What do you do if you disagree with a doctor’s prescription?

That happens quite frequently. A lot of doctors aren’t in tune with the new developments, especially with prosthetics.

The first thing we’ll do is we’ll get in contact with the doctor [and] explain what we need to do. Sometimes they’ll ask to see articles from journals showing that it works.

Right now the biggest thing for me is educating doctors about amputation sites.

I wish doctors would call and ask, “What length would you like?” I have two patient advocates who talk to doctors about [amputation sites].

I have one patient who had numerous surgeries to repair her ankle, and finally decided to have an amputation. Before it occurred, she got eight to ten different types of prostheses, and decided that she wanted the Harmony system.

She discussed the amputation site with her prosthetist and even had it marked, but the surgeon made the amputation site way too long. She was quite frustrated and ended up getting it re-amputated. Now she’s running and doing all of the things she wanted to do.

Patients are sometimes more informed than the doctor. [If a patient comes in with a recommendation], I’ll talk it over with the patient and then get in touch with the physician.

If patients come in and want something I don’t think is appropriate, I’ll tell them. They see the C-Leg and want that. If it’s overkill we’ll tell them.

I have patients who say, “I see those guys running on the TV with their legs—why can’t I do that with mine?” And I look at these 40-, 50-, 60-year-old guys and I say, “Well, did you run before?”
Norbert Fliess, CP, RTP
American Limb & Orthopedic Co.
South Bend, Ind.

I try to look at it from the doctor’s point of view. It’s not that I disagree with the prescription, it’s just that the doctor doesn’t know there’s something better. They had a half-day of experience in O&P and can’t keep up with the advances in the field.

We have set up a desk reference here with pictures of manufacturers’ items (with their permission to use them) and pictures of custom items we’ve done here. The desk reference also includes the diagnosis codes for each item.

I usually fax a photocopy of what is prescribed, along with one or two others. I include all the pros and cons of the braces. The point is to still give the doctor the final choice.

[For example], there have been so many changes in orthotics. Some doctors love to prescribe corsets, and they don’t know there are products out there that are easier for our patients to don.
Lucinda Stephan, CPO, LPO
Fidelity Orthopedic Inc.
Dayton, Ohio

Most physicians are not trained in O&P. They’re focused on their profession, not on our profession. But they count on us as allied health professionals to do our jobs. So if I disagreed with a prescription, I’d state my opinion.

For instance, I had a gentleman in here recently who had Charcot foot in both feet. They weren’t totally deteriorated, but they were heading that way. The orthopedic surgeon wanted to do a conventional AFO. I suggested that we make the change to CROW walkers on both feet, because he was over 300 pounds. And we did.

If [the doctor] stands firm, I say, “Yes, sir!” They’re the ones who have ultimate responsibility. Until we get independent status and out of this DME situation, that’s what we need to do.
Johnny Morgan II, CP, LPO
ABC Orthotics & Prosthetics
Mobile, Ala.

The bottom line is: my job is to make the doctor look good and spare us both a lawsuit. It’s just like a pharmacist who is required by law to inform a physician of a drug interaction. I have doctors who say, “John, don’t let me mess up. I’m not going to be mad if you tell me there’s a problem—I’m going to be mad if you don’t tell me.”

Thirty years ago, there were so few orthotic variations out there that [doctors] knew what to order. Now there are so many variations on the same thing, they don’t.

I’ve never had a real big problem. Physicians will go to something like the Northwestern [University] O&P course for doctors and at the end [the professors] say, “Rely on your orthotist.”

Now some [doctors] are getting their CEUs from places like the Academy show where manufacturers like Zimmer or DonJoy will have credits in a course on the side. I’m just saying DonJoy because I thought of them first, but maybe they’ll say they have an XYZ brace that cures everything from ACL [definition] to the common cold. And some physicians might believe that. An orthotist is trained to be objective and say, “It’s good for this one, but not so good for that one.”
John D. Gilbreath, CPO
Southeastern Orthotics & Prosthetics
Chattanooga, Tenn.

Have a question? If you’d like to suggest a question—or answer—for this column, contact Becky Kesner at bkesner@AOPAnet.org or (571) 431-0815.