Podiatry Students Unethical?

Not at all! As I said last week, the 4th year Podiatry Students at the University of Johannesburg(UJ), had their first taste of me starting the lectures on Practice Management and Ethics. There are many concepts to take on board including grasping the difference between ethical values & standards – represented by core values which are aspirational or value-oriented – such as Respect for persons, Human rights, Truthfulness,  etc., and ethical guidelines -represented by specific rules or duties associated with professional practice. We started to examine the challenges faced in daily practice and led into how we apply ethical reasoning to move from the understanding of guidelines to using them to influence our practical decision making and choices.

I’m usually never short of a word or two on most subjects! But beginning this course has made me think very hard again at the way in which I reach and make my day to day decisions. So just for fun!!! Let’s look at the 4 steps of ethical reasoning:

The problem: formulate  the problem and ask is there a better way of understanding it?    

Information: gather all the relevant data, clinical, personal, social etc.

Options: under the circumstances, consider all reasonable options, choices or actions.

Moral assessment: weigh the ethical content of each option by asking –

•     what are the likely consequences of each option
•     what are the most important values, duties and rights? which is strongest?
•     what are the weaknesses of your view?
•     how would you want to be treated in the circumstances of the case? i.e. apply the Golden Rule

(I acknowledge the Health Professions Council of South Africa (HPCSA) as the source of the above).

Easy isn’t it? Hopefully someone at the HPCSA will be able to tell me this week what the Golden Rule is, I think I know but I’d better get the official opinion on it!

Naturally we are all making choices every moment of our lives, some better some worse, but getting into deep philosophical discussions can be quite daunting – especially when all most of us want to do is practise our profession.(Oh, and make lots of money!)

Perhaps as you read this you should start to apply some ethical reasoning to why you should or should not book an appointment with your podiatrist. Are you a person with diabetes who hasn’t had a diabetic foot assessment recently or ever? Have you any idea what a podiatrist can do to help your feet if you suffer from some form of arthritis? Are your children normal or do they have some biomechanical anomaly (odd alignment) that is undiagnosed but could be treated by a podiatrist? Do you care if your Gran can’t cut her toenails? Do you really have to but another pair of running shoes to get relief from foot and leg pain or should see a podiatrist? Is it possible that a podiatry consult could shed some light on the cause of by chronic back pain?

This morning I saw the effects of good podiatry care in a 5 year old who has good foot alignment although she has rheumatoid arthritis. She has been wearing foot orthotics for one year and has not developed any deformity in this time. As part of the team at Chris Hani Baragwanath Hospital I hope that the future choices we make will produce such pleasing results. It comes as a surprise to most people that children can suffer with arthritis, so I’m going to write about this during the next few weeks.

In the mean time spare a thought for my students who must be faced with ethical decisions about whether they should do the assigned reading for this week or go to the movies in the hope that  I’ve got it all sorted!

Podiatry Students Under Threat?

University of Johannesburg 4th year podiatry students are in for a new experience on Tuesday 5th February! For the first time in 12 years I am returning to lecturing. I will be lecturing Private Practice Management, which is part of the course on Health Systems Management.  I’m looking forward to re-joining the academic team, despite a dislike of marking. It seems to me that full-time academic life in 2008 is like a road full of potholes called "admin,"  so I hope I can avoid these potholes as a part-timer! Being burdened with too much "admin" was one my reasons for leaving in 1995!.

Podiatry education in South Africa started in 1977 at the Witwatersrand College for Advanced Technical Education (WCATE), as a 3-year Diploma plus a year of in-service training. Then it became a National Higher Diploma after 4-years of study after WCATE became Technikon Witwatersrand(TWR). It evolved into a 4-year Bachelor’s Degree at TWR and when TWR and the Rand Afrikaans University merged to form the University of Johannesburg(UJ), this became the latest home for the degree. The degree isn’t offered by any other University in South Africa,  which is disappointing and leads to all sorts of difficulties in enrolling students from around the country. However graduates from UJ are distributed all over the world and many have gone on to become leaders in the profession in their new countries. In fact this week another young podiatrist is leaving Johannesburg for Australia, another went to Canada last Christmas and another two also left for Australia in 2007 whilst yet another relocated to Saudi Arabia (Hopefully this is only a temporary posting).

Fortunately there are some of us left in South Africa, mostly in private practice, but there are more posts being created in the State Health Services, including the Military, with students having to work back their bursary committments. As yet there is no requirement for podiatrists to do Community Service, mainly it seems due to the lack of available supervisors and posts. If and when Community Service becomes a requirement, podiatrists are well qualified to perform an important role in the management of foot problems associated with chronic disease and more importantly I think those affecting children.

Fitting Children’s Shoes – Again!

Fitting children with shoes can be really difficult and is often unpleasant for all involved. That includes brothers, sisters and fathers hanging around nearby! This means that the responsibility for getting the correct usually lies with Mum. The trauma increases due to the fact that in South Africa, there are virtually no shops who know how to measure children’s feet and fit the correct size of shoe.

Some stores have had measuring boards available in the shoe section for some years, but using it was left to the customer. At the same time there was no guarantee that the size system on the board matched the size system of the shoes. Anyone who has bought sports shoes/trainers recently will know that they have three or four different size numbers on the tongue of the shoe. This is because the shoes are made in Asia for sale all over the world where the basic unit of measurement differs – including different centimetre units.

In an attempt to bring some order and science into the art of shoe fitting, the South African Podiatry Association (SAPA) has been working with various manufacturers and retailers to establish standards for footwear in this country. There is a committee of experts headed by a podiatrist who has done ground-breaking original research into the feet of South African women. This committee assesses lasts(the plastic shape around which a shoe is built) and footwear design, against a checklist based on this scientific research.

One retailer is Woolworths and if you buy your child’s shoes there – although you will have to fit them yourself – you will see certain styles have the SAPA approval logo on the green tag. Look out for other large retailers getting involved in 2008.