11
Feb

When I started college, I was a mechanical engineering major. I wanted to invent and design. After a couple years, the artist inside of me decided that engineering school was way more math and science than I anticipated, and I wanted to do something where I could help people more directly. I switched majors to pre-physical therapy and it was through volunteering in PT that I was exposed to prosthetics and orthotics. I realized that this was a career where I could apply engineering design to build devices that directly help people to regain mobility and function in their lives.

Fast forward a few years, and tack on quite a few student loans, and I started working my first job as a resident, excited to apply my knowledge in the real world. That was twenty years ago. Man, saying that makes me feel old! Since then, I’ve had eight residents working with me. Though verbalizing “how’s and why’s” to my residents, these teaching efforts have given me insight into my own ways of doing things that, in retrospect, have made me a better practitioner. We get a lot of applicants for residents that we have to turn down, and I regret having to tell potential residents that we do not have openings. I get it. Denver is a desirable place to live. When I applied for residencies, I wanted to move to the Washington D.C. area. I called and emailed every business there and followed up over the course of two years. During that time, nothing became available, at which point I was done with my residencies and ready to take board exams.

This gets me to the purpose of this post, which is some lessons I learned and wanted to share with the new aspiring CPO’s out there. First, be flexible about your first job. Shoot for the best residency even if you have to move to a place that may not be that desirable based on your personal tastes. It can springboard you to the next place and advance your skill-level working with the right people. I was fortunate to get a good orthotic residency at the Connecticut Children’s Medical Center, which led to a prosthetic residency with some good people in Florida.

Second, be energetic and dynamic. As students, we are so used to taking everything in and absorbing the things around us. In rotations, we observe and try not to get in the way. As residents, we’re expected to grab the bull by the horns and start practicing. That doesn’t mean making moves that are wrong or that you’re unsure of, but it does mean anticipating the next move… going to grab a tool, printing out measurements, looking though a chart, or setting up a room for casting. Time management is tough in our field because the work doesn’t stop once the patient leaves. We have notes to do, materials and parts to order, fabrication to complete, phone calls to return, messages to respond to, etc. There’s no time for mistakes and as we get better, we’re able to keep track of multiple things going on at the same time.

Third, don’t drop the ball. Use technology to your advantage. Keep a to do list. Send yourself reminders. Put things you need to take with you in a place you’ll remember. I delay reminders for things I don’t need to do for a few days or more and I keep my inbox as close to zero as I possibly can so that it’s easy to scroll through and address important emails. I get notes done within a day of seeing a patient. I like to modify molds soon after I cast so that it’s fresh in my head. Doing so requires coordination with my scheduler so that I box out time to get those tasks done in a timely manner. I like to actively help with scheduling, which really helps to avoid future Zach stress. A habit our office has gotten into is going through the next day’s schedule before we leave work because there is nothing worse than a patient showing up without something being ready.

At this point, I’ve just talked about task-master stuff. To me, this is half of our job; advancing things forward as quickly and accurately as we can (think hot potato!) without dropping that hot potato. The other half are the “Mr. Potato Head skills” necessary to excel at patient care. If you’re not familiar with Mr. Potato Head, please go out and buy one – you had a deprived childhood!

Mr. Potato Head’s hands will be the skills required to cast and modify for the best fit possible. There is a lot of variability in thought processes and methods out there, but it all boils down to a couple things – comfort and efficiency. Do everything you can to objectify your casting and modification methods. A mistake I made early on was not taking measurements. I was arrogant and thought that I could just trust my intuition on how much to reduce my mold to account for soft tissue feel and volume. Since I started measuring the same way and comparing initial check socket fits to modifications, my fits have gotten much better. Consistency is key, and tweaking your methods when you start to see patterns is important. For example, my transfemoral fittings were gapping on the proximal anterior lateral. I started making a fingerprint to that depth during casting, which drastically improved the fit and required less work with a heat gun or padding.

Mr. Potato Head’s ears stick out for a reason – to listen better… with difficult personalities, the best approach is to try our best to understand their problems from their perspective. This requires an attitude of accepting full responsibility. Of course, there are limitations and boundaries, but in general, taking this approach often diffuses stressful situations and helps us gain trust with our patients. An example is a person who we’re working with to make the twelfth heat relief on an area of the socket that is very sensitive to pressure (in this case, the patella tendon/tibial tubercle). This patient could be getting very angry and expressing how they “can’t stay any longer” and “might as well be in a wheelchair.” Accepting full responsibility means saying something like, “we can recast you” or “I’m really sorry and I understand you are frustrated. I don’t want you to have to stay here so long, but thank you for being patient with me as we figure this out together” and then working with them to try to solve the problem.

Mr. Potato Head’s nose isn’t that important unless you think about it in terms of safety and self=-care. Don’t skip steps on taking care of “Numero Uno.” This means taking the extra step of putting on a mask and protective eyewear when grinding plastic or carbon. Take a lunch break. Spend that extra minute to listen to a coworker’s dad joke and give the courtesy laugh. Breath!

Mr. Potato Head’s eyes have to do with watching. Don’t see how fast you can do dynamic alignments, see how good you can do them. If you see a pivot out at heel strike, try shifting the foot forward. Didn’t learn that in school, huh? When you take the prosthesis back to make adjustments, try to address all of the gait deviations at once rather than one at a time. Eyes have to do with long term success as well… Measure often. Use that data to make informed decisions to add a pad, recast, change liner, etc.

Mr. Potato Head’s mouth has to do with patient education. Set your patients up for success by educating them on all the things that could go wrong and what to do about them. This involves learning as much as you can yourself. When I was starting out, I read all the magazines cover to cover, all the textbooks, all the listserv posts on certain topics, etc.. Go to a national meeting if you can and go to the courses you want to become an expert in. Learn and pass on that knowledge to your patients my communicating openly with them.

Mr. Potato Head’s hat has to do with respect. Humble yourself to be an equal with all colleagues no matter how important you see yourself. Offer to help out a coworker having to stay late and never think you are too important to fill a cast or schedule an appointment. The same goes for colleagues outside our profession who might try to tell us how to do our job. Just try to understand their perspective before interjecting your own opinions. That ultimately results in more credibility from their perspective. A good response to a bad idea might be, “ok we could try that but, I’ve done that before and this or that happened.” By predicting the inevitable, it may result in reconsideration or a poor result which would affirm our warning.

Mr. Potato Head’s mustache has to do with fun. Wearing a fake mustache is a requirement at my facility for the first week of residency (just kidding!). Have fun and enjoy this amazing profession. We are not only fun at cocktail parties telling people what we do, we make the world a better place by being awesome T handle wrench turning, navicular controlling potato head CPO’s!… Hope this was helpful. I wish you all success!