Footnotes: Foothealth

No doubt it is going to be expensive, if you are mobile the cost of petrol is shocking, if you are surgery based the cost of gas and electricity are going through the roof. This got me thinking, is there any way that I could reduce my costs? I could increase my fee, but this may reduce the number of patients coming through the door. Not a thrilling prospect. It takes such a long time to build up a good patient base, so I have shelved that idea for the moment.

If like me, you have patients who you only see once i.e. “I have an ingrowing toenail”, or a corn etc. I have decided to charge a First consultation Fee, an extra £5.00. I have it clearly displayed on the notice board, with a message reading “if another appointment is made within the next 12 months, the fee reverts to the standard fee charged”. I have been doing this for the last 4 weeks and not one patient has mentioned it. Some of my regular patients have even tried to give me the extra money, when I tell them it is not meant for them, they are very pleased. So far it has covered the cost of the extra electricity. As my surgery door opens straight onto the outside world, I wait for the patient to approach the door and open it for them, they come in and I close it behind them very quickly. As they are about to leave, I put my hand on the handle and after saying goodbye I open it for them. It sounds simple, but how many patients open the door, and then stand there with it wide open, telling you what their Grandson did in his last football match. Letting all your lovely warm air escape. As I have electric heaters in the surgery. I also turn them off when the last patient comes in, I find that the room remains warm enough, and I can save on my heating bill. I changed all the down lights to energy efficient bulbs, and I have invested in a dustpan and brush, so I don’t have to use the hoover so often. It would be fantastic to hear from anyone who has any money saving ideas. If you have any you would like to share, drop me an email fenton303@ntlworld.com or let Julie at head office know julie@iocp.org.uk and we can pass them onto everybody. Happy New Year! Regards Ian

I haven’t stopped, but I am loving every moment!

University has been a thoroughly rewarding experience so far. In Southport, I was excited to meet a handful of like-minded people, who shared my passion for podiatry; you can imagine how enjoyable it is to be surrounded by dozens of friendly future podiatrists, new friends and expert lecturers. For developing your knowledge and pushing yourself further, there really is nothing like being in and amongst your peers. It should almost go without saying, but the quality of the lecturers and the knowledge they are passing on is incredibly valuable. The standards we are set and the assignments we will be taking on are of an extremely high level; the work is taxing, but I know it will all be worth it when I can provide the very highest gold standard of care for my patients. What’s more, is that as I am learning, my work in the clinic is naturally becoming more advanced. I am growing more comfortable discussing advanced terminology with the podiatrists I work alongside. It works both ways as well, as I can take my practical experience of working as an FHP into the university clinic and help my peers who may not have as much experience as myself. It’s fair to say that I am eager for future lectures so that I can learn even more. Although if I’m honest, I am nervous to learn about biomechanics and MSK, as these were not covered in too much detail by the FHP course. Still though, the physics involved intrigues me and it will be a great challenge to push me further. It’s nice to see my fellow peers all in our uniform during the clinic hours at university. You can really see the next generation of podiatrists. I am proud to be a part of it. Looking forward, I can’t see the hurricane slowing any time soon and I think the next four years as a student are going to fly by. It’s bittersweet in a way, to think that this experience will all too soon be a part of my past. But certainly, I am taking nothing for granted and enjoying every moment while I can.

Dean Watterson

Louisa-Jayne Viccars Maria Lloyd

Somuz & the Graduation Group David Kenny

Emma Bretherton

Brieanna Barber Katherine Campbell

Charlotte Duff

The Graduation Group

Marie Benoit Philippa Mann Mariya Ahktar Lucie Francis

Natasha Lea

A good medical history will include health information about the patient and close family. This can be particularly helpful to understand hereditary issues such as bunions and likely diseases in the patient’s family that may play a role in the patient’s health, such as diabetes. The risk for diabetes, or heart disease, and several types of cancers can be genetically inherited. While this doesn’t mean the patient will become ill, it does help the health practitioner, and the patient has more awareness of any hereditary conditions. It can often be a good guide for lifestyle changes, especially with the prevalence of many conditions that can influence the future health of the patient’s feet. This will also include the patient’s past and current medication, and vaccination records.

It is not unusual for patients who encounter medical or allied health professionals to have medical histories taken. The level of detail the history contains may depend on who is taking the medical history and, on the patient’s main complaint. The most detailed and complete history, when time is not a factor (not an emergency or where the patient is unconscious) may include primary, secondary, and tertiary histories, a review of the patient’s symptoms, and a past medical history.

The primary goal of obtaining a medical history from the patient is to understand the patient’s state of health and to further determine if the patient’s medical history is related to the patient’s presenting health complaint being evaluated, assessed, or diagnosed. The secondary goal is to gain information to prevent potential harm to the patient during treatment, for instance, avoiding any medicament being used i.e., skin preparations that could potentially cause an allergic reaction. For medical practitioners i.e., GPs this can be a complicated problem while trying to avoid administering or prescribing a medication the patient has previously taken and had an adverse reaction too.

For most allied health, chiropody, podiatry, and foot health professionals, taking medical histories usually entails taking down the patient’s name, address, date of birth, age, height, weight, (shoe size) and complaint/s. Thereafter, gathering the primary history, such as the symptoms and how long the patient has had the symptoms, which may reveal how much pain, on a scale of 0 to 10, the patient is experiencing. This would usually be recorded on the patient records or a separate medical history form, so there is an accurate account of what the patient tells the health practitioner.

The health practitioner should then expand on the patient information with a secondary history. This is where the patient is asked about any symptoms they are experiencing, related to their foot problem. Any associated symptoms can often be key to making a correct diagnosis and providing suitable treatments. Although it is not uncommon for the patient to understand or view associated symptoms having any relationship to their foot complaint. could also include reviewing the symptoms and list anything that the patient feels might not be normal and wants the practitioner to look at.

Any past medical history or background information can help the health practitioner know more about the patient’s health, not just the current chief complaint or foot issue, as follows:

It is important to communicate with the patient about their medical history, which can have a significant impact on preventing possible medical or treatment errors. Whereby the health practitioner can provide the correct treatment/s. It is just as important to record the patient’s medical history with the patients record accurately, which may reduce medical/ health professional errors or improper assessments and/or diagnoses and treatments provided.

Any information gathered by any means will crucially guide and direct the care and treatments provided to the patient. Although, it should be during the initial encounter with patients that a patient’s medical history is taken and then any follow up or subsequent visits/ treatments should then only require a review of the medical history and possibly an update with any changes to diagnosed illnesses/ conditions, hospitalisations, or medications. It can also be important since Covid-19 to check immunisation status. An accurate medical history will support all aspects of the health professionals practice, and if necessary, any interprofessional team involved in the care of the patient.

Overall, a medical history is an inquiry of the patient’s medical history, past surgical history, family medical history, social history, allergies, and medications the patient is currently taking. This can direct treatments and avoid any potential harm to the patient regarding allergies or limited care during previous treatments; especially useful to support a patient’s current foot complaint.

All the best Beverley Chair of Ethics and Vice-Chair of Education

A tertiary history is anything in the patient’s past medical history that may have something to do with the current foot or feet complaint. This further supports a clearer assessment of the problem and the care plan or treatment ideally suited for the patient. The health practitioner

BMJ 2018;324:1533

Ingram S. Taking a comprehensive health history: learning through practice and reflection. Br J Nurs. 2017 Oct 12;26(18):1033-1037. doi: 10.12968/ bjon.2017.26.18.1033. PMID: 29034702.

Nichol JR, Sundjaja JH, Nelson G. Medical History. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534249/

van Diermen DE, Brand HS, Vissink A. Het belang van een goede medische anamnese [The importance of adequate medical history taking in dentistry]. Ned Tijdschr Tandheelkd. 2006 May;113(5):172-5. Dutch. PMID: 16729560.

Yorath MC. Why Complete H&Ps Should Be More Common In Podiatry. Podiatry Today. September 2005.