“What’s the toughest news you’ve had to give a patient and how did you handle the situation?”

The toughest news I ever had to deliver to a patient was to inform a man that it was necessary [to revise] his amputation. He was a transfemoral amputee, and the fittings I was trying with him just would not relieve his pain and discomfort. I tried different socket styles and nothing seemed to work.

Breaking the news was rough: he didn’t want to be an amputee in the first place, [and] making the limb even shorter was going to pose additional mechanical problems that he hadn’t thought about (though it would help alleviate the pain issues).

The thing I would do differently next time would be to speak more with his doctor before recommending the revision, so that it would be clearer to the patient at the outset that, even though this was an unappealing option, it was the best course of action to relieve some of his physical discomfort.

Kyle Sherk, CP
Hanger Prosthetics and Orthotics
Oklahoma City, Okla.

The toughest news that I have to give patients is when addressing the limits their insurance plans place on the level of orthotic and/or prosthetic care that will be covered. Most patients are educated on their own medical conditions and how they were treated in the clinic prior to being evaluated by a prosthetist or orthotist.

But it is difficult to explain to someone that a KAFO may better suit their needs than an AFO and then tell the patient, “I am sorry the item that will best suit your functional needs is not covered.”

When faced with this situation, I attempt to empower the patient. I let them know that I will assist in every way possible, [through actions] like writing letters and providing clinical research to their insurance company, but the outcome of the situation will be determined by the patient’s own willingness to be their own advocate and fight for what they deserve.

Travis Carlson, CPO
Clark & Associates
Dubuque, Iowa

The toughest news I have to deliver—almost every month—is to elderly patients [when] they may no longer be able to live on their own because they do not have the physical strength to be mobile with a device after an amputation.

These patients are [undergoing rehabilitation] after AK amputations. They have been told that once they get their prosthetic device they will be back to their normal lives once again. The problem is, between the time of their surgery and the time they have [been through therapy] enough to want a device, they do not have the ability to wear the device and go from a sitting position to a standing position. Once you inform them that their mobility is lost, they usually have no choice but to move into a nursing home.

The problem is that the technology just isn’t there for elderly (and some bilateral) amputees who do not have the ability to go from the sitting position to the standing position. There are elevating wheelchairs that can help, but not enough: what good does that elevating wheelchair do if you can’t get out of your truck at the store? Hopefully, innovative technology will solve this problem in the future, but it remains one of the toughest things I must do as a prosthetist.

Tim Leppert, CP
Hanger Prosthetics and Orthotics
Nashville, Tenn.

I was faced with a patient who was a pilot, was injured on the job and hoped to fly again. She was told that she would have to have a hip disarticulation amputation, but she had already lost one leg below the knee and she only had about 4 inches of femur remaining with a lot of damage to the tissue around the remaining femur. Her doctors told her that she wouldn’t be able to be fit with a prosthesis and needed to amputate the last bit of femur she had left because they felt she would be more functional as a hip disarticulation patient than one with a short femur.

My first meeting with her was the night before her scheduled amputation. She wanted to see if there was some way I thought a prosthesis could be fit for her so she could avoid the amputation. It was a difficult situation, since she had other injuries and it had only been a matter of days since her [accident]. We did a physical evaluation of her residual limb and basically struck a deal.

The first thing I did was tell her that the doctors might be right. [Then] I made her an offer. We would try to make her a prosthesis that was functional, but if it turned out that the doctors were right, we had to go back [and] do the amputation. Our deal was that she had to give us the right to fail, and fortunately, we didn’t fail and she is a successful and functional amputee now.

Dennis Clark, CPO
Clark & Associates
Waterloo, Iowa

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