Finkel M L, McCarthy E G, Miller D
Med Care. 1982 Aug;20(8):862-70. doi: 10.1097/00005650-198208000-00010.
A second-opinion podiatry program, designed to contain costs and enhance the quality of care, was established in the greater New York City area by the Building Service Employees' Health Fund. All nonemergency foot surgery recommended by a podiatrist that cost over $100 was included in this program. Of the 363 individuals who had a second opinion, 82 per cent were confirmed for surgery; however, the confirmation rate among those seeing a podiatrist serving as consultant was 94.3 per cent, while the confirmation rate of those seeing an orthopedists serving as consultant was 49.5 per cent. For every condition, the podiatrists overwhelmingly confirmed the need for surgery. Conversely, the orthopedists were more conservative in their recommendations regarding surgery. The program's cost was $311,813. If a second opinion consultation wasn't required for removal of corns or ingrown toenails, the total would be much less. It seems sensible (economically and medically) to encourage or require a consultation with an orthopedist for conditions such as bunions, hammertoes and heel spurs, and not to require a second opinion consultation for superficial podiatric conditions such as corns and ingrown toenails, which are treated predominantly by the podiatrist.
建筑服务员工健康基金在纽约市大都市区设立了一个二次诊断足病治疗项目，旨在控制成本并提高护理质量。足病医生建议的所有费用超过100美元的非紧急足部手术都纳入了该项目。在接受二次诊断的363人中，82%的人被确认需要手术；然而，在找足病医生作为顾问的人中，确认率为94.3%，而找骨科医生作为顾问的人中，确认率为49.5%。对于每种病症，足病医生绝大多数都确认需要手术。相反，骨科医生在手术建议上更为保守。该项目的成本为311,813美元。如果去除鸡眼或嵌甲不需要二次诊断咨询，总成本会低得多。从经济和医学角度来看，对于拇囊炎、槌状趾和跟骨刺等病症，鼓励或要求咨询骨科医生似乎是明智的，而对于鸡眼和嵌甲这类主要由足病医生治疗的浅表足病情况，则不需要二次诊断咨询。
