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Prosthetic Components: Making the Right Choice in the 'Fitting Game'
By Judith Otto It's a little like a TV reality show: A customer comes to your
facility to be fitted for a prosthesis, and his prescription is
typically nonspecific. As a result, you're faced with choices,
choices, choices & how do you make the call that will:
(a) make this person happiest,
(b) serve his functional needs most effectively,
(c) create the fewest reimbursement nightmares, or, if you're
really ambitious,
(d) accomplish all of the above, making you a genuine survivor?
To discover the answers, it's necessary to explore several
questions. The first one is: Patient input is, of course, vital to
the success of the fitting process--but what about the influence of
marketing hype on patients? A little learning can be a good thing
OR a dangerous thing! (Other relevant questions will be discussed
in upcoming issues.)
Karl Fillauer, CPO, FAAOP, chairman and CEO of Fillauer,
Inc., Chattanooga, Tennessee:
 "I spend 80 percent of my time in patient care,
and like other prosthetists, I've seen my share of patients who ask
for inappropriate prosthetic choices--one of them just left my
office. He had seen a film on the LuXon Max foot, and was impressed
by how well and fast the wearer functioned. He saw the end
results--how one can run faster than a speeding bullet and leap
tall buildings in a single bound--and naturally he wanted one for
himself, although his overweight condition, functional level, past
history, and future goals did not indicate this was a reasonable
choice.
From the manufacturing/marketing side, I think it's beneficial
for the consumer to have product knowledge; I've always been an
advocate for consumer awareness. The good news is, there's a lot of
choice today; the bad news is, there's a lot of choice today!
Because of that we have to be very selective in what we choose; and
what we choose must meet functional goals: In addition to range of
motion, strength and all the standard evaluation points, our
initial discussion covers what the patient wants to do with this
device, and what his daily activities are going to consist of. The
criteria that I use in determining components are based on my
initial evaluation and the data that I receive from this
interview.
Based on that data, I narrow the choices to what's acceptable
and what I think fits their functional needs, and then let them
help me choose what is best. If the patients are adamant about
choosing inappropriate items, I simply work with them, as long as I
don't think it's going to hurt them. If they need a Chevrolet, but
they've decided they want a Ferrari, you simply tell them you think
this is overkill, and you don't think they really need this item.
If they persist in their request for the specific product, then ask
them to sign off on a document that states that this is by their
choice that they are mandating this particular component. However,
I would not sign off if it were something dangerously inappropriate
for them."
Todd F. Anderson, CP, director of professional services,
Otto Bock Health Care, Minneapolis, Minnesota:
 "Obviously when we put together a marketing
package or ad, we're trying to appeal to the masses across the bell
curve. If it's a patient-directed ad, we want them to know this
technology is out there. The C-Leg® is probably a great
example; myoelectrics would probably be another one: These allow us
to demonstrate the things that can be done with prostheses.
Unfortunately, manufacturers use athletes a lot, which I think is a
little bit misleading because they're at the end of the bell curve.
Otto Bock has been pretty good about trying to stay in the bulk of
the bell curve, trying to design products for the K-2 and K-3
patient, not just the K-4 patient."
Meredy Fullen, public relations/marketing specialist, Ohio Willow
Wood Co, Mount Sterling, Ohio:
 "Ohio Willow Wood remains sensitive to the
difficulties direct marketing to end-users can cause for
prosthetists. In many ways, as end-users become better informed
consumers, they are the ones ultimately responsible for raising the
bar for the prosthetic community and practitioners. Consequently,
while practitioners are our customers, as end users become more
computer savvy, they demand more from us as manufacturers. We have
the recent marketing moves in the pharmaceutical and contact lens
industry to thank for this, but at the same time, it is a general
trend for all consumer behavior. For us to want more choices is
truly driven by society."
Frank Snell, CPO, FAAOP, president, Snell Laboratory, Little Rock,
Arkansas, board chairman of PrimeCare O&P Network,
LLC:
 "Patients with preconceived ideas based on
marketing hype? I've certainly faced this issue! You want to give
customers an informed choice. First of all, you want to recognize
their accomplishment and acknowledge that they are taking personal
responsibility for their care by doing their homework. Then you
want to speak with them about your responsibility as a provider. I
always try to tell patients that they are the boss--I work for
them, so to speak. At the same time, as a professional and as a
business owner, I'm also responsible for the various contractual
relationships and promises that we have made to our third-party
payers.
It can be a little tricky to try to blend the two
responsibilities together and balance the needs of both. If
patients have made a good choice in their homework and you agree
with them, you have an ideal situation--you applaud them for their
accomplishment and tell them why you think their choice works for
them. Rarely is there a case where you can't offer a tweaking of
their particular selection to improve it for them.
If they choose a particular foot, and you decide that the foot
might work, but it might work more appropriately with an ankle
joint attached with it or another specific modification, you expand
their knowledge as well as build trust and credibility through your
professional input.
It gets stickier when they come in and they have a concept that
simply is the wrong concept. At that time, you really have to
choose your words carefully, you have to go back and do your
homework and bring in data and proof that what they want does not
fit their needs.
I'll give you a recent example: An elderly hip disarticulation
amputee had been fit with her initial prosthesis about 40 years
ago--a conventional hip disarticulation prosthesis which she never
did successfully wear. She had heard the hype concerning the new
microprocessor stance phase control knee joint, and she and her
grandchildren knew that this was going to be the answer to all of
Grandma's problems!
It took 30 to 45 minutes of very carefully explaining to her
Medicare functional levels, discussing who was and was not a
candidate for these types of knees, and why. I wasn't popular with
her--even when I told her that I was basically cutting myself out
of a sale. Obviously we both knew she could go down the street and
go to my competitor, who might sell it to her. I hadn't helped
myself, I've possibly alienated a patient and future client--but I
know I've done the right thing, because in the case of this
particular lady, she had rejected a prosthesis previously, she was
40 years older than when she had first rejected it, and my
professional judgment told me this was going to be a futile
effort."
Jose Dan Escarda, MD, medical director, Prosthetic
Amputee Clinic, Department of Veterans Affairs (VA) Hospital, North
Little Rock, Arkansas:
"Most of the patient population we see in the VA prosthetic
clinic are experienced amputees and previous prosthetic wearers. In
general, our patients prefer the features of their old prosthesis.
The new ones are evaluated for the component parts of what would be
an ideal socket type, what kind of suspension system, etc., they
would need. This is discussed with the patients, and they are
assisted in their choice by input from the prosthetic team and
outside vendors, depending on the level of amputation and
activity."
Judith Otto is a freelance writer based in Holly Springs, Mississippi. 
Table Of Contents - July 2003
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