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What do Physicians Think of O&P?

What Do Physicians Think of O&P?

Survey indicates physicians have generally positive opinions about contributions of O&P professionals

So, you really want to know what physicians—your referral base— think of O&P professionals? To answer this question, we conducted a survey of a couple dozen surgeons and physiatrists.

According to respondents, O&P professionals generally receive about a B+ rating. Of course, the survey is not large enough to have real statistical validity, but perhaps you’ll recognize a few results as comparison points—and identify areas where others in our profession, and maybe even yourself, might improve.

In large measure, the physicians in our survey recognize the O&P professional as an important part of the care team—88 percent, or 15 of 17, agreed with this statement. There also is good continuity of care; one physician said, “I often escort patients into their office to describe what I am looking for.” Another noted, “Prosthetists accompany patients to their ortho clinic appointments.”

Participating physicians were asked which diagnoses they were most likely to refer to an orthotist for orthotic intervention. The most common responses

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were poststroke patients and patients who have suffered a traumatic spinal injury, followed by patients with osteoarthritis, scoliosis, and plagiocephaly, in that order. Seventy-five percent of respondents said they never refer patients for plagiocephaly, but that may reflect more on the surgeons and physiatrists included in the survey.

When asked about their impression of the value that O&P professionals provide within the care team and the services provided to patients by O&P professionals, results were almost uniformly favorable, with a poignant comment that “they have the content expertise.”

The physicians were asked whether they had been involved in a very disappointing experience with a patient they referred to O&P. Not surprisingly, about half were able to highlight such an episode, with responses such as, “Socket doesn’t fit very well,” and, “Miscommunication/not listening to the patient.” There was a fair assessment that the “level of skill is not the same in all practitioners.” There also were a couple of “business” intrusions into patient care cited: “Frequent incremental prescription requests for equipment that is more expensive but not always indicated,” and “… Typically, bad experiences happen when the process in not patient-provider based, but rather like a salesman selling or simply delivering a piece of medical equipment.”

The surgeons and physiatrists all had very positive suggestions for what O&P professionals could do to better serve the limb loss and mobility challenged population. Responses included, “… Make sure surgeons know they are available for patients and see them concurrently with the team.”

We all wish all of our grades were perfect in school—straight As! Overall, the comments reported by physicians in the survey do seem fair and directed toward improvement.

It may be helpful to recognize that, for surgeons, amputation is sometimes

not the outcome they had hoped or anticipated for a particular patient.

Finally, sometimes when you have a bit of a tough conversation or encounter with a referring physician, you can

QUESTION 1

What is your medical specialty?

Orthopedic surgeon

Vascular surgeon

Physiatrist

General surgeon

Other (please specify)

QUESTION 2

0%

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Are orthotists and prosthetists part of the care team for your limb loss or mobility challenged patients?

Yes

No

Other (please specify)

0%

never be sure what happened that day in practice, and what tough news they may have had to deliver to a patient. Remember that physicians have a tough job, too, and deserve the benefit of the doubt.

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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QUESTION 3

In what type of setting do you interact with orthotists and prosthetists with your patients?

(Example: “I see patients in a clinic setting with a prosthetist to evaluate their prosthetic needs,” or “We have an orthotist on staff at our facility.”)

RESPONSES

I call orthotists and prosthetists to discuss patients after I see them in clinic. But I do not work with them directly as they are not part of our hospital or clinics.

Office operating room clinic Both are true Clinic & inpatient rehabProsthetists accompany patients to their ortho clinic apptsClinic. Inpatient service.

I work in a rehab facility with in house prosthetists and orthotists. I run the prosthetic/orthotic clinic 4 days/week with CPO present all the time.

We have a multidisciplinary amputee clinic and a CPO is present from our facility.

We have several O&P staff at our facility and we have a monthly clinic with a prosthetist present to evaluate prosthetic needs.

We have those services available - but I do not have any overlap with them.

Orthotist on staff. I often escort patients into their office to describe what I am looking for. Patient and inpatient unit I refer patients to the prosthetist

University-based amputee clinic and rehab clinic. The university employed P&O and a few community-based P&O individuals who work with the university attend clinic.

International education programs

QUESTION 4

Which of the following diagnoses would you most likely refer to an orthotist for orthotic intervention?

Poststroke

Scoliosis

Traumatic Spinal Injury

Plagiocephaly

Osteoarthritis

0 1 2 3

Total Weighted Average

QUESTION 5

What has been your impression of the services provided to your patients by prosthetists and orthotists?

RESPONSES Excellent care provided, as I primarily work with amputees and refer to prosthetists. Good Excellent Very patient centered, effective, helpful, timely. Excellent. A great, invaluable member of the team. Good Excellent quality and service. Very compassionate. Follow-up on every patient. Excellent Very good Thorough Generally good

Varies by who the practitioner is, I have found qualified and experienced practitioners who are willing to listen and work in a team approach. Others are in just for the most expensive device and no follow up.

Excellent My experience has been good. An important part of the care team. Always helpful.

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QUESTION 6

In what ways do you see value in having prosthetists and orthotists as part of the care team for your patients?

RESPONSES

They bring their expertise to the patient in preparing them for new activities such as walking again. They can be very helpful to discuss prosthetics with patients before they have an amputation (especially to allay their fears, and answer their questions).

Input + patient evalThey are an essential part of any nonoperative treatment.

Educated/informed source to help patients get correct/appropriate care & DME (OT)/orthoses & prostheses.

They aid in operative decision making.Coordination and communicationI rely on their opinion and guidance, O&P prescription, and adjustments when I see patients.Improving patient careIn clinic evaluation to help determine the best orthosis for a specific patient.Continuity of care. Rehabilitation.

Open communication. They will often stop by my office with questions regarding a particular patient’s care.

When they are knowledgeable and experienced they add to the patient care.They have the content expertise to help patients with mobility.

Education for our patients as to what a prosthesis or orthosis can offer them, what the different device options are, and how the process to order, fabricate, fit, and align the device actually works.

It is a necessity.

QUESTION 7

What are the most important outcomes expected as a result of your patients working with a prosthetist or orthotist?

RESPONSES

Satisfaction with the use of their prosthetic, and refitting as needed to achieve best outcome of walking again, pain-free.

Cooperative working environmentPain relief, improved functionImproved function - improved quality of lifeComfort in their socketFunctional gainsGood fit, good quality of device. Follow-up with patient. Communicate back to me with issues.Excellent fitting/functioning prosthesis/orthosisMobility, ability to walkSuccessful rehab/prosthetic fitProper fit. Often difficult to have patients pick something off the shelf.Improved mobility, ADLsImproved quality of life. Excellent fit. Patient satisfaction with service

A collaborative process that ultimately improves the mobility, stability, or activity of daily living that was in need of help. Also a patient/provider experience that was professional and kind.

They are receiving needed P&O services.

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QUESTION 8

Have you or your patient ever had a very disappointing experience when you have referred the patient to a prosthetist or orthotist? What could orthotists and prosthetists learn from any such episode?

RESPONSES NoYesYes, usually due to poor communication with physicians (referring) and patients.No, but limited experience as a resident physician.Not yetSocket doesn't fit well—very hard and not well-placed Rarely happens, but when it does, there is often some miscommunication to the patient.No Not that I can think of. No No

Practitioner is not a good listener and dismisses the physician and patient. Frequent incremental prescription requests for equipment that is more expensive but not always indicated.

Yes. Did not listen to patient. Needed better fit. Limited options offered.

Yes. These bad experiences typically happen when the process is not patient-provider based, but rather like a salesman selling or simply delivering a piece of medical equipment.

Yes. The level of skill is not the same in all practitioners. Some adapt but some do not.

QUESTION 9

In your opinion, how can prosthetists and orthotists better serve the limb loss and mobility challenged patient populations?

RESPONSES

Be willing to go to patients’ homes to discuss amputation, prosthetics, perhaps initial evaluations in the home setting since it is challenging for freshly post-op patients to make it to another office.

Be more involved in surgeryOurs work well on our teamI wish prosthetists were considered clinicians instead of technicians.Embrace new technologies, adjustable sockets

Community education. Ensure follow-up of patients to prosthetist/orthotist for device issues, and follow-up to physician from medical issues.

I think they already do a great jobMore options for joint clinicsNot enough experience for me to comment on this.Schedule routine interval follow up to ensure proper fit and patient satisfaction.

Be willing to participate as a member of the care team, do not go for the quick profit but for the long term well-being of the patient

Make sure surgeons know they are available for patients and see them concurrently with team

By being health-care professionals, being patient and kind, and always trying to educate the patient and their family. Also understanding that the process takes time, and custom devices need many modifications and adjustments to be successful.

Remaining a part of the health-care team.

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QUESTION 10

Do you believe that prosthetic and orthotic services are important to the rehabilitation and mobility of your patients?

RESPONSES Yes Yes

QUESTION 11

QUESTION 12

In your opinion, how can prosthetists and orthotists better serve the limb loss and mobility challenged patient populations?

RESPONSES Better interaction between them and relevant surgeons. Come into the operating room.

What is your process for obtaining prosthetic and/or orthotic devices for your patients?

RESPONSES

Already have direct lines of communication to a prosthetist and hand therapists (not orthotists).

I am not sure.

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