Footnotes

With Dr. Kaufman
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Honesty is the Best Policy

Hello to you, and hello 2025!

I was going to focus on surgical intervention for some common foot and ankle ailments that I treat and considerations that should be made before scheduling surgery. But instead, I would like to discuss the importance of properly (and honestly) completing or updating your patient medical, family, and social history paperwork.

I know that the intake paperwork can be tedious and even lengthy, and the importance of properly completing this paperwork may seem obvious. Yet it never ceases to amaze me the number of my new patients who simply do not feel that their non-podiatric medical conditions are in any way pertinent to their podiatric care. Or that their family history of diabetes or heart disease is important for me to know about. Even more concerning is the number of my patients who have no idea what medication(s) they are taking, the dosage, or even why they have been prescribed their medication(s).

What does any of this have to do
with my foot?

I have encountered numerous patients through the years who, when I am going through their incomplete paperwork and asking for the missing information, ask me “What does any of this have to do with my foot?”. My answer is always the same: “Well, your foot is connected to your body”.

While my specialty is the foot and ankle, I am a physician and a member of my patients’ care team. It is just as important for me to know as much about my patient’s history as it is for their primary care doctor, cardiologist, nephrologist, and on and on. It’s all connected!  

As an example, if I was considering prescribing medication for a patient that is processed by their kidneys or liver, it would be imperative for me to know whether the patient has impeded kidney function or liver disease. Or if I do not know that a patient has uncontrolled diabetes, and I perform a procedure on them (could be as simple as removing an ingrown toenail), they may not heal properly and could develop a severe infection that goes into their bone and results in amputation. (Yes, this sounds like an extreme example, but it does happen.) Knowing about my patient’s medical diagnoses and history is key to excellent care. As is knowing who their primary care provider is (or if they even have one. Oftentimes, this is left blank).

I cannot stress enough   the importance of a complete medications and allergies list.

I cannot stress enough the importance of a complete medications and allergies list. This also includes supplements. I prescribe, among other things, antibiotic medications. However, if I were considering prescribing a penicillin-based antibiotic to a patient, would knowing  they have a history of severe anaphylaxis be crucial? Absolutely. Additionally, there are many medications that do not interact well with other medications. They can increase or decrease the concentration of another medication the patient is taking, effectively increasing or decreasing the amount in their system. In the case of blood pressure medications, this could be a serious and even life-threatening problem. Similarly, with an anti-inflammatory medication and the patient is on a blood thinner, that interaction could put the patient at risk for prolonged bleeding. 

While my electronic health records system can automatically populate some of my patients’ medications, there may be others that, for various reasons, do not automatically populate and the system cannot cross check them for potential interactions with any medication that I may prescribe, leaving that patient at risk for a possible adverse interaction. That is why it is imperative to ensure a complete list of medications being taken can be added to our records. Come prepared, or follow up as soon as you can!. 

There are vitamins and supplements which can interact negatively with prescription medications, or which thin the blood and increase the risk of bleeding during and after surgery. (Fish oil is an example of a blood thinning supplement.) So, these need to be listed as well.

My clinic is a 
'No Judgement Zone'

I would like to encourage everyone to keep an up-to-date list of all medical diagnoses, medications and allergies either in your phone, or as a written list that is kept with you. We’ll need a bit more detail than “I take an orange pill in the morning, and I have a green pill I take three times a day for an infection”!

Surgical history is also important, and, in my clinic, I ask for all surgeries within the past 10 years including any complications that may have occurred. I have so many patients who do not list non-foot-related procedures because they do not think this information is important. But it is!

I may have a new patient whose paperwork shows no surgical history when, in fact, they have had a triple bypass, a pacemaker implanted or a joint replacement. And, if they had problems with surgical anesthesia or a history of post operative infections or suffer from a chronic pain condition that is worsened by surgery if not properly treated before and after the procedure, that information would likely not be recorded either.  Remember, your foot is attached to your body!  

Family medical history is also important as there are medical conditions which are inherited and may influence how I manage their care. This is, of course, only for blood relatives and does not include in-laws or adoptive families.

I have also found that some of my new patients will knowingly omit certain medical diagnoses they have or medications they take because they are embarrassed or concerned that I am going to pass judgement on them. Rest assured that this is furthest from the truth. My clinic is a “No Judgement Zone”. My need to know the details of my patient’s medical, social, and family medical history is so that I can best manage their foot and ankle care appropriately and safely.

Another equally important but often only partially completed (or left blank altogether) is social history. Social history includes past or present tobacco use (including vaping and chewing tobacco), alcohol consumption including any history of alcohol abuse, recreational/illegal drug use, and prescription drug use or history of addiction.

It is a well established fact that smoking impedes healing. To properly heal, a person needs oxygen. Smoking cigarettes depletes the oxygen carrying capacity of blood not only while the cigarette is being consumed, but for an hour afterwards. And vaping causes wax build up in the lungs which results in lower blood oxygen concentration as well as decreased circulation in general and poor healing. 

Alcohol abuse, particularly long-term, can cause damage to the liver and brain. But it also damages the peripheral nerves, which provide sensation and/or function to the feet. So, if I have a patient complaining of loss of normal sensation in their feet or toes, my first two questions are going to be whether they have diabetes and whether they drink and–if they do–how much and for how long. 

Patients with a history of drug addiction (past or present) can pose a challenge if they need to have a surgical procedure that requires post operative pain medication to be prescribed. I do not want a recovering addict to get hooked on pain medication again, and if they are taking medication to help manage their addiction, there is a risk that I could prescribe something that may cause severe vomiting or other significant adverse interaction. (This also goes back to the importance of knowing all medications a patient is taking.)  

I realize that it may be difficult or embarrassing for a new patient to be open and honest about an addiction. There are social stigmas surrounding this. But it is in the best interest of my patient to be honest about it so that I can manage them properly and safely.

Honesty is the best policy,

particularly when it comes to your health.

Finally, if there is a primary care physician taking care of my patient, they should be listed as well since I will want to make sure they receive my chart notes and, if I need the patient to have a medical clearance for surgery, the primary care provider is the person to whom I will send the request. 

I do hope that this Foot Notes article does not come off as “preachy” but instead is informative and gives a better understanding about why I (and your other providers as well) need this information. Honesty is the best policy, particularly when it comes to your health.

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