Chapter XXVI · THE PODIATRIST’S OFFICE

The equipment of an office of a professional man or woman, whether it be the surgeon, the dentist, the podiatrist or any other of the practitioners of the allied branches of medicine, cannot be set to an absolute standard. There are several factors that govern variations, one from the other, among which are considerations of finance and the amount of available space. Regardless of these differences, however, certain fundamental principles must be observed in equipping such an office, and these depend upon two cardinal requirements: (1) cleanliness, and (2) the comfort of the patient. Such an office must be fitted out with the laws of asepsis and antisepsis ever in mind, otherwise it will prove unsafe for the treatment of patients whose feet require surgical attention. Again, the patient must feel at ease while being treated, or revisits will be scarce.

There are other and secondary standards which should be considered among which is the appeal to the eye. First impressions often are lasting ones, and an office which makes a favorable impression will help attract patients. One often hears the thoughtless layman express himself, “Go to Dr. Blank for treatment, he has a beautiful office.” So it often occurs that a professional person is judged by the equipment in his office, and the effects of such an impression should be considered.

The Waiting Room. The waiting or reception room should be furnished with chairs upholstered in leather or made of solid wood. In waiting rooms in which many patients must wait at the same time, and space is valuable, smaller chairs with cane seats are very useful. The table should be of polished wood, covered with a plate glass top. The wood work of the room itself should be white, and the walls should be painted in preference to being papered. Buff is a pleasing color to the eye, and readily matches all kinds of furniture. The floor should be of hard wood, and may be covered by linoleum or rugs. Carpets should not be tolerated, as they are dirty; and even though frequently swept, they become the repositories of dust and of germs.

The Operating Room. The operating room must be scrupulously clean. As a white background best shows dirt spots, that should prevail in furniture and in decorations. A door, either of glass and wood or entirely of wood, should separate the reception room and the operating room; if hangings must be used, they should be of some washable, white material, that can be readily changed. The floor should be of tile, marble or stone; if these materials are not available, hard wood floors, well polished, are permissible. No covering of any kind should be used for the floor of this room. The ceilings and walls should be painted white, and the wood work should be enameled the same color. Tile or marble walls are preferable to plaster or wood. No curtains should be used on windows or doors, and if necessary the glass can be frosted to secure privacy. A wash basin, with running hot and cold water, should be in the operating room, and the valves should be controlled by foot levers in preference to hand faucets.

To summarize, everything in the operating room should be of such a character as to make it possible to wash it daily with soap and water. Nooks and corners that tend to collect dust and dirt must be thoroughly cleaned, bearing in mind that disease-producing bacteria will not grow, unless a breeding place be provided for them. Wall pictures and their frames should be selected with a view to having them equally sanitary.

The Equipment. The equipment of a modern office is divided into three classes: (1) the furniture, which, when bought, is permanent; (2) the instruments; and (3) the supplies, which are replenished from time to time as they are exhausted.

Furniture should consist of the following in the order of their importance:

Sterilizer Operating Chair and Stool Cabinet Glass-Top Table Drill High Frequency Machine Air Compressor Galvanic Machine Wall Cabinet and Extra Accessories.

The authors are not interested in the wares of any manufacturer, and any equipment that is efficient and well made will answer the purposes of the podiatrist. There are many styles of chairs, cabinets, electric machines, etc., on the market and the selection of such furniture and equipment rests with the finances and the taste of the individual.

Chairs should be roomy and have a suitable rest for the patient’s back and head. The foot rest should be adjustable and so arranged that the patient’s foot is made comfortable, regardless of the position in which it is held. This part of the chair is very important, as upon it often depends the result of the podiatrist’s work. If the foot and leg are held so that the patient is uncomfortable or so that muscular cramps are the result, both patient and operator are at a disadvantage which it is difficult to overcome.

There are two types of foot-rests on the market which have proven efficient. One gives support along the entire length of the leg and allows the foot to hang free at the end, and the other gives support at the foot proper and is so arranged that it gives this support no matter in what position the foot be held. The chair itself should be so constructed that no matter how the weight of the patient’s body may be distributed, the chair will remain firm, with no danger of spilling its occupant. It is on this account that a chair with a heavy metal base or with heavy spreading legs is best. When the chair is placed in a horizontal position so that the patient is prone, it should be as firm as with the patient in a sitting posture. The stool should match the chair and should be adjustable.

The cabinet is the most important part of the podiatrist’s equipment from an aseptic standpoint, for therein are kept the instruments, dressings, drugs, etc. There are many styles and shapes from which to select, but only those that afford proper protection from dust and dirt should be considered. Drawers should be provided for bandages and dressings, and one drawer should be divided into compartments for the various sized shields. This adds to the neatness as well as to the efficiency of the cabinet. Special movable racks which fit into shallow drawers should be provided for the instruments, so that, if necessary, they may be collectively removed, thus avoiding the need for handling each instrument separately. Instrument compartments of this type should be so made that the blades of the various instruments are suspended in the air; moreover such racks and drawers are easily cleaned. Drugs should be kept in special compartments provided with glass doors, or, if the cabinet has no such provision, the bottles should fit in metallic clamps arranged in the rear of the top of the cabinet. Glass tops on the cabinets are best for they are easily cleaned, but white enameled metal tops are quite as good. The towels should be kept in a compartment of the sterilizer, otherwise in a special compartment in the cabinet, one having a glass door being preferred.

Sterilizers may be heated by gas or electricity and when boiling water is not available, even formaldehyde gas is better than nothing for sterilizing purposes. The sterilizer, a necessity and not an ornament, should be cleaned and polished and the water should be changed daily. Unfortunately in the past, practitioners of podiatry did not use the sterilizer with regularity, and one could enter many of these offices and not even find such a contrivance. This state of affairs, however, is becoming a memory because the practitioner, as well as the public, has learned the importance of asepsis and antisepsis. The podiatrist who fails to observe the needs of this dispensation is unworthy of the title he bears.

The sterilizer should be kept on a white enameled table with a detachable metal top, so that boiling water or hot instruments will cause no damage to it, as might occur on a glass-topped table. This table should have a glass shelf below, on which may be kept additional remedial agents for which there is no room in the cabinet.

The surgical drill or rotary file is a valuable asset to the podiatrist in treating the nails, and should be a part of the equipment. There are several makes of rotary files, all with the same fundamental structure. The motors and cables are of one type, and are held either by a wall bracket or suspended upon a metal hook, resting on a metal pedestal. When the instrument is kept in only one operating room, the former type is sufficient, but when the drill is moved from one room to another, the latter style is necessary.

Other accessories in the office, such as an air compressor, high frequency coil, galvanic machine, wall cabinet, etc., should be selected with care as to quality, and with judgment as to their harmonizing with the other equipment. If space allows, all of these accessories are desirable because useful, but when quarters are contracted, care must be taken in arranging the paraphernalia that the effect is not such as to give the patient the impression that he is in a podiatry supply shop.

“Cleanliness is next to Godliness,” should be the slogan of every practitioner of medicine in any and in all of its collateral branches and the manner in which he conducts his office should be evidence that such is the belief and the practice of every podiatrist.

FOOTNOTES: