Is your Prosthetist and your prosthesis allowing you to be your best?

By Jackie O’Conner BPO (Bachelor Prosthetics Orthotics with Hons) - MAOPA Policy and Advocacy Manager (AOPA).

When was the last time you thought about what else you need and what you would like to do in life but are having trouble doing it? You probably think about this a lot when things are not working out the way you planned.

Chances are it’s annoying you. So, let’s pose the question “when was the last time you discussed the things you want to do with your Prosthetist and asked if they could help you to achieve these things?” 

As a Prosthetist, I often found that my clients didn’t always discuss what they wanted to achieve. Having goals doesn’t mean that they have to be visions of grandeur - it could be basic things such as wanting to be able to shower more easily when you’re away from home or having the ability to stand up in your own shower. This may not have been something that you thought about, or even thought was necessary, in the early stages after your amputation but it might be something that you would like now. 

Have you tried to do something like riding your bike on your current prosthesis? You might be finding it difficult because you are trying to hold on with one arm or you can’t bend your knee enough because your socket is causing you pain. Does not being able to do these things make you question if it is possible? Maybe you feel defeated. Perhaps that makes you think “maybe I can’t do this activity anymore?” rather than asking your Prosthetist if something can be done (to your prosthesis) to make it easier and/or pain free. 

There might be things your Prosthetist can help you with that you didn’t realise. Perhaps technology has changed and now there are solutions available that didn’t exist before. 

Discussing your needs with your Prosthetist People’s bodies and lifestyles change over time, as does prosthetic technology and funding. So, it’s a good idea to make sure you talk with your Prosthetist about what you need and to ensure you are up-to-date with any changes in technology or funding. 

When meeting with your Prosthetist it’s also a good idea to discuss your current prosthesis and what you do or don’t like about it, as well as talk about other options that would better suit you and your lifestyle. 

When talking to your Prosthetist about your current prosthesis think about what you already know, which may include:

• that you know your skin reacts to a silicone liner, you sweat too much to wear a liner so you might like to talk about other suspension options.
• that you need to kneel down to do your job and this often ruins your prosthesis.
• the things you like or don’t like about your prosthesis and what is important for you (eg. look, feel, weight, length, function, type).
• that you need your prosthesis to be as light as possible and you don’t care what it looks like as long as it lets you do everything you need to

When speaking with your Prosthetist ensure that you talk about yourself more broadly, which may include:

• changes to your financial situation which may impact on your ability to pay for prosthetics (or parts) you have used in the past 
• any other health issues you might be experiencing
• difficulties in attending your prosthetic clinic for regular checks, which might indicate Is your Prosthetist and your prosthesis allowing you to be your best? Jackie O’Conner BPO (Bachelor Prosthetics Orthotics with Hons) - MAOPA Policy and Advocacy Manager (AOPA) you need a prosthesis requiring minimal maintenance.
• changing a baby’s nappy
• playing golf, going surfing, gardening or walking up and down a hill.
• goals you would like to achieve (eg. return to work, driving, sport and recreation activities)

Before meeting with your Prosthetist also think about the activities you need to undertake or would like to be able to do in the future. It is a good idea to discuss these during your appointment as this will help to guide the decisions you can make with your Prosthetist. Such activities may include:

• mowing the lawn 
• getting up and down stairs.
• cooking, showering, driving a car or anything else you may need to start doing on your own

When speaking with your Prosthetist discuss changes to prosthetic parts, funding and emerging technology. While this information might not be relevant to you at the time, it may be of use down the track. You may want to:

• Find out about changes to prosthetic funding, such as the National Disability Insurance Scheme (NDIS)
• If you need to, ask for any information in writing and/or take some notes yourself so that you can discuss these matters with family members or friends. 
• Learn about different prosthetics, prosthetic componentry and new technology that you have heard about, and ask whether any of these would suit you and your situation. 
• Ask to trial new prosthetics. Think of working with your Prosthetist as a ‘team effort’, one can’t work effectively without the other.

 In order for you to make decisions and get the best outcomes: 

• Ask to take time to read about the componentry recommended for you before you go ahead and approve it. 
• Discuss possible prosthetic options and their advantages and disadvantages of each part, so that you can work together to decide what will be best for you; 
• Ask questions about any other expectations you have of your Prosthetist and/or the facility they work in, for example: “how long will it take from the time funding is approved until I receive my prosthesis?” or “I need to know about my appointments at least two weeks in advance so I can arrange to take time off from work” or “can we please book the next appointment now?” 

Having more specific discussions with your Prosthetist. 

Sometimes there are specific things that you might be worried about discussing for fear of offending your Prosthetist in some way. You should know that all health practitioners are required to be approachable about anything that you need to discuss and a good Prosthetist won’t be upset if you ask questions. Most likely he or she will enjoy the opportunity to work with someone who is motivated to get the most out of their prosthesis. 

A Prosthetist’s skill is being able to discuss whether a component is suitable for you, and if not why not. A Prosthetist should also be able to assess and discuss whether the benefits listed in an advertising brochure are things that you will be able to take advantage of. Ask your Prosthetist as many questions as you need so that you can understand. 

Some scenarios and ways of approaching each with a Prosthetist are provided below: 

Mr Smith has been to see his Prosthetist for a similar problem every fortnight for the past three months. He really likes his Prosthetist who always sees him quickly and tries his best to help Mr Smith, but it’s starting to feel like things are not going anywhere. Mr Smith is getting tired of needing so many appointments. It would be a good idea and very appropriate for Mr Smith to ask any of these questions: 

• Do you think it is worth seeing another Prosthetist for a second opinion?
• Would it be a good idea for me to have this problem reviewed at the amputee clinic with the Doctor?
• I have realised that my prosthesis has X,Y and Z limitations but what I love about my current knee unit is A,B and C, I am wondering if I can solve X,Y and Z without giving up A,B and C?
• I have found information about these components on the internet, I am wondering if you think that they will suits my needs?
• For cultural reasons I wonder if it would be possible for me to see a female Prosthetist? Is there a female Prosthetist available at your clinic?
• Checking to see if your Prosthetist is an Australian Orthotic Prosthetic Association (AOPA) member.
•  Do you think that I would be able to see someone else, just to get a fresh pair of eyes on this situation as this problem has been going on for a while now? 
• Do you think this is a problem which I’ll have to manage and put up with for life? 
• We have tried to fix this same problem many times now, I have never had this problem with another prosthesis - do you think it’s time we considered a new prosthesis? 

Miss Jones has been wearing the same knee 21 and foot componentry on her prosthesis for 10 years. Miss Jones likes her prosthesis and is comfortable with it, but it’s not perfect. Miss Jones is starting to think that in the past 10 years things must have changed so maybe there is something new that would be better for her. Miss Jones sits down and thinks about the specific limitations (things she doesn’t like and can’t do) with her current prosthesis and starts researching new prosthetic knees on the internet. Miss Jones finds some prosthetic devices that she thinks might be good for her. Miss Jones’ next step should be to go to her Prosthetist and discuss the following: 

Mrs Andrews has never had a prosthesis before and didn’t realise what would be involved. She is feeling uncomfortable about seeing her male Prosthetist, due to cultural and gender issues. Mrs Andrews doesn’t know any of the other Prosthetists in the clinic and is wondering if there might be someone more appropriate for her to see. Mrs Andrews should feel comfortable to ask:  

• I am wondering if there is anyone here who speaks my language or whether we might be able to get an interpreter? My English is not too bad but this is all very new and important to me and I want to make sure I understand. 
• The look of my prosthesis is the most important factor to me. I want it to be as normal looking and unnoticeable as possible, can you please help me with that and tell me what that means for the other parts of my prosthesis that I might have to compromise on?

Talking to others if you can’t talk to your Prosthetist. 

If you ever feel that your Prosthetist has said something inappropriate, makes you feel uncomfortable or unhappy, or you don’t feel that you can talk about something important related to your care you should consider who else you can talk to. It is important to raise concerns you have because speaking up can help prevent it from happening again, either to you or to someone else. 

Should this ever happen you should consider: 

• Asking to speak to the manager of the clinic where you have received treatment. Raise your concerns in a factual way and consider what you would like the result of your discussion to be (eg. do you want an apology? do you want reassurance that the manager will speak to the Prosthetist? do you want to make sure you remain anonymous? do you want a referral to another clinic?)
• Asking about the clinic’s formal complaint policy. Every organisation is required to have this type of policy and explain the process involved in lodging a complaint.

You can check at www. opa.org.au/findapractitioner. If your Prosthetist is an AOPA member, and you feel it is appropriate, you can make a complaint through AOPA. This will mean that AOPA will investigate whether the Prosthetist is practicing at the standard expected in Australia.