time to move on

time to move on 01.27.14

I’ve written here and talked on Amp’d about how to select a prosthetist. In both forums, I’ve* briefly touched on the equally troubling topic of deselecting a prosthetist. In an ideal world, you find the perfect prosthetist as soon as you need your first prosthesis and you never have to look elsewhere for care. However, if you require a prosthesis in the first place, you’re already acutely aware that the world is rarely ideal. What do we do in those situations? When is it time to move on?

*”We’ve,” in the case of Amp’d, thanks to my podcast partner, Peggy Chenoweth aka The Amputee Mommy.

1. what’s the reason?

fit: a zero-sum game

I can’t sugarcoat it: prosthetic fit is all or nothing. You can either comfortably wear and use your prosthesis or you can’t. If you can’t, that high-tech, state-of-the-art prosthesis that got you (and your prosthetist) featured in your local newspaper has no value.

I’ve seen countless amputees show signs of end-stage “A-for-effort disease” when confronted with this situation. Common symptoms include prolific use of the phrases, “I really like him,” “He’s doing his best to figure it out,” and “He spends so much time with me,” all uttered while sitting down since the speaker can’t put weight on his prosthetic leg without requiring painkillers.

Let me be blunt: the prosthetist who’s a great human being, who tries really hard to solve your problems (but doesn’t), and who keeps you in his office 4 hours every visit not solving your problems has failed. That isn’t a personal indictment. It’s entirely possible that this individual has fit other people successfully. He undoubtedly is trying to fix things and make you happy. But so is the plumber you fire without a second thought after 3 consecutive visits to your house to fix the same leaking pipe.

Now the caveat: you have to apply a “reasonable patient” test. I knew amputees who came into our prosthetic facility thinking that every prosthetic issue they’d ever had would disappear immediately after receiving a prosthesis from us. But the process of getting a comfortable fit is exactly that: a process. If you’re lucky, it takes only a few weeks. Normally, though, it takes longer. While there’s no hard and fast rule here, my radar would start pinging after 3-4 months of consistent issues. Once you get to the 9-12 mark of non-stop problems, it’s probably time for you to hit the “eject” button.

psychological warfare

A close cousin to compromised fit, psychological warfare refers to the clinician who regularly reminds his patient that she just needs to “suck it up” because “pain is part of being an amputee.”

Unless you’ve got reflex sympathy dystrophy, daily crippling bouts of phantom pain, intermittent claudication, or some other medical condition producing regular and pervasive pain, using a prosthesis should not bring to mind being dragged across the scorching sands of a remote desert while tied to a racing stallion.

Unfortunately, I’ve heard countless tales of prosthetists trying to avoid responsibility for their own inability to fit patients comfortably by playing the “it’s not me, it’s you” card. And amputees – especially newer ones who don’t have as much experience as the prosthetist telling them this – often accept it as true. If you hear this, smile, think to yourself, “actually, it  is you,” and get out.

the price of greatness

At one time in my prosthetic-wearing life I went to a nationally-renowned facility that happened to be within easy driving distance of where I lived. My first scheduled visit there, I waited about an hour to speak to anyone besides the receptionist. I wrote it off as a bad day. My next scheduled visit – for casting – I waited 4 hours in the reception area without any explanation. At 1 pm, the clinician came out and told me he couldn’t guarantee that he’d see me that day but I could continue to wait if I wanted.

While Cara (appropriately) smoldered next to me, the following thought went through my head: “This guy’s one of the best in the world. Not thrilled about sitting here, but it’ll be worth the wait.” I sat for another 2 hours before he came back out and told me that I’d need to reschedule.

That should’ve sent alarm bells off in my head. It didn’t. This was just the cost of being a patient at the world’s greatest prosthetic facility, I told myself

While I ultimately received a great prosthesis, every trip to this facility reminded me of a simple military operation gone horribly, irrevocably wrong: think of a tactical strike devolving into an ongoing pitched ground battle against armed insurgents. Let me say this plainly: no prosthetist is so great that you should accept anything less than excellent customer service. Trust me, look hard enough for a prosthetist who can fit you well and run a practice that treats you with respect and you’ll find her. Don’t settle for one or the other: require both.

I owe what?!? 

What would you do if you went to pick up your brand new car and the salesman told you when you arrived that, oops, due to a minor addition error in the paperwork, you now owed an additional $3,000? My guess is that many of you would, at a minimum, have a colorful discussion with the salesman. I’m betting a clear majority would leave without the car.

As a patient, you have a right to know exactly how much you’ll have to pay: deductible, coinsurance, balance bills – the prosthetist should make everything clear before you receive the prosthesis. If I told you today that you could have the greatest prosthesis in the world – guaranteed – but you’d have to pay $7,000 out-of-pocket for it, I suspect most of you would reply, “I’d love to get it, but I don’t have that kind of cash taped to my air-conditioning duct like Walter White.” I’ve seen prosthetists seek $7,000 from patients after delivering a prosthesis without any previous financial discussion ever having occurred.

This puts you in an incredible bind – you’re using the prosthesis and feel a sense of obligation to make sure the prosthetist gets paid, but you’re getting blindsided financially. Nothing sours the patient-prosthetist relationship faster than financial disputes, even when you’ve gotten a wonderful prosthesis and have loved the prosthetist up to that point. In this scenario, patients quickly switch from, “What a great guy” to “He’s only in it for the money” mode. I’ve watched 100% positive patient-prosthetist relationships violently implode around these kinds of issues.

My guidance is to employ a zero tolerance policy for these kinds of “oversights.” Once they occur, it’s highly unlikely that you’ll ever feel the same way about walking into that facility or the prosthetist who’s treating you again.

why have you left?

I’ve presented 4 scenarios that I think compel you to find a new prosthetist. But I’m interested in your personal experience. If you’ve left a prosthetist of your own free will (excluding geographic relocation and other events you can’t control), why did you? For all of my prosthetic-wearing readers, I’d ask you to take one more minute out of your life and answer the survey below.

7 thoughts on “time to move on

  1. other: I am possibly one of the fortunate ones that has stayed with the first prosthetist I went to. We worked through the first pair of sockets that were cast too small, and currently have an adequate fit.

  2. I voted “other” as well. My main reason is my prosthetist has a lack of interest with technology. My fit has been and continues to be adequate, but I like a prosthetist who seeks information and actively presents technological options to me, the PROS n CONS if you will. I have been with the same Prosthetic company for the past 17+ years because I like there locations and breadth of practitioners on their team. Having the team of practitioners provides the amputee the opportunity to learn and get different perspectives.

  3. Other. 18 years ago I didn’t know I would need another AK socket. Ever. I left with a badly fitting quad socket and tried to wear it for years. Africa. Gotta love it. 10 years down the line I met my current CP. Been blessed and mobile ever since.

  4. I voted other because many reasons could come into factor. Of course the most common forms would be cost, fit and rude staff. I believe all of the above would make my vote. Also I want a prosthesis that is eager to go out of his way (within reason) to help you accomplish all the things you ask for out of a prostetic. Help you be the best you are capable of being!

  5. I was very fortunate in that I have had 3 prosthetists in 24 years—my first one closed his practice to go work at UCLA, and the other 2 worked together until 1 of them went to work for Hanger–I stayed with the other guy but I see the guy @ Hanger if I have an emergency, I can always come in without an appointment, etc. –That article describes many of the horror stories I have heard as a Peer Visitor and being involved with Mutual Amputee Aid Foundation (MAAF). I am thankful that I have gotten caring and capable people—because the fit is everything.

  6. I responded other. I am still with my original prosthetist and just had my third one made. They have always been responsive to my needs.

  7. Reblogged this on LIM359 and commented:
    Dave McGill explores the idea of when it might be time to move on and find a new prosthetist. It’s not an easy decision to make, but Dave points out the reasoning behind it and describes a few situations in which it probably is time to move on.

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