CORRESPON DENCE
family physician's office have nonsurgical problems of the musculoskeletal system, for which there is To the editor: I read with interest often an easy diagnostic and therathe report by Charlotte Gray about peutic modality available.1 As these the problem of paramedics trying to modalities 'are not taught in medical do more and more in the medical school, they are virtually unknown field (Can Med Assoc 1 119: 370, to most family physicians. Therefore, 1978). patients with these problems must I am very sympathetic with the seek help from lay manipulators. plight of physiotherapists who are D.M. FRASER, MD well trained and capable in the diag145 Queenston St., Ste. B7 nosis of lesions of the musculoskelSt. Gatharines, Ont. etal system, perhaps more so than many of our family physicians and References orthopedic surgeons. One article 1. CYRIAX J: Personal view. Br Med J written by Dr. James Cyriax,1 an 4: 292, 1972 orthopedic physician, aptly expresses 2. Idem: Textbook of Orthopaedic Medicine, vol 1, Diagnosis of Soft Lethe problem in the diagnosis and sions, 6th ed, Williams & Wilkins, treatment of musculoskeletal disBaltimore, 1975 orders today. Indeed, he has proposed that the only way we can avoid To the editor: I find it interesting treatment by lay manipulators (e.g., that Dr. John Bennett, as the director chiropractors, osteopaths and foot- of professional affairs of the Canaball trainers) is to have an adequate dian Medical Association, has done body of trained family physicians so little research into the training of who are able to recognize and diag- podiatrists. Dr. Bennett and many nose the lesions and then, if they other physicians refer to podiatrists cannot give the necessary treatment, as a "nonmedical professional health refer the patients to physiotherapists group [demanding] to be allowed to who are equally well trained. Simi- practise primary health care". larly, all medical students learn to I invite Dr. Bennett to visit one recognize the signs and symptoms of of the colleges of podiatric medicine acute appendicitis, yet few family in the United States; he would disphysicians perform appendectomies. cover that the students there are The dilemma, however, is that taught to "generalize before specialthere are very few trained orthopedic izing." Schools of podiatric medicine physicians, but Cyriax gives 8 to 10 are graduating doctors who, in fact, courses per year in the United States are trained as physicians specialized and occasionally in Canada. If in treating disorders of the feet and courses in orthopedic medicine could related structures by medical and be given at medical schools or to surgical means. Reference to podifamily physicians as part of their atrists as a nonmedical group is erfamily practice internships, the prob- roneous. A comparison of podiatric lem would be solved within a genera- and general medical education demtion. It has been shown clearly that onstrates this fact. 20% of all patients who come to a Besides taking the same Medical
Role and training of paramedical groups
122 CMA JOURNAL/JANUARY 20, 1979/VOL. 120
College Admission Test as medical students, podiatry students undergo a basic medical sciences program that is practically identical to that found in major medical schools. The questions on the national board exams of the two groups reflect this. Pharmacology and therapeutics are no exception, contrary to the thinking of Dr. Robert Clark, executive director of the Alberta Medical Association. Since the foot cannot be divorced from the rest of the body, the clinical years at the colleges of podiatric medicine provide general medical training to "diagnose for the whole body". Included are courses in neurology, anesthesiology, general and vascular surgery, traumatology and emergency medicine, that, once again, are practically identical to those given to general medical students. Additional courses in podiatric surgery and biomechanics are taught so that early specialization is possible. The California College of Podiatric Medicine has an exchange program with the University of California Medical Center in San Francisco, whereby 3rd- and 4th-year podiatry students rotate through the various medical clinics at the University of California hospitals and vice versa. Podiatry students participate in other clinics across the United States from Stanford Medical Center in Palo Alto, California to the John F. Kennedy Memorial Hospital in Stratford, New Jersey. Following graduation, most doctors of podiatric medicine take a 1-, 2- or 3-year residency program. (Presently the Vancouver General Hospital is the only hospital in Canada that has a podiatry residency program.) Is it really "a threat to patients' welfare" when they see a podiatrist,
family physician's office have nonsurgical problems of the musculoskeletal system, for which there is To the editor: I read with interest often an easy diagnostic and therathe report by Charlotte Gray about peutic modality available.1 As these the problem of paramedics trying to modalities 'are not taught in medical do more and more in the medical school, they are virtually unknown field (Can Med Assoc 1 119: 370, to most family physicians. Therefore, 1978). patients with these problems must I am very sympathetic with the seek help from lay manipulators. plight of physiotherapists who are D.M. FRASER, MD well trained and capable in the diag145 Queenston St., Ste. B7 nosis of lesions of the musculoskelSt. Gatharines, Ont. etal system, perhaps more so than many of our family physicians and References orthopedic surgeons. One article 1. CYRIAX J: Personal view. Br Med J written by Dr. James Cyriax,1 an 4: 292, 1972 orthopedic physician, aptly expresses 2. Idem: Textbook of Orthopaedic Medicine, vol 1, Diagnosis of Soft Lethe problem in the diagnosis and sions, 6th ed, Williams & Wilkins, treatment of musculoskeletal disBaltimore, 1975 orders today. Indeed, he has proposed that the only way we can avoid To the editor: I find it interesting treatment by lay manipulators (e.g., that Dr. John Bennett, as the director chiropractors, osteopaths and foot- of professional affairs of the Canaball trainers) is to have an adequate dian Medical Association, has done body of trained family physicians so little research into the training of who are able to recognize and diag- podiatrists. Dr. Bennett and many nose the lesions and then, if they other physicians refer to podiatrists cannot give the necessary treatment, as a "nonmedical professional health refer the patients to physiotherapists group [demanding] to be allowed to who are equally well trained. Simi- practise primary health care". larly, all medical students learn to I invite Dr. Bennett to visit one recognize the signs and symptoms of of the colleges of podiatric medicine acute appendicitis, yet few family in the United States; he would disphysicians perform appendectomies. cover that the students there are The dilemma, however, is that taught to "generalize before specialthere are very few trained orthopedic izing." Schools of podiatric medicine physicians, but Cyriax gives 8 to 10 are graduating doctors who, in fact, courses per year in the United States are trained as physicians specialized and occasionally in Canada. If in treating disorders of the feet and courses in orthopedic medicine could related structures by medical and be given at medical schools or to surgical means. Reference to podifamily physicians as part of their atrists as a nonmedical group is erfamily practice internships, the prob- roneous. A comparison of podiatric lem would be solved within a genera- and general medical education demtion. It has been shown clearly that onstrates this fact. 20% of all patients who come to a Besides taking the same Medical
Role and training of paramedical groups
122 CMA JOURNAL/JANUARY 20, 1979/VOL. 120
College Admission Test as medical students, podiatry students undergo a basic medical sciences program that is practically identical to that found in major medical schools. The questions on the national board exams of the two groups reflect this. Pharmacology and therapeutics are no exception, contrary to the thinking of Dr. Robert Clark, executive director of the Alberta Medical Association. Since the foot cannot be divorced from the rest of the body, the clinical years at the colleges of podiatric medicine provide general medical training to "diagnose for the whole body". Included are courses in neurology, anesthesiology, general and vascular surgery, traumatology and emergency medicine, that, once again, are practically identical to those given to general medical students. Additional courses in podiatric surgery and biomechanics are taught so that early specialization is possible. The California College of Podiatric Medicine has an exchange program with the University of California Medical Center in San Francisco, whereby 3rd- and 4th-year podiatry students rotate through the various medical clinics at the University of California hospitals and vice versa. Podiatry students participate in other clinics across the United States from Stanford Medical Center in Palo Alto, California to the John F. Kennedy Memorial Hospital in Stratford, New Jersey. Following graduation, most doctors of podiatric medicine take a 1-, 2- or 3-year residency program. (Presently the Vancouver General Hospital is the only hospital in Canada that has a podiatry residency program.) Is it really "a threat to patients' welfare" when they see a podiatrist,
