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PRACTICE PERFECT

BY JARROD SHAPIRO, DPM Classifications, Posture, , and

These seemingly disparate topics blend to create better healthcare.

53 Practice Perfect is a continuing ev- sharp, and the faculty members are of gingival health. Too bad. Apparently ery-issue column in which Dr. Shapiro excellent. Going to this clinic for reg- no one is a zero, so perhaps it’s not as offers his unique personal perspective ular dental maintenance always pro- bad as one would think. on the ins and outs of running a po- vides one with interesting things to Most practitioners are generally not diatric practice. think about. So, let’s talk about a few giant fans of classifications. Most clas- seemingly disparate topics that ac- sifications are just fodder for ne of the perks of being tually blend together to form quality interview questions, and for doctors to part of a university with healthcare. get their names into the medical liter- a lot of colleges is the First, classifications. Apparently, ature. However, in some cases, classi- convenience of obtaining there is a classification of gingival qual- fications can be useful. One such clas- care (as long as you’re ity that is based on the depth of the sification is the International Working Ookay with treatment by students). pocket between the gum and the tooth Group on the Diabetic (IWGDF) Most patients going to the Western and the amount of plaque. Zero is best, system that categorizes risk in diabetic University College of Dentistry clin- three is worst. At first, it may sound patients.1 This classification is useful ic have been very happy with their reasonably good to be a two, but if you for two simple reasons. The first is that care. The students are friendly and think about it, two is on the lower half it has been validated by legitimate re- search. Second, it’s useful in predicting the risk of diabet- FIGURE 1 ic complications. Figure 1 shows the odds ratios of various diabetic foot complications as a result of each category. It’s vali- dated, easy to use, descriptive, and perhaps even edu- cational for our re- ferring primary care doctors and pa- tients. What more can we ask from a Figure 1: IWGDF Foot Risk categories and associated complications (PN = Peripheral neuropathy. PAD = Peripheral classification? arterial disease). Continued on page 54

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Classifications (from page 53) was so bent over the patient’s feet that to master (with a judicious sprin- we thought one of his intervertebral kling of wisdom from those who’ve Posture disks was going to shoot out his back. come before to guide us). It’s not So, what does posture have to do The one unfortunate part of this always comfortable or easy, but mas- with podiatry? Recently, there was an dental story is that the student tering technique gives us the power interaction between a student dentist didn’t seem to appreciate the “sitting” to translate what is in the mind to and her attending about proper sit- discussion. Some eye rolling was seen the world of the physical, to actually ting position. Understandably, den- during and after the conversation. Be- “fix” our patients. tists are going to have a very intimate relationship with their apparently expensive chairs. The attending dis- It takes two sides of this coin— cussed, demonstrated and corrected the student’s sitting position with a the mental yin to the physical yang—to make us full explanation of the advantages to various sitting positions for optimal effective patient care providers. ergonomic and clinical effectiveness. At Western University, we are constantly harping on my students for ware to all of you who don’t heed the It takes two sides of this coin— their poor sitting and standing posi- warnings of your elders! Hunch and the mental yin to the physical yang— tions when in clinic and . One lean at your own risk. God only knows to make us effective patient care pro- cannot count anymore the number how much eye rolling my students do viders. Think of that the next time of times inexperienced students will when they are corrected! you sit down to treat a patient. PM slowly get closer and closer to the sur- When you think about these two 54 gical field while they’re suturing. It’s issues, you realize how seemingly References 1 almost as if they’re going to try suturing unrelated they are and yet how in Lavery LA, Armstrong DG, Murdoch DP, et al. Re-evaluating the way we classify with their faces! This would be funny reality they blend to form the basis the diabetic foot: restructuring the diabetic if they weren’t going to contaminate for quality medical care. Here’s how. foot risk classification system of the Interna- the surgical field. In clinic, they lean The classifications topic is a meta- tional Working Group on the Diabetic Foot. over patients’ feet, and a few times phor for the mind, the thinking as- Care. 2008 Jan;31(1):154-156. when entering the room while they’re pects of our medical science. working, it seems as if the students are On the other side of this coin is Dr. Shapiro is editor of PRESENT Practice Per- turning into Quasimodo, the hunch- the physical aspect, the technique, fect. He joined the faculty of Western University back of Notre Dame. Kyphosis here we of and surgery. Proper of Health Sciences, College of Podiatric Medi- come! One time, one of the students technique takes time and experience cine, Pomona, CA in 2010.

PRESENT Podiatry PRESENT Podiatry (podiatry.com) is a -owned-and-run company that proudly serves as the largest provider of online CME to the podiatry profession. One of the key lectures in their online CME collection is highlighted below.

MARCH 2015 | PODIATRY MANAGEMENT www.podiatrym.com