Walking the Walk and Talking the Talk

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As an orthotic resident at National Orthotics and Prosthetics Company (NOPCO), Boston, Massachusetts, I spent the first seven weeks of my residency working on my technical skills at the central fabrication facility. When I was transferred to a clinical setting, I was eager to work with patients.

As a new resident, barely a month into the clinical part of my residency, I could count on my fingers the number of times I've casted for a custom ankle-foot orthosis. Nevertheless, I was confident that I could take an acceptable cast on the first day of this portion of my residency, without help from a practitioner. I explained the procedure to the patient and began to prepare the supplies. (Don't worry, I remembered the cutting tube!) That's when the questions began:

"So," the patient said casually, "How many thousands of these have you done so far?"

Later on, one older patient quipped, "You're too young to have been doing this very long. How much experience do you have?" And another patient, who is barely older than I am, asked, "Do you even have a medical degree?"

While my hands kept preparing the supplies, questions like these made my brain stop in its tracks. I wondered what I should say. Half of me was laughing and wanting to say, "Umů How many? Ten? Maybe? How long? A few weeks?" The other half of me was thinking "No! Don't let on that you are still a novice!"

How is it that my patients had discovered my inexperience so quickly? Had I made it that obvious? The biggest struggle of my first few months of residency has been putting on an air of confidence and an "I know what I am doing," demeanor when I'm not always feeling that way. I am normally a pretty confident person, and sometimes I find myself on the defensive when patients question my competence. I want them to feel confident that they are still receiving quality care. But I also want to examine the situation and evaluate what I could have done better. Was it really me? I am still learning the art of seeing things from my patients' point of view—whether they are in pain, whether they have been poked and prodded a hundred times before I walked in, or, perhaps, whether they had been ignored, condescended to, or forgotten by some other healthcare practitioner. All of those things could have affected my interactions with them, making them leery of "what's next." I am learning to be especially sensitive to the inpatients I see, who are subjected to a sea of unknown faces all day and hear a mantra of sometimes-unfulfilled promises. I just have to remind myself that not every question is an attack, and each patient has a right to question. All I need to do is make sure that, to the best of my ability, my patients leave satisfied with the care I provide.

Even beyond this learned empathy, I am discovering that it is okay to let on that I am still learning, because it's not a crime. Everybody starts somewhere! Some days, even after I've answered all the questions and made all of the adjustments, if my patient is still antsy, I can always bring in a fellow practitioner to "verify" the fit. For reasons I have yet to understand, this method seems to work wonders! Much like myself during this whole learning process, everyone needs a little reassurance that everything is A-OK.

Already, my confidence is increasing with my patient care. Although I am still too new for anything to be "old hat," I can breathe a sigh of relief when I leave a patient's room, knowing I have confidently and successfully answered all the patient's questions, all by myself! The patient is happy, I am happy, and I am one step closer to becoming the "seasoned" practitioner that all residents strive to be.

Stephanie LeGare is a graduate of the master of science in prosthetics and orthotics program at the Georgia Institute of Technology (Georgia Tech), Atlanta. She is a resident at the National Orthotics and Prosthetics Company (NOPCO), Boston, Massachusetts, and will be sharing her experiences as she completes her first year as an orthotic resident.

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