Q: How do you deal with a patient whose expectations don't match your assessment?

I think it’s up to the practitioner to do whatever is possible to fulfill [patients’] expectations. But if I have to tell them that I think some activity is dangerous, then I will. We do have a lot of patients that do hiking in Asheville. I’ll say, “I don’t think the components will hold up to that standard.” 

If the person has never run a marathon and that’s what he or she needs to do to feel validated, then I would say, “Let’s try some smaller races,” and send them to a trainer. You have to be their friend as much as a practitioner and say, “I don’t think you can do a whole marathon. Your prosthesis may not be capable. I don’t think you’ll succeed and that’s going to set you back even further.” I hate to say that, but I have done it. 

But that’s rare. You don’t want to put a shadow of doubt in their minds. Whatever it takes to get to that goal, we’ll work together. If we fail, we fail together.

Brad King, BOCO
Skyland Prosthetics & Orthotics Inc.
Arden, N.C.

[If patients expect too little of themselves,] you have to tell them that based on your opinion and experience, you think they’ll do better. I use the support groups extensively—we have a really good representative from the [Amputee Coalition of America] in this area that does home calls. I give them the literature from support groups and then I encourage them to call these people. 

There are people that are never happy, no matter what you do. Either it’s the color of the device or the fact that they have to wear something at all. You just have to say, “This will help you increase your activity level.” Accentuate the positives of what they’ll be able to do eventually instead of what they’ll be able to do this minute.

Dave August, CPO
Hanger Prosthetics & Orthotics Inc.
Pittsburg, Pa.

Being an amputee myself for over 50 years, I guess I expect a lot out of my patients. There are some very good prosthetists who are not amputees, but sometimes the patients themselves feel that the prosthetist being an amputee is a plus. There’s nothing like talking to someone else who has experienced the same thing. 

Here in our facility we have four amputees employed. I just had a patient yesterday who felt very good after seeing them working and living normal lives. 

There are some people that you have to bring down to reality. When patients go to bilateral above-the-knee limbs, their expectations are sometimes great. You kind of have to say, “Hey, there will be more limits than when you’re a below-the-knee amputee.”

Sidney M. Nicely, CP
Virginia Prosthetics Inc.
Roanoke, Va.

I recently fit somebody with an Otto Bock Compact™ knee, which is one of the electronic knee systems. This person is relatively young, in his early fifties, with a fairly low weight and an anticipated functional activity level of K3. 

His expectations were unrealistic in that he expected to be able to put on the prosthesis and immediately see all of its advantages--things like stumble recovery and automatic adjustments for gait--right from the start, without having to go through a prosthetics rehabilitation gait training program. He was frustrated, and complaining about the therapy that was required and refusing therapy. 

One of the things that I tried to explain is that since he hadn’t had [a device] before, he needed to first learn to use an above-the-knee prosthesis, which requires a lot of compensation from other muscles and joints. Then he would be able to realize the benefits that it can provide. 

It’s not totally resolved yet. It’s still something that we’re working with. It’s an ongoing process of working with him, the physical therapists and his family, through follow-up visits and through therapy, to discuss these things with him so that he can have more realistic expectations of what he can do.

John Craig, CPO, LPO
Abilene Artificial Limb Co. LLP
Abilene, Texas

With my mastectomy patients, these people come in here and they are the saddest people you have ever met. They walk out feeling like new women. It never fails. It doesn’t matter who they are. They all walk in here with the lowest expectations and they always leave here smiling.

Cynthia Beattie, COF, CMSbr  
Central Brace and Prosthetics Inc.
Corbin, Ky.