Conservative Care

by Jarrod Shapiro, DPM
PRESENT Resident Editor
Botsford General Hospital
Farmington Hills, MI

Good holidays to everyone. I hope your respective holidays and New Year are going well. Yesterday I spent a long and exciting day in surgery, so what topic do I want to talk about? Conservative care! Surgical exposure always seems to be the hot topic when it comes to residencies. From choosing a program to national reputation to job hunting, everyone wants to have a ton of surgical experience.

But what about exposure to conservative care in our training? Even though it’s lower profile work, I’d argue conservative care is just as important as the surgical aspect of our profession. How many patients will walk into your office demanding a triple arthrodesis or flatfoot reconstruction? I’ll bet by the time they get to that point, they’ve had several conservative interventions (orthotics, bracing, physical therapy modalities, injections, etc). In fact, if you don’t at least attempt a course of conservative therapy prior to surgical intervention, you may have a harder time defending yourself in court. In addition, a period of care before an anticipated surgery creates a stronger relationship between you and your patient; they’ll trust you (and be less likely to sue) because they know you and have faith in your skills as a physician.

With that said, how many of you receive training in conservative care at your residency programs? One of the strengths of my particular program is a resident run-attending-overseen real world clinic. We see patients referred from physicians in our hospital system and in the area. Residents have the opportunity to work up and treat patients. We do generate surgeries from this office, but as importantly, we also treat them nonsurgically. Over my three years as a resident, I’ve learned when to treat foot and ankle pathology conservatively and when a problem needs the OR. I’ve also seen my share of postoperative complications. As an added benefit, we also learn CPT and ICD-9 coding. In my opinion, it’s this very diversity of experience that the CPME advocates in the new PM&S model of residency.

For those of us that don’t have a resident clinic, the question then is “how do I get exposure to more conservative care?” The answer will require some work on your part. As we know, some parts of our education are not handed to us on a silver platter and require some effort. I’d recommend speaking to attendings and asking to shadow them in their offices. This provides a great opportunity to see not only conservative care routines but also how a business runs. You might also see some of your own surgery followups!

What’s your experience with conservative care? Do you see enough? Too much? Do you have a clinic? How important is conservative care to you? Will you learn it “on the job” after residency? Should residency strictly teach us surgery? What are your opinions? Write in and let the rest of us hear them. I know you have opinions. Take five minutes and email them in.
Have a great New Year!