Prosthetic Documentation: A Ventriloquist Act

By Ashley R. Muller, MSPO

Sixty-six is an important number. It's the number of credit hours I and the other recent graduates of the University of Pittsburgh's Master of Science in Prosthetics and Orthotics program completed as aspiring prosthetists and orthotists. We have entered a profession with much creative potential, yet we are most limited not by what is scientifically possible, but by policies that have little regard for what is best for our patients.

Since our clinical notes were disallowed as part of patients' medical records, we have had to find allies among other healthcare professionals to stay afloat in our practices. It is no secret that prosthetists across the country are still reeling from the determination that their notes are self-serving, and years later, it has not gotten easier to acquire the documentation that we need.

I inadvertently came across the heart of this issue early in my prosthetics residency when I was asked to find a way to condense the clinical notes written in my office, an endeavor for which I decided to probe the minds of my colleagues across the country via the OANDP-L listserv. In my post, I asked about notetaking to compare to the processes where I work: How long does it take you to write each prosthetic clinical note? What program are you using to write your notes? Which Medicare region are you in? But it was the last question I asked that had the greatest impact on me, and it was one that I asked not for the task at hand, but to satisfy my own curiosity: Would you say that doctors in your area are compliant with the requirements of documentation in their physician notes? I naively thought the lack of cooperation from local physicians who treated my patients had something to do with the fact that I practice in a rural area where physiatrists within even a 50-mile radius are scarce. I was wrong.

The responses to this question were overwhelmingly similar and had a common theme: "No. We tell them what to document." Despite that our clinical notes are not deemed part of the patient's medical record, we act as ventriloquists, speaking through the physicians, and ultimately provide the documentation to Medicare in a roundabout way-costing us time and money. It is clear in many cases the physicians are no more interested in providing the documentation than we are in tracking them down to get it. They do not understand the importance of the details in documentation, and without financial repercussions, nor do they care.

One can imagine that the reason physicians' notes count is because physicians are higher on the education totem pole than those of us who went through certificate or master's degree programs. That does not change the fact that in a clinical note, a physician recently referred to my patient's endoskeletal prosthesis as a wooden leg. This brings me to another important number: zero. That's the number of credit hours specific to O&P required for completion upon graduation by the physicians who treat our patients. The notion that a person is an expert in a profession does not make him or her an expert in our profession.

Ashley R. Muller, MSPO, is a resident prosthetist at Northern Orthopedic Laboratory, Watertown, New York. She can be reached at .