Going The Extra Mile For Extra Patients

     While the majority of my podiatry practice occurs in my clinic between 8 a.m. and 5 p.m., there are activities I call extras. These are professional services that occur after hours, on weekends or sometimes in conflict with the office hours.      The past week was full of extras. My cell phone/pager started humming and playing a Bach fugue Tuesday morning. It was a nurse from the OB department announcing that a baby boy, born 30 minutes earlier, had bilateral club feet. I like to start care within the first hour so I grabbed some casting material and headed to the hospital with my assistant.      We manipulated the baby’s feet using the Ponseti technique and had him in casts by the time he was one hour old. I explained to the parents what was going on as we gently maneuvered the twisted little feet into maximal correction.      My office patients were all completely understanding about the reason for the delay. I was back to podiatry as I came to know it 30 years ago. The rest of the morning was ingrown toenails, plantar fasciitis and sprained ankles. Three requests for wound care consultations came in during the rest of the day. This translated into another hour and a half at the hospital after clinic. I made it home for dinner at 7 p.m.      My partner and I were taking a break Wednesday at noon. I take my breaks in the hospital physician’s lounge where there is free coffee and snacks, Internet and a TV. Best of all, the lounge is where you hear the best gossip. We were enjoying a juicy story about one of our MD colleagues when the cell/pager erupted. It was the ER with a fellow who had trashed his ankle on a motorcycle. We were a bit late getting back to the office for the afternoon clinic.      I saw all of my afternoon patients, completed the charts and I headed home by 5:30 p.m. I was on time for dinner and looked forward to an evening of reading or perhaps a DVD movie. At 9 p.m., my pager went into a tantrum. The baby had kicked one of his casts off.      There is always the option of waiting until the next morning to manipulate and reapply the cast but with talipes equinovarus, a delay like that can set progress back weeks or even cause the need for complex rearfoot surgery.      I drove to the hospital and gently manipulated the little foot. Then I reapplied the child’s cast. The mother was quite upset because she had actually pulled the cast off while changing a diaper. I let her know that her baby’s feet are my highest priority. I also let her know that if patients ever stop calling me for help, I will have to get a real job. She was laughing as I left.      Thursday was an easy day. The ER sent an os trigonum fracture and an Achilles rupture to the clinic. We leave appointment slots open for emergencies so the regular patients do not encounter constant delays. My partner had the day off until the orthopedic clinic called to see if he could take care of a teenager with a fractured navicular. Our orthopedic surgeons are totally swamped with major joint replacements and back surgeries. They are happy to pass their foot and ankle extras to us and we are happy to accept them.      I still did not get home until 7:00 that evening. There were more inpatient consults. I never try to determine if the extras are cost effective or generate a profit for the practice. There is no doubt in my mind that if I spent that time seeing clinic patients, my bottom line would look better. However, I believe that being a doctor should always be more about good patient care than the pursuit of revenue.      Many of the patients who come to the ER after hours do so because they do not have access to most physicians without insurance or resources. This is a sad fact about our society and I am hoping the next elected president will deal with our need for universal medical care in this country.      Saturday was perfect. I attended a high school graduation. I gave a short speech and granted scholarships on behalf of a foundation I belong to. This was also one of the extras that I enjoy so much about being a podiatrist.      Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.