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Australian Scope of Practice??

Discussion in 'Australia' started by Burke, Jun 5, 2012.

  1. Burke

    Burke Member


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    Hi all,
    I was searching our Podiatry Board of Australian and ANZPAC sites for a definition of our scope of practice in Australia and can't find anything! Does it finish at the ankle? knee? Or does our new Health Practitioner Act give us a broader definition based on demonstrated competencies? I notice that our new list of drugs includes some Intravenous drugs (for pod surgeons), so does that mean we can perform intravenous cannulation in a body part other than the foot? i.e. the hand or arm? Does anyone know?

    Cheers
    Burke
     
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    There is no scope of practice. Good luck working out where the line is to avoid stepping over it.

    LL
     
  3. Pes Perfectus

    Pes Perfectus Member

    Fantastic (sarcasm)... It'd be really good to sort this out - I'm having an ongoing battle with some nurses about lower leg and foot wound care. They have done the one day (6 hour) debriding course and now consider themselves to be the experts on wounds and wound care/management.
    They say:-
    1. that I'm not allowed to touch anything above/proximal to the ankle
    2. that they are allowed to debride what they want, on whomever they want and that they are just under the GP in the rank of the patient's wound care
    They don't seem to understand why I don't agree with this.
    They then asked me to mentor them with their wound debridement...
    Why is there so little respect from nurses and GPs about our abilities??
    Where's the nursing scope of practice in relation to wound debridement??
    Also, is there a scope of practice in relation to footcare assistants/podiatric assistants and HK debridement?
     
  4. Kara47

    Kara47 Active Member

    I attended the NSW Pod Assoc conference last week & it was stated " there is no scope of practice as it's too limiting"
    Where's the limit to be drawn if you get taken to court I wonder?
    I've been led to believe we can treat from the hip/pelvis down ( & maybe lower back muscles), especially as far as musculoskeletal things are concerned.
    Spoke to a friend who works in public health & they treat from the ankle down, don't even look at venous ulcers, nurses claimed that in their hospital.
    Can I (legally) reduce someone's chauxic thumbnail? We supposedly are experts on nail care but can't touch the hand.
    Pod assistants aren't allowed to use a scalpel.
    Had a px tell me the other day the beautician scrapes their HK with a "razor type thing on a handle"
    What next?
    I find it interesting that you can purchase a scalpel from some pharmacies, yet only RN's, doctors & pods are allowed to use them ( & I don't know of 1 RN locally that does!)
    Cheers,
    Kara
     
  5. Paul Bowles

    Paul Bowles Well-Known Member

    I love how people in here are discussing limits of podiatric practice and we end up discussing toenails and callous.......

    :deadhorse:
     
  6. Burke

    Burke Member

    I find it weird that the pod board here have guidelines for all manner of things, but nothing about this. We really do need to define our scope of practice or those nurse practitioners will move into our domain while we timidly stay below the ankle. I work in a major hospital, and the wound clinic run by nurses are always treating foot wounds and overlap with our work. The american pods treat lower leg ulcers, so if our definition is broad then we need to start with that too.
     
  7. bmjones1234

    bmjones1234 Active Member

    WOW! That is pretty unprofessional and very disheartening. I thought the Nurses would have had more respect! [Perhaps common sense - seeing as there is a reason why we do a degree in Podiatry] My thoughts are we should train for longer and harder to reach Dr status. That way we'd be 'above' Nurses to stop this ambiguity of where we sit and gain respect from the the GPs. Also if a Pod specialises in wound care [Diabetic] then there should be no reason that they:

    A) Cannot do the whole lower limb and in realistic terms upper limbs (Torso, neck and Head are off limits)
    B) Should have to justify their scope of practice to nurses, it should be taught as part of their curriculum where our scopes overlap and where they end

    There may also be more so feel free to add.

    I was chatting to a Chiropractor the other day and he was saying how frustrated he is with Podiatrists. We learn from the foot up to the hip - and the stop! He was finding this crazy because out implication will eventually affect spine and torso. I am a firm believer that for our role to develop more holistically and rounded we need to Learn the entire skeletal system and the implications of forces from the ground up - throughout the mechanical system. It wouldn't harm us to learn restorative stretching I.E. Calfs Etc. But all rehabilitation, massage techniques, specialist soft tissues issues Etc. are referred on to a Physio.

    As far as nail treatments go, we should be able to do the hand. In fact point of interest, if we can learn the foot one of the most complicated multi-joints in the body - why not inter-grate the hand? We do significant amounts of dermatology, this could be expanded, surgery would still have to completed but an orthopaedic surgeon, but nail removal could certainly be carried out by us.

    Also with the amount of general scalpel work we do, it would be very beneficial for all surgeons to work on Diabetic ulcers and general callous and it would improve hand-eye and motor co-ordination use in general with a scalpel.

    Think the biggest problem is that because every country is slightly different, every country has different aims. As Podiatrist we really need to unite globally and raise our game. The Americans have the right idea, but here in the UK we are very restricted. In Aus & Canada I'm getting the impression it is frustrating too. If we could globally agree this is where we want to have all our institutes heading towards with teaching and have a Global Guild of Doctors of Podiatry we could then prevent some of the confusion with our scope of practice. Would also allow qualifications to be globally assessed and recognised without the need to rejoin different board Australian/NZ/UK Etc. Would allow us to travel between countries and know what is expected of us regardless of where we go. It means longer training, but seeing as we have CPD for life it makes sense to spend time laying strong foundations. With a longer course inter-grated sabbaticals and side degrees with research could allow for breaks and certain level exit points allow for different qualifications.

    To provide a possible example:

    8 year course:

    2 years - leave as foot-care assistant - no scalpel use, basic duties
    3 years - leave as podiatry assistant - scalpel use, no diagnosis of Lower-Limb
    4 years - leave as a podiatrist - Current UK level scope of practice [Example I hasten to add]

    @ This point sabbatical year(S) possible. Divergent Degree I.E. Virology, Immunology Etc.

    5 years - Master of Podiatry - Specialist in one or more field
    6 years - Major research project to contribute towards field
    7-8 year: Choice of:-
    1)Enhancement towards full body comprehension - General Dr of Pod with specialism from 5th year;
    2)Pre-requisites for surgery - Specialism for Podiatric Surgeon [Inclusive of whole lower limb, and diabetic management];
    3)Extended PHD project - Research Specialist Dr of Podiatry - New research or depth project from 6th year.

    After which the Title of Dr is awarded. We would be the same level as a GP and would either work towards consultancy or surgery depending on our path. Or specialise in research. OR would have exited earlier if we want to simply so chiropody etc. The option to return would allow for gap breaks between each year if one desired. The holiday would always offer a combinatory work experience with volunteer work to allow focus in a field, emphasis on caring [Volunteer] and work to aid finance of course [Also very cheap labour to use for learning]

    Now imagine this concept was embraced globally, if all institutions of podiatry delivery even some of this and then 1 major institute finished the remaining years one would have a very clear understand on what it is we do and how much we cover and that we are level to Drs depending on our level of exit.

    Well just a thought ....
     
  8. Bug

    Bug Well-Known Member

    Honestly? That is a hell of a lot of study, why not just become a Dr, then you can do whatever you want without the argument of who owns what.
     
  9. bmjones1234

    bmjones1234 Active Member

    Aye, well fair point. Still just a suggestion for perhaps B-level entrants or those who couldn't/didn't like medicine/dentistry but prefer a slightly obscure route. But your probably right just do Medicine and the nurses will leave you alone lol
     
  10. blumley

    blumley Active Member

    Bmjones

    although the length of extra training you are suggesting may be excessive, I do think you raise an interesting point. Whilst out on placement many of the practitioners have suggested that they do not feel new graduates are properly equipped to deal with the regular patients that are being seen in NHS clinics.

    Although I am not experienced enough to form a judgement on this, perhaps it is time that the course becomes a 4 year programme or perhaps a compulsory pre registration year i.e. similar to pharmacy.

    With regards to scope of practice I was talking to a physio about where they think the cut off should be. They seemed to work on the basis that anything below the knee was left to podiatrists, but I'm not sure how strict that cut off is.

    Ben
     
  11. Tuckersm

    Tuckersm Well-Known Member

    The AHPRA Act only limits 3 things: Cervical spine manipulation, Dental Procedures and Optical Prescriptions. Eveything else is based on your own competancy, education and skill, as well as a "what does the profession think about this" type question as well as patient consent, and if you work in a health service, local policies. There are other acts which can further restrict practice (Health Act, Posions act etc.).
     
  12. Kara47

    Kara47 Active Member

    Paul Bowles,
    The majority of the population out there think that IS our scope of practice, that's why it was brought up. If I explain I do Neurovascular Ax or ulcer tx, I get " oh, can you do that, can you?"
    If we had an idea of what our limits are the profession could be promoted more to educate the general public.
    Cheers,
    Kara
     
  13. bmjones1234

    bmjones1234 Active Member

    You see I appreciate that Physio won't touch feet per se, but in reality when I think of a Physio - I think Soft Tissue Manipulator. When I think of Chiropractor - I think Skeletal Realignment (Both I hasten to add go hand in hand - with the ideal being an immediate bone realignment, followed by soft tissue adjustment then restored + maintained posture by Podiatrist) so each have their place.

    But with more clinical experience I wouldn't stop at the knee, i'd go to the hip and think OK what are the issues here that could be causing foot pain or a result of foot pain, although I might not treat it (soft tissue -physio/bone - chiro) I should be able to understand how from a podiatric perspective it 'could' be affected. So you might say our scope of practice would end at the limit of our investigative abilities, but with some CPD course in tissues manipulation/ bone alignment you could be very able to treat a range of conditions. I would probably draw the line at the spine without some serious training because of the complexity and because of the seriousness of mucking up with the spine could very debilitating.



    Thats interesting, so what your saying is a lot of professional limitation is based upon what your peers think. If that is the case you could back up all your treatment beyond you normal scope as long as you could prove you either had training or sound evidence practice to back up your treatment. For example, in university we are taught the muscles of the hip etc. but very rarely use them at the moment. However, if we felt we could identify which muscle was the restrictive one in question, there would be no reason we couldn't prescribe a stretch routine and provide some soft tissue manipulation as a physio would. Some might argue that is out with of podiatry, but i'd argue it is still the lower limb. I would obviously weigh up a lot of issues, like is it worth me learning to do such CPD because i reality to treat one patient with this issues it would be very inefficient as the time require might be an hour appointment - so referral might be the better option.

    The local polices seems like a very bureaucratic interference, unless from a medial board. Local council would not be qualified to tell us where are profession ends only a peer or medical professional of suitable nature. For example a GP might not be a great option because unless they have experienced our field they may make the common misconception - oh they just do feet. But the 3 restrictive ones makes sense optical, dental and cervical spine are areas i'd never go near unless i retrained - too specific.

    In some respect it will depend on the practitioner and their personal characteristic. If an individual through the CPD spent enough time looking into nail surgery and dermatology why wouldn't they train and handle cases on the upper limbs as well as feet and lower limb? Likewise biomechanics really is only appreciated when the whole body is taken into account that is the nature of the study. So perhaps better display of qualifications and capabilities from us as professionals would make our life easier, perhaps using a global database portfolio which could provide access to all our qualifications and skills. That way professionals need only look online and say: "ah right, Mr X is a biomech specialist with spinal manipulation and soft tissue therapy - you makes sense they treat up to say lumbar spine" Also a fantastic way for professional bodies to monitor CPD - very up-to-date and could be done in a similar style to Facebook or preferably 'Linked-In'.

    Thoughts peeps?
     
  14. Tuckersm

    Tuckersm Well-Known Member

    correct, but training and evidence.

    By Local policies I was referring to those developed and imposed by Health services and Hospitals on their employees and visiting medical staff.
     
  15. bmjones1234

    bmjones1234 Active Member

    Thanks for the clarification, that makes more sense :drinks
     
  16. pdoan01

    pdoan01 Active Member

    there is no cut, if you are competent and have had prior background training, education or assessment then why not. why would a physio determine whats right for our profession? obviously as we have prescribing rights we therefore need to learn the systemic body and its physiology and pathophysiology. im pretty sure undergrad podiatry nowadays consists of lower and upper limb anatomy. rheumatology is another big part of podiatry, eg OA can occur in hips, knees hands and shoulders. if you are confident and have justification you can treat wherever you want to the best of your abilities
     
  17. bmjones1234

    bmjones1234 Active Member

    You are indeed absolute correct. As an undergraduate we cover a heck of a lot for the body in general. Physiology and Patho-physiology are studied extensively.

    Our course doesn't cover the upper mechanics per se other than in MSK and neurological impairment affecting gait and perhaps arm swing, which sunrises me as the all interrelate.

    Interesting to know for the future though, if I were ever to be in Aus. I wouldn't want to over-step my scope of practice. However the consensus appears to be if I can justify my reasoning I should be safe. Although that might not cover the Legal aspect which is the wonderful grey area that I think most people would like to have addressed.

    Thanks for you insight.
     
  18. Burke

    Burke Member

    Thanks everyone for your input. Under these new terms there seems to be a window of opportunity for our profession to set our own scope of practice, before someone else does. We also need professional development courses to pick up our expertise, eg proper limb arterial examinations. We should routinely examine popliteal pulses and femoral pulses when foot pulses are poor, so we can report at what level we suspect occlusions. If we suspect leg length disorders, why shouldnt we explore the pelvic girdle and lower back, and correct what we find (if possible). Its almost like we now need a bridging course to start thinking above the ankle. Many of us do, but now we can do it with more authority. When I first trained in Western Australia we were told to drawer a dotted line around the ankle, since our legal scope of practice was below that, and that we could not treat the knee directly, only by correcting foot function that MAY have secondary effect on the knee. I think there were different definitions from state to state on scope of practice that may have been broader than that. However, we seem to be a very conservative profession, and I suspect some will feel uncomfortable about embracing a broader scope of practice.

    Cheers,
    Burke
     
  19. amcheli

    amcheli Member

    Doctors in the UK do only 5 years, so therefore maybe Podiatry can point at that direction...
     
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