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| 01 Grew up in Cardiff. Worked in steel industry. Grandmother had diabetes – leg amputated. I was admitted as mature student to Cardiff School of Chiropody… | |
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| 02 …in 1976, aged around 23 (in fact 20). Considered mad to give up job. Course not very scientific, more practical than now - treated 1000s. | |
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| 03 1st year worked on fellow students, then patients’ simple conditions. 2nd year – ulcers. 3rd year – all conditions. Met diabetes in 3rd year. Realised seriousness after qualified – met GP going blind. Diabetic’s life miserable then – weighing food, large needles. | |
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| 04 Got job easily – NHS shortage. Worked along Avon coast in GPs’ surgeries. Not so isolated as many podiatrists. Unsupervised. | |
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| 05 1st day, saw 22 patients. (As student, saw 6.) Could listen to patients, unlike dentist. Saw patients repeatedly - got feedback. Got to know them – unlike now. I planned home visits. | |
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06 Not just diabetes - elderly with deformed feet. Chiropody/podiatry keeps people mobile. Diabetics were often emergencies. Gas gangrene.
NHS employed private podiatrists. (Now privatisation returning.)
Care simple – no advanced off-loading. | |
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| 07 Patient happy if podiatrist affable. Before me, chiropodists private – no records. I began records – recorded what patients said. Now use SOAP format – patients’ reactions first. | |
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| 08 Moved to Oxford, 1983. At interview, demonstrated computerising of records. Still in primary care, still Senior II Chiropodist, but less quiet. NHS politics & shortages. | |
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| 09 Deprived areas. More ethnic backgrounds, more diabetes, more other podiatrists – less isolated. Took mobile unit to villages. Society changed – mobile unit vandalised. | |
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| 10 In 1979 ‘chiropodist’. Title changed to Podiatrist – qualified by 3-year course. Few older podiatrists. | |
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| 11 Next job at John Radcliffe Hospital. Saw more vascular & diabetic outpatients. Nurse taught me – warned re overwork. Also saw inpatients… | |
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| 12 …saw how patient recovered. Little patient education. Thinking re prevention recent. Clinics in late 80s/90s endless… | |
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| 13 …50 patients in afternoon. Also UKPDs clinics – less busy. I ran general clinic alongside diabetic clinic – saw increasing numbers of diabetics. David Matthews succeeded Hockaday – opened diabetes centre at old Radcliffe Infirmary. | |
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| 14 Moved to Infirmary around 1994. Cramped but friendly. Solely treating diabetes. | |
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| 15 Around 1989, podiatry degree introduced. I did degree 1990-1. Thesis on patient education - found information conflicting. Patients knew what to do but didn’t do it. Started to think more re patients’ viewpoint… | |
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16 Patients’ perceptions & mine differed.
Clinics at Infirmary multidisciplinary – plastic surgeon, vascular consultant, diebetologist &, later, bone infection specialist looked at foot. | |
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| 17 Diabetic foot clinic gaining respectability. 1st diabetic foot meeting in Malvern. Doctor from Brazil watched my work & set up Brazilian service. | |
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| 18 We’ve kept people mobile for years – William Jeffcoate says this should be measured outcome. Rarely see gas gangrene – good primary care infrastructure. Began to take hospital-type care into community. Needs more resources. | |
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| 19 When moved to foot clinic, became Chief III podiatrist. Too old to become surgical podiatrist. Now on prescribing course – podiatrists may get independent prescribing rights. I run module on Warwick Masters degree. | |
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| 20 After about 10 years, diabetes centre moved to new building. Podiatry suite too small – rebuilt. Achievement to get NHS, University & private companies to fund new building. | |
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| 21 Now many devices for keeping pressure off foot. More infection treatment – though problem of MRSA. In 2004 did MA at Cardiff Wound Healing Research Unit. Found patients not much happier when ulcers healed because… | |
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22 …still non weight-bearing. Compromise between what patients want & what I want.
Now more awareness of footcare. | |
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