Foot In diabetes UK

Who: John McCall

Where: Ayrshire & Arran

I’m the lead diabetes specialist podiatrist for Ayrshire & Arran where I have worked for the past 17 years. I’m based in secondary care but have many years experience working in community. I’m clinical lead for a team of podiatrists responsible for the delivery of our podiatry diabetes care programme.
I’ve been involved in the development of the Diabetes Dataset for Scotland and then the development of the Foot Screening Tool and Foot Ulcer Management screens as part of our national computerised diabetes record for Scotland (SCI- DC)
I’m vice chairman of SDSP (now the Scottish part of FDUK) and a member of the Scottish Diabetes Group (Scottish Health Executive).
I’m webmaster for www.sdsp.org.uk and www.footindiabetes.org

Describe your typical work day

No such thing as a typical day (!) but here are some of the things I might be doing:
Foot Ulcer Clinics (between 4 and 6 sessions per week )
Admitting patients to the ward
Participating in nurse led Vascular Clinics
In-Patients (high risk foot only)
Orthotics and pressure relief
Educational Presentations and Workshops (to other professionals)
Phone Calls, Emails & Letters
Referrals
Liaison with Vascular and Orthopods
Liaise with district/practice nurses and community pods
Meetings, meetings and meetings.

How did you first become interested in working with the foot in diabetes?

A post for a hospital podiatrist arose in Barnsley way back in 1987 and I was keen to work with patients who presented a real challenge. People with diabetic foot disease certainly do that!

Why does this speciality appeal to you as a career choice, and who, if anyone influenced / motivated / guided you in this area of work?

The challenges and variety of the job. The buzz of knowing that your actions are preventing or at least postponing the end results of diabetic foot disease and prolonging the patent’s quality of life.
It’s also an opportunity to support patients through a difficult and frightening process.
First influences: Reading the first edition of ‘The Foot In Diabetes’ way back in 1986. Since then the work of Ali Foster, Andrew Boulton, Jodi Booth, Neil Baker, Allistair McInnes and many other contributors to ‘The Diabetic Foot’ have all had a bearing on how I try to work now.

What have been your best and worst moments working in this area and why?

The worst moments are when the patient realises that he or she has a problem that is going to (or maybe already does) affect the rest of their life.
The best moments are when an ulcer is healed or we prevent an amputation.
Also I can look back twenty or so years to times when patients used to come to the diabetic clinic with ‘nasty surprises’. Often the first we knew of a patients foot risk status was when they turned up at A&E or the diabetic clinic with an infected DFU.
It’s good to see the way services have developed and Podiatry skills have become more recognised and integrated over the years so that problems are usually detected earlier and care swings into action much more easily.

Do you have any coping strategies you can share with us that get you through the worst bits?

Peer support doesn’t come easily to podiatrists who, as we all know, can spend a lot of their time ‘alone’ professionally speaking. I firmly believe that there is an awful lot to be gained by creating the opportunities for podiatrists to give each other friendly, non-judgemental peer support through how we structure our working week, through conferences, educational events and of course via the FDUK website and members’ forum.

Do you have any new related projects in development at the moment?

We’re reviewing our podiatry diabetes team structure to try to provide more opportunities for staff to more easily ‘cross the boundaries’ between primary and secondary care and provide the best possible care.
We aim also to develop a competency based skills development programme for our specialist podiatrists.
I’m converting a paper version of a Guide to Diabetic Foot Screening (written by Suzanne Ralston, Lothian) into a web format which will be linked to the SCI DC foot screening tool.

What do you feel are currently the most challenging issues for people working with foot in diabetes in 2007/8?

1. Finding ways of preventing it!
2. Patient motivation is always an issue because often the patients with diabetic foot complications have been poorly motivated or less able to deal with diabetes to start with.
3. We need interventions that will prevent or maybe even reverse complications.
4. A huge challenge is of course the growing numbers of people with diabetes.
5. Getting more recognition for the implications of diabetic foot disease and the part that multidisciplinary teams play in prevention and treatment.