Donít Trust Everything You Learned in Kindergarten!

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From the day I started O&P, I heard about the importance of working with the "healthcare team" to maintain excellent contact, communication, and follow up. Working in a private office, I don't have direct access to the physicians and physical therapists who also treat my patients. I feel like I am playing the kindergarten game of "telephone," where the physical therapist whispers to the physician and the physician whispers to the patient and the patient whispers to me which brace to make. And just like in the telephone game, the end message is rarely the same as the original.

I experienced this firsthand while evaluating a new patient. The prescription? "PLASTIC AFO." The prescription was a blessing because it was flexible and a curse because I didn't know what my fellow healthcare practitioners had in mind. I was leaning toward fabricating a hinged AFO. I returned to the room and the patient announced, "I just called my physical therapist, and she wants a solid AFO." A solid AFO wasn't contraindicated for the patient, so it seemed like a satisfactory solution.

What was the verdict? My patient thought it was terrible! Even after multiple adjustments, she was unhappy with the AFO. I pulled one of my fellow practitioners in to help troubleshoot, but the patient remained unhappy with the function of her brace. Knowing when to stop, I asked the patient to take a break, bring the brace to her physical therapist for gait training, and schedule a follow-up appointment for adjustments. I also asked her to have the physical therapist call me with concerns.

I look back at that situation now and see where good healthcare communication could have eliminated a few headaches. Knowing I had a different treatment idea in mind than the therapist's, I should have called her to review ideas for orthotic intervention and the primary goals for improving the patient's gait before going ahead with the brace. But I didn't. Three days later, the call from the physical therapist came.

She said: "Why is it so bulky? Why does it go all the way around the ankle? I was expecting a posterior leaf-spring-style AFO!" What? My game of "telephone" had failed me!

In a sense, this was no big dilemma. The patient was returning for a follow up. I could easily convert the solid AFO to a PLS, make her and her therapist happy, and go on my way. But I still wasn't satisfied. Although the patient and the physical therapist had the brace they wanted, I felt that we were falling short of our true potential in orthotic intervention. The patient had multiple issues with her gait, and although the PLS helped a little, it wasn't her best option.

I wrote a letter to the physical therapist about my evaluation and called again to see if she would be interested in other ideas that we hadn't considered before. I think the therapist had already lost confidence in me because of my lack of communication from the start. Neither the therapist nor the patient were interested in exploring other orthotic interventions at this time—they decided to stick with just the PLS.

I learned many lessons from this encounter. Calling the therapist before fabricating the brace would have been a great way to avoid the little "re-do" I had after the first fitting. I also could have done a better job taking in the "overall orthotic picture" and consulted the therapist and the patient regarding other orthotic options before proceeding with the AFO.

In the end, my experience accentuates the need to keep in touch with the healthcare team from the start. It would have saved everyone a few headaches and saved me more time in the end. Therefore, I recommend chasing down those doctors and therapists to ask questions. And rememberÖnot everything you learned in kindergarten will help you. Beware of playing "telephone" with your healthcare team!

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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