On Tuesday of this week, I was to report to the Podiatry department found in the Windsor Road Christie Clinic site. I was privileged to meet and shadow one of the top physicians and administrators of Christie Clinic, Dr. William Pierce. Dr. Pierce is CMO (Chief Medical Officer) of Christie Clinic. He dedicates about 20% of his time to clinical and surgical podiatry as a DPM (Doctor of Podiatric Medicine) and he spends most of his time conducting administrative work in Christie Clinic. Dr. Pierce diagnoses, treats, and helps prevent diseases and disorders affecting the feet and ankles of adults and children. He specializes in diabetic foot complications and reconstructive foot surgery. He also has a strong interest in the pathobiomechanics (abnormal function) of the foot and ankle. I was warned by Dr. Pierce’s assistant, Jenna, that he was very busy and may seem distracted as he was taking on his own and another doctor’s patients who had called in sick [D].
Despite Dr. Pierce’s full schedule, I was mind blown by the amount of information he threw at me in the 4 hour span. He made sure to explain each case before entering and seeing each patient. He began the first lesson of the day by asking me “what does a banana smell like?” The question took me by surprise because it was so trivial but I answered “yes.” It did not occur to me that Dr. Pierce would then make an important analogy as he asked his second question, “What does it smell like?” This question is of course silly and unanswerable, but Dr. Pierce would then conclude that a patient’s pain is like a banana. The patient can’t necessarily explain the pain he/she are experiencing (similarly, you cannot explain how a banana smells), so that leaves the doctor to play the “detective role” and trying to uncover the mystery. Dr. Pierce explained that a patient may be experiencing pain on the dorsal (top) side of the foot but the problem may initially be in the hind foot. Because of the functionality and biomechanics of the foot, a kinetic chain is triggered when the joints move and an inflamed region of the foot may put stress on other components, thus causing pain in a foreign area [D]. This applies to other biomechanical factors of the body as well. It is important to grasp this concept because a doctor has to put all the pieces he/she has together (such as results from physical examination, radiographs, history, and patient’s impression) in order to distinguish between the “banana and the plantain” [A].
As I shadowed Dr. Pierce I made observations. Something I quickly picked up on was the lack of diversity of his patients. Most of his patients were older women with chronic foot pain, generally as a result of a tight calf muscle. Because the calf muscle is linked to the Achilles tendon, many of the foot’s mechanics are controlled by the gastroc (calf) as the patient goes through the gait cycle (walking cycle). To compensate for the tight calf muscle the heel is lifted off the ground early, causing an abnormality in a patient’s walking cycle. The abnormal force that the Achilles tendon and calf muscle exert causes midfoot collapse and pain in that region. This condition can be treated conservatively by stretching the calf muscle and elongating it. Pain relief is found in orthotics, which are soles placed in the patient’s shoe to help control pronation (irregular tilting of the foot/ankle), support the midfoot and distribute forefoot pressure. Dr. Pierce also made references to how this condition applies to many athletes, which may be detrimental to their running technique and mechanics. Many sports rely on the sound movement of the feet, so it is important to manipulate podiatric treatment to improve an athlete’s performance.
This is just scratching the surface of what I’ve learned with Dr. Pierce. I received advice on how to communicate with patients as well as how a doctor thinks critically when diagnosing each case [A]. It was a fast paced and exhausting day, but proved to be extremely productive [F]. I would like to get more exposure to podiatry in the future. Dr. Pierce welcomed me to come, but he only works in the clinic on Tuesdays because of his administrative duties. It would be interesting to see more preoperative and postoperative cases to get more of an idea of which cases require such measures to be taken.
No comments:
Post a Comment