This may come as a surprise given some of the things Professor Paterson discovered .

Between 2010 and June last

which have remained largely

year , there had been 82 notifi-

unexplored .

cations relating to 25 podiatric

One is the planet home to

surgeons — five times higher

the podiatric surgeon , a rare and

than normal podiatrists and

exotic breed given they are oper-

nine times higher than the

ating on people without having

comparable group of orthopae-

gone through medical school , never mind making that long and arduous journey to qualify as a normal surgeon .

Last year , a few media stories surfaced about bad things happening — one patient claim-

dic surgeons receiving notifications for treating feet or ankles .

He then says it is also concerning that 66 % of these notifications related to nine podiatric surgeons who had all received three or more

‘ Professor Paterson even asks if the complaint rates against surgical podiatrists tell us anything important .’

ing in a 60 Minutes exposé that

notifications .

her foot surgery to fix corns

And what were the issues in

on her toes had gone horribly

these 82 complaints ?

wrong .

He says nearly half of them

“ He came out in his white coat , saying he ’ s a doctor and a surgeon . So of course you think it ’ s a medical doctor you are conversing with ,” she said .

related to :

• Unsatisfactory treatment or surgery

• Postoperative complications such as infection or chronic

“ He said he had previously

swelling , with surgical cor-

done a procedure where he released the tendons of the toes and that alleviated the

rection being required

• A perception that surgery was inappropriate or badly

problem , so he was confident it

done — for instance , screws

would help me .”

in the wrong location or

As a result of some of the publicity , Professor Ron Paterson , a law academic and famed patient safety expert from New Zealand , was asked by AHPRA

floating plates

• Poor writing and verbal skills .

However , Professor Paterson says these are “ outliers significantly inflating the results ”,

over the past 13 years revealing a pattern of patient dissatisfaction , this does not indicate widespread safety and quality problems .

rates are not confined to podiatry . Over the same period , orthopaedic surgeons had a notification rate double that of medical practitioners ( 97.9

allocated to surgical clinics results in brief consults does not seem to relate to any findings in its own study .

In fact , it is difficult to

is the case for much orthopaedic surgery ).”

So notification rates do not matter ?

He does not seem to ask

to conduct a review .

arguing generalisations are

Part of his rationale is that

compared with 46.4 per 1000

find where it does come from

the $ 64,000 questions : just

Turf war

It turns out there are only 40

difficult given the very small number of podiatric surgeons and the number of notifications

the notifications received did not seem to focus on any specific procedure or group of

because the claim does not seem to be referenced at all .

And “ heterogeneity between

how complicated is the surgery being attempted , and are the outcomes and / or notifi-

podiatric surgeons in Australia

they attract .

procedures or area of the foot —

lators in Australia from 2011

doctors ” — again not referenced

cation rates substantially dif-

— half of them located in WA .

That may be true .

forefoot , midfoot or ankle .

to 2016 found that the rate of

— seems to refer to doctors as a

ferent when the procedures

Some are working in private

But nine practitioners with

Some may be asking

complaints was more than 10

whole , not orthopaedic surgeons

are performed by orthopaedic

hospitals and day procedure

a serious complaint rate seems

whether that makes a dif-

times higher for surgeons than

in particular where it would only

surgeons on patients of simi-

centres alongside anaesthetists

alarming given there were just

ference . Bad practice is bad

physicians .

be relevant if it logically fol-

lar complexity ?

and other doctors .

But it is actually difficult to work out from Professor Paterson ’ s report what it is podiatric surgeons are doing in terms of the specific procedures they offer , which does

18 surgeons on the register when AHPRA began and only 40 registered now .

Professor Paterson says despite a “ close analysis of the nature of the notifications ”

practice .

But then he asks whether the notification rates tell us anything important anyway .

This is his answer : “ Striking variations in notification

“ Orthopaedic surgeons are subject to a high rate of complaints and claims .”

Then he refers to a qualitative research study of patients unhappy after foot and ankle surgery performed by an ortho-

lowed that heterogeneity in itself meant some were substandard .

It does not but that is an aside .

Complaint rates

Professor Paterson continues :

Big problem ?

But that seems to relate to one

fairly major problem in his analysis — he admits he does not have the denominator data showing how many foot and

not help inform the discussion

paedic surgeon in an Australian

“ The risks involved in surgery

ankle procedures were per-

about whether they are putting

public hospital which high-

and unfulfilled patient expec-

formed by podiatric surgeons

patients at unnecessary risk .

Subtalar arthrodesis , ankle arthrodesis , ligament reconstruction , bunion surgery ? It is not clear , despite the report ’ s considerable length .

But Professor Paterson is dismissive of the complaints raised by orthopaedic surgeons of dodgy work .

That is mainly a turf war , he

Foot and ankle surgery is inherently complex .

— Professor Ron Paterson

lighted the “ high number of patients allocated to surgical clinics results in brief consultations ” and the “ heterogeneity between doctors regarding their level of training and experience in managing foot and ankle complaints ”.

It is important to point out here , in a way that Professor Paterson does not , that the

tations may explain the high complaint rates .

“ Foot and ankle surgery is inherently complex and can leave patients with persistent pain .

“ Where surgery is selffunded , in private facilities , a patient unhappy with the result may be more motivated to complain than a patient

in order to assess the notification rates as good or bad .

“ Nor is there a good-quality clinical registry for foot and ankle surgery in Australia with data about adverse events and patient-reported outcomes ,” he adds .

This seems to undermine the entire enterprise he has been tasked with .

suggests , and goes on to argue

qualitative research study only

whose surgery occurred in

Nevertheless , his conclu-

against any move to restrict

had 12 participants . Its claim

the public health system or

sion remains that the “ exten-

their scope of practice .

that high numbers of patients

was covered by insurance ( as

sive material examined for