ACROSS the vast universe of healthcare , there are some obscure planets |
This may come as a surprise given some of the things Professor Paterson discovered .
Between 2010 and June last
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which have remained largely |
year , there had been 82 notifi- |
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unexplored . |
cations relating to 25 podiatric |
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One is the planet home to |
surgeons — five times higher |
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the podiatric surgeon , a rare and |
than normal podiatrists and |
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exotic breed given they are oper- |
nine times higher than the |
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ating on people without having |
comparable group of orthopae- |
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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-
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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
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‘ Professor Paterson even asks if the complaint rates against surgical podiatrists tell us anything important .’ |
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ing in a 60 Minutes exposé that |
notifications . |
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her foot surgery to fix corns |
And what were the issues in |
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on her toes had gone horribly |
these 82 complaints ? |
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wrong . |
He says nearly half of them |
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“ 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
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“ He said he had previously |
swelling , with surgical cor- |
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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
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problem , so he was confident it |
done — for instance , screws |
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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 ”,
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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
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is the case for much orthopaedic surgery ).”
So notification rates do not matter ?
He does not seem to ask
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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 |
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Turf war
It turns out there are only 40
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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 |
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because the claim does not seem to be referenced at all .
And “ heterogeneity between
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how complicated is the surgery being attempted , and are the outcomes and / or notifi- |
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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- |
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— 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 |
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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 |
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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- |
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centres alongside anaesthetists |
alarming given there were just |
ference . Bad practice is bad |
physicians . |
be relevant if it logically fol- |
lar complexity ? |
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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
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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 ”
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practice .
But then he asks whether the notification rates tell us anything important anyway .
This is his answer : “ Striking variations in notification
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“ 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-
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lowed that heterogeneity in itself meant some were substandard .
It does not but that is an aside .
Complaint rates
Professor Paterson continues :
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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
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not help inform the discussion |
paedic surgeon in an Australian |
“ The risks involved in surgery |
ankle procedures were per- |
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about whether they are putting |
public hospital which high- |
and unfulfilled patient expec- |
formed by podiatric surgeons |
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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
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Foot and ankle surgery is inherently complex .
— Professor Ron Paterson
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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
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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
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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 .
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suggests , and goes on to argue |
qualitative research study only |
whose surgery occurred in |
Nevertheless , his conclu- |
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against any move to restrict |
had 12 participants . Its claim |
the public health system or |
sion remains that the “ exten- |
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their scope of practice . |
that high numbers of patients |
was covered by insurance ( as |
sive material examined for |