the podiatrist in 1/13 (8%) cases recorded by the orthopaedic surgeon

Discussion: Reasonable correlation was observed between proposed surgical interventions for forefoot problems. Poor correlation was observed for mid- and/or hind foot problems. Avoidable adverse outcomes might have been anticipated in 19/88 (22%) patients listed for surgery by the Operative Podiatrist

Conclusion: The employment of unsupervised non-medical surgical practitioners in hospital based orthopaedic practice is not appropriate.