A prosthetist responds to the AUA idea.
George Boyer
Description
Collection
Title:
A prosthetist responds to the AUA idea.
Creator:
George Boyer
Date:
9/15/1999
Text:
{One of your own people responding here, name deleted at his request.}
George,
Once again, you are a very forward thinker. A few thoughts on your
response to Reed Coleman, CP:
>The AUA would give amputees some leverage in bringing needed change
to the
practice of prosthetics. I think the 'industry' is resistant to
these
changes, thus I speculate that you people have anxiety about a
union of
amputees since historically unions HAVE been effective in bringing
about
change.
In response to this, not all unions have a favorable public image. Who
hasn't been frustrated when they see a construction
project with 10 guys just standing around??? I know this can't exactly
be attributed to union intervention, but that is
what a lot of people think. Perhaps just the word union is the one
that causes anxiety, where coalition does not??
>The agenda of changes I have in mind (others will add their own and
amend
mine) are found below in my discussion. This includes
restructuring of
your 'professionalism', evaluation of talent as well as formal
credentials
(testing etc) of persons working in the field, development of a
meaningful
education effort directed to amputees and their families and the
public at
large, among other things.
Evaluation of talent... George, this is where you just kill me. We,
along with other prosthetists and amputees on the list
have discussed the subjectiveness of the evaluation of talent. Do we
want it to become like the Eastern Bloc sports
systems, picking athletes based upon measurement taken of children?
Sometimes you make it seem so simple, like as if
there was a check-off sheet... NB - DO YOU THINK SURGEONS DO NOT
EVALUATE THE TALENT OF THEIR RESIDENTS?
>I want you people to become true professionals and separate
yourselves from
the selling of products.
This is a wonderful idea.... I have seen exactly what you are about to
describe in your next sentence and it bothers me.
>The 'bottom line' for your businesses is too
evident in the handling of your patients' (clients) needs. In the
same
breath I add that I want you to realize benefits in all ways
comparable to
the MDs, to which I consider you (or want to consider you) equal in
your
own right, noting that the restorations you provide are fully as
important
as the medical interventions occasioning them.
Once again, very sound thinking. Sometimes I get the feeling that we
are truly on the bottom of the barrel, or the lowest
rung on the ladder, in the eyes of other medical professionals. But
this is probably to be expected, because we provide a
product as well as a service.
>You can't be truly
professional until you can concentrate and really focus on the
problems of
the amputee, which are the reason for your existence. You provide
a NEW
limb for a human being which I consider absolutely as demanding as
the care
of the health of that person.
Would you consider the care provided at, say, a Shriner's Hospital to be
more professional in nature, since (1) they see lots
of pediatric cases and thusly could be considered specialists, and (2)
they can practice their craft/profession without
restriction or constraints from insurances, etc.?? To me it sounds like
you'd like every place to be a little bit like a
Shriner's. (I have no affiliation with any Shriner's Hospital, and if
I'm wrong in my perceptions, somebody please correct
me). Is that a good example ??
>I propose that the union of amputees set up a system of evaluation
of
prosthetic services, which would recognize the value of the work of
truly
talented persons and would work to see that insurers would
favorably view
such superior work as the most economical.
This is so subjective I don't know that this will work. One person may
be thrilled with one socket while the the next person
may hate it. I don't think it's quite as simple as it seems on paper
(or LCD screen). But I already spoke about this.
>The question of talent of individuals practicing in the field is
now
largely ignored, but its importance is central. Anybody, talented
or not,
can pass the testing hurdles given assiduous preparation. My own
experience in passing the architectural boards is an example.....I
certainly was NOT a talented architect but I did pass.
So are you saying that you should have been singled out as a
non-talented architect and denied the right to practice, despite
all the hard work you had put into your studies, etc.??
>And in this field
the talent of the prosthetist impacts with immense intensity in his
work.
So mere passing is not enough. People without talent must be
shifted to
non-critical areas.
This sounds very Big Brother and Orwellian to me. Talent? Important.
But do you feel like some of this stuff just can't be
learned?? Why not just create some sort of re-education program for
those that don't meet the standards?
{No - some of this stuff can't be learned by SOME people, who shouldn't
be doing it.}
>The education of people entering this work must be
extended to include meaningful residency programs (far beyond the
current
2000 hrs.....that's merely one year) where the accomplished skills
of the
master practitioner are absorbed and the talent for the work is
assessed.
To be honest, it's difficult to extend the residency period for students
simply because of the size of most practices. Most
places couldn't afford to have a resident for two years and not have
that resident develop into a full-fledged practitioner.
Also, if the residency were to be extended, there would not be enough
new residencies for the new crops of graduates. I
think you have a good idea that may not be financially feasible for most
facilities.
>I think it important that specialties in prosthetics be established
(AK,
BK, HD, HP etc) and that a saturated preparation be required for an
individual to do such work. (EG, not every prosthetist can fit a
Symes....perhaps it takes a special talent, and preparation, for
this and
for all levels as well.)
With the development of specialties in prosthetics, you'd most likely
see a large increase in the numbers of people that
have to travel to obtain prosthetics services. Would you have separate
credentials, like, John Smith, C.P., practice
limited to Symes and Transtibial Prosthetics??
>The AUA will also provide pressure toward a new educational vector
to be
provided by the newly professional prosthetists. This will include
education in depth of amputees and their families about their new
situation. Education of the public at large about limb loss and
replacement to dispel the general ignorance and anxiety. This is
an effort
in which prosthetists could really shine and alleviate huge
suffering
because the greatest part of the suffering of a new amputee
eventuates from
his enormous anxiety and ignorance as he embarks on his changed
life.
Paying more attention to Patient/client education is probably the
easiest and quickest way a CP can improve the level of
service he provides.
Even more importantly, education of the general public BEFORE amputation
is even a concern, about the complications of
diabetes and PVD. It seems like so many cases I see could have been
prevented or at least been reduced in severity.
There can never be too much patient/client/new amputee education. The
more time I spend with someone, just talking,
discussing as many issues as we can think of, the less time I have to
spend with them later because they are doing
something incorrectly (donning, sock management, etc.). I'd rather
spend that time with them working productively to
improve socket fit, or alignment, or who knows what else. If I see an
amputee who has their suspension on wrong, or
doesn't understand that they need to adjust/regulate their fit with
socks, etc., then it means that I haven't done my job
correctly in the first place.
As a result, I'm trying to have our office schedule less appointments
per day, with more time per appointment... this way, if
we need to discuss something, my client and I are not rushed to free up
a room or finish before we are ready.
>Another important work is the development of protocols covering
readiness
to be fit....ending once and for all the tragi-comic steeplechase
after the
new amputee.
It seems that at the same time things are both rushed and too slow. I
believe firmly in the benefits of IPOP and rigid
dressing fittings, but rarely have the occasion to fit them. Then,
later on, they write Rx's for patients whose wounds have
barely closed.
Perhaps the above sheds some light on my interest in a union of
amputees.
And the 'industry' is certainly free to start its own union, I
doubt square
one. As for taking charge of my own prosthetic needs....welllll, I
did go
that way back in the early 70s, got all the course work, lacking
'clinical
affiliation' and was discouraged.
It's a shame you got discouraged and didn't pursue prosthetics in the
end. You would have probably been an interesting guy
to work beside. Was your prosthetics schooling before you lost your
leg?? How did you originally get interested in
prosthetics, if so??
George,
Once again, you are a very forward thinker. A few thoughts on your
response to Reed Coleman, CP:
>The AUA would give amputees some leverage in bringing needed change
to the
practice of prosthetics. I think the 'industry' is resistant to
these
changes, thus I speculate that you people have anxiety about a
union of
amputees since historically unions HAVE been effective in bringing
about
change.
In response to this, not all unions have a favorable public image. Who
hasn't been frustrated when they see a construction
project with 10 guys just standing around??? I know this can't exactly
be attributed to union intervention, but that is
what a lot of people think. Perhaps just the word union is the one
that causes anxiety, where coalition does not??
>The agenda of changes I have in mind (others will add their own and
amend
mine) are found below in my discussion. This includes
restructuring of
your 'professionalism', evaluation of talent as well as formal
credentials
(testing etc) of persons working in the field, development of a
meaningful
education effort directed to amputees and their families and the
public at
large, among other things.
Evaluation of talent... George, this is where you just kill me. We,
along with other prosthetists and amputees on the list
have discussed the subjectiveness of the evaluation of talent. Do we
want it to become like the Eastern Bloc sports
systems, picking athletes based upon measurement taken of children?
Sometimes you make it seem so simple, like as if
there was a check-off sheet... NB - DO YOU THINK SURGEONS DO NOT
EVALUATE THE TALENT OF THEIR RESIDENTS?
>I want you people to become true professionals and separate
yourselves from
the selling of products.
This is a wonderful idea.... I have seen exactly what you are about to
describe in your next sentence and it bothers me.
>The 'bottom line' for your businesses is too
evident in the handling of your patients' (clients) needs. In the
same
breath I add that I want you to realize benefits in all ways
comparable to
the MDs, to which I consider you (or want to consider you) equal in
your
own right, noting that the restorations you provide are fully as
important
as the medical interventions occasioning them.
Once again, very sound thinking. Sometimes I get the feeling that we
are truly on the bottom of the barrel, or the lowest
rung on the ladder, in the eyes of other medical professionals. But
this is probably to be expected, because we provide a
product as well as a service.
>You can't be truly
professional until you can concentrate and really focus on the
problems of
the amputee, which are the reason for your existence. You provide
a NEW
limb for a human being which I consider absolutely as demanding as
the care
of the health of that person.
Would you consider the care provided at, say, a Shriner's Hospital to be
more professional in nature, since (1) they see lots
of pediatric cases and thusly could be considered specialists, and (2)
they can practice their craft/profession without
restriction or constraints from insurances, etc.?? To me it sounds like
you'd like every place to be a little bit like a
Shriner's. (I have no affiliation with any Shriner's Hospital, and if
I'm wrong in my perceptions, somebody please correct
me). Is that a good example ??
>I propose that the union of amputees set up a system of evaluation
of
prosthetic services, which would recognize the value of the work of
truly
talented persons and would work to see that insurers would
favorably view
such superior work as the most economical.
This is so subjective I don't know that this will work. One person may
be thrilled with one socket while the the next person
may hate it. I don't think it's quite as simple as it seems on paper
(or LCD screen). But I already spoke about this.
>The question of talent of individuals practicing in the field is
now
largely ignored, but its importance is central. Anybody, talented
or not,
can pass the testing hurdles given assiduous preparation. My own
experience in passing the architectural boards is an example.....I
certainly was NOT a talented architect but I did pass.
So are you saying that you should have been singled out as a
non-talented architect and denied the right to practice, despite
all the hard work you had put into your studies, etc.??
>And in this field
the talent of the prosthetist impacts with immense intensity in his
work.
So mere passing is not enough. People without talent must be
shifted to
non-critical areas.
This sounds very Big Brother and Orwellian to me. Talent? Important.
But do you feel like some of this stuff just can't be
learned?? Why not just create some sort of re-education program for
those that don't meet the standards?
{No - some of this stuff can't be learned by SOME people, who shouldn't
be doing it.}
>The education of people entering this work must be
extended to include meaningful residency programs (far beyond the
current
2000 hrs.....that's merely one year) where the accomplished skills
of the
master practitioner are absorbed and the talent for the work is
assessed.
To be honest, it's difficult to extend the residency period for students
simply because of the size of most practices. Most
places couldn't afford to have a resident for two years and not have
that resident develop into a full-fledged practitioner.
Also, if the residency were to be extended, there would not be enough
new residencies for the new crops of graduates. I
think you have a good idea that may not be financially feasible for most
facilities.
>I think it important that specialties in prosthetics be established
(AK,
BK, HD, HP etc) and that a saturated preparation be required for an
individual to do such work. (EG, not every prosthetist can fit a
Symes....perhaps it takes a special talent, and preparation, for
this and
for all levels as well.)
With the development of specialties in prosthetics, you'd most likely
see a large increase in the numbers of people that
have to travel to obtain prosthetics services. Would you have separate
credentials, like, John Smith, C.P., practice
limited to Symes and Transtibial Prosthetics??
>The AUA will also provide pressure toward a new educational vector
to be
provided by the newly professional prosthetists. This will include
education in depth of amputees and their families about their new
situation. Education of the public at large about limb loss and
replacement to dispel the general ignorance and anxiety. This is
an effort
in which prosthetists could really shine and alleviate huge
suffering
because the greatest part of the suffering of a new amputee
eventuates from
his enormous anxiety and ignorance as he embarks on his changed
life.
Paying more attention to Patient/client education is probably the
easiest and quickest way a CP can improve the level of
service he provides.
Even more importantly, education of the general public BEFORE amputation
is even a concern, about the complications of
diabetes and PVD. It seems like so many cases I see could have been
prevented or at least been reduced in severity.
There can never be too much patient/client/new amputee education. The
more time I spend with someone, just talking,
discussing as many issues as we can think of, the less time I have to
spend with them later because they are doing
something incorrectly (donning, sock management, etc.). I'd rather
spend that time with them working productively to
improve socket fit, or alignment, or who knows what else. If I see an
amputee who has their suspension on wrong, or
doesn't understand that they need to adjust/regulate their fit with
socks, etc., then it means that I haven't done my job
correctly in the first place.
As a result, I'm trying to have our office schedule less appointments
per day, with more time per appointment... this way, if
we need to discuss something, my client and I are not rushed to free up
a room or finish before we are ready.
>Another important work is the development of protocols covering
readiness
to be fit....ending once and for all the tragi-comic steeplechase
after the
new amputee.
It seems that at the same time things are both rushed and too slow. I
believe firmly in the benefits of IPOP and rigid
dressing fittings, but rarely have the occasion to fit them. Then,
later on, they write Rx's for patients whose wounds have
barely closed.
Perhaps the above sheds some light on my interest in a union of
amputees.
And the 'industry' is certainly free to start its own union, I
doubt square
one. As for taking charge of my own prosthetic needs....welllll, I
did go
that way back in the early 70s, got all the course work, lacking
'clinical
affiliation' and was discouraged.
It's a shame you got discouraged and didn't pursue prosthetics in the
end. You would have probably been an interesting guy
to work beside. Was your prosthetics schooling before you lost your
leg?? How did you originally get interested in
prosthetics, if so??
Citation
George Boyer, “A prosthetist responds to the AUA idea.,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/212831.
