Developing a Clinical Identity
July 2009 Issue
My year as an orthotic resident is racing to an end, and I have transitioned to the final phase of my residency—supervised autonomy. I have been given the responsibility of managing my own schedule of patients, yet I have the safety net of my colleagues to ensure that I have chosen an appropriate plan for each patient. Each rotation throughout this past year has built upon the substance and skills from previous rotations. I have had a lot of guidance along the way, but it is during my autonomy that I get to take the various approaches and techniques and meld them into a methodology for my own clinical practice.
Treating the patient comes first and foremost, but as most of you know, there is a lot more involved in the care process than clinical interactions with the patient. During autonomy, I am responsible for juggling the treatment plan while working with various insurance providers, in addition to ensuring that modifying, fabricating, or ordering is done before the scheduled fitting appointments. To top it off, as a resident I need to complete the necessary patient logs, case studies, assessments, and research milestones to keep the National Commission on Orthotic and Prosthetic Education (NCOPE) satisfied, as well as finalizing plans for the end of my residency and preparing for the ABC exam. I am glad that I have the experience of a previous career, as I feel that it has prepared me to handle the details efficiently and not be frustrated by all that happens above and beyond the initial patient visit. However, no matter how organized I think I am, there always seems to be that looming wrench ready to plunge itself into my well-defined plan. It is a tough lesson to learn as a new clinician that while you have eagerly developed the best orthosis in your head to help your patient, it can be easily defeated by the phrase "coverage denied."
Learning how to manage all the facets of practicing O&P during residency is important in developing a clinical identity. I think of how I feel when I'm a patient, and I'm looking to someone else for the solutions and reassurance. No matter what is going on outside the exam room, I want to be able to give my patients a sense of comfort that the person standing before them is capable and willing to do the job. I find this to be a great struggle because I want my patients to trust me and be confident that I can provide quality care, but how can I convey confidence when the person sitting before me presents with something that I've only experienced in textbooks?
I get excited when I see a patient on my schedule with a pathology that I haven't seen or a prescription for a device that I've never made. I eagerly pore over my textbooks and journals to prepare for the initial visit with my patient. I wonder whether or not the patients who come to me for orthotic help know that they are really helping me to learn more about orthotics. It's an interesting conundrum. They may have been living with their condition for many years, and they probably know more about it than I do. While I may not be able to empathize with the various conditions of my patients, I try to compensate by developing a balance of compassion and eagerness that my patients can identify with.
As a resident, it has taken great effort to know what I know, but the larger lesson is that it takes humility to know what I don't know. I'm comfortable enough to admit that I may not have the right answer but that I am willing to keep working to find the answer that is right for my patient. The standard of clinical care that I will uphold for my patients is the same care I would hope my family and friends would receive, and this gives me the confidence I need to give my patients the best care that I am capable of providing.
Sara Pschigoda is a graduate of the master of science in orthotics and prosthetics program at Eastern Michigan University (EMU), Ypsilanti. She is a resident at the University of Michigan Orthotics & Prosthetics Center (UMOPC), Ann Arbor, and will be sharing her experiences as she completes her residency.