Clinician Insights, Series 3, Episode 1

You can listen to the conversation on Radii Devices' Substack, or read a transcript below. Can you please tell us a bit about your career in O&P? John - I started as a technician in 1967 for Blatchford’s and qualified as a prosthetist with Blatchford in 1974 after four years of prosthetic training. I started in Roehampton, and moved to the Stanmore Limb Fitting Centre, the Royal National Orthopaedic Hospital in London. In 1988 I left Stanmore with four other prosthetists and we formed our own company, Prostech, which was contracted to the NHS. I ran the company for 12 years as the chairman and founder of the company, while always working as a full-time prosthetist. We employed 35 people. At around the age of 60, I moved down to Portsmouth to fulfil a few years of carrying out just clinical prosthetic duties, which was absolutely marvelous. Gary - I started going to school working with my father, my uncle, my cousin in a large facility. I went to NYU and then I got out, and within a year I opened up OTF Prosthetics and Orthotics, my facility. That was in 1985 and I've been here since then. How do you think the O&P industry has changed, and how do you think the development of digital technologies has affected it? Gary - The main changes have been to the business model, which has changed drastically, not only technology but as far as the management, insurance and university too. A digital workflow first made its presence–I believe 20 years ago–through Seattle systems. That was a heavy investment, and time wise kind of an archaic way of putting a socket together. Whereas today there’s more flow to it, the only problem is the cost of the technology. The plaster model is still my favourite way to go, especially when it comes to irregular shapes, I find it to be a little bit easier. I've made check sockets the old-fashioned way using vacuum, and I've also modified casts, scanned the cast and then 3D printed, which also came out well. I still question the strength of the materials in 3D printing and there’s a difference timewise as I could do it the conventional way much much faster. But digital technology is the future. You have to accept it, which I definitely do. There are experienced people who still think that their way is better and are afraid. That's fine–but they’re gonna miss the boat, it’s as easy as that. John - When I started out, it was a highly practical and labour-intensive process to build an artificial limb. There were 150 people working within the Blatchford factory. Half were metal workers producing metal shins and anything on the metal. Outside you had woodworkers doing the woodworking, and leather workers, and you had assembly workers, and you had plastics workers, so collectively it moved from area to area to complete a full artificial limb. It was very standardised because it was checked by the foreman, and what the foreman said was highly important. If it wasn't up to standard, it was bounced back to you! The design of sockets was researched by people, I think Professor Ratcliffe and James Foort, and the New York Manual was written, which is still the standard which all the universities still train by. Methods were all structured from this manual with patella tendon bearing sockets for below knees and quadrilateral sockets for transfemorals. I have adapted to digital technology, as best as I can. But I do show a lot of concern about how the race to digitise things is going to make it that much easier to reproduce failures more quickly, because I do feel within the industry we are no further forward to having standardisation of approaches to clinical practice and outcome. If you could give yourself advice at the beginning of your career, or to new clinicians just starting theirs, what would that be? Gary - If you look back, the technology just didn't exist. The business challenges did not exist. There were business challenges to stay alive and to keep going, but if you knew what you were doing, the chances were very good. You can't compare today with back then, because it's everything, the whole environment has changed. The advantage new clinicians have is being able to use technology easier than the ones coming 15–20 years ago, but you have just got to know what you're doing with the end result. The user has to use it. If patients are happy, they're happy. If you have problems–which everybody does–but if negative problems arise and patients are unhappy, then you're doing something wrong. John - When I started my prosthetics career, I'd obviously been in the industry for a good number of years. I didn't know the prosthetics side, but it was always viewed as a target you would love. Even when artificial limbs got passed out, they were passed out by the consultants, or medical officers in those days, but even the experienced prosthetists had to stand there while the consultant was talking to the patient. There was that sort of humbleness about it, so I guess I felt quite privileged and proud to become a prosthetist. It's a wonderful industry caring for people a very fruitful profession. It's very difficult when you're starting because you feel so lonely. The public often gets a totally different concept of how difficult it can be as a patient. You get good days, and you get very bad days. The leg doesn’t change, but the poor body does, and it's a very difficult profession to think that you can give back to somebody something that they've lost. You're trying to load a patient's body, loading certain parts of the residual limb, trying to make sure you don't hit the bones. It's not like getting a pair of shoes where you're off for four or five years. Patients are with you for a long time, so you have to get used to seeing recurring problems that you sometimes can't resolve. That could be a clinical issue, or it could be a psychological issue. What have been your most memorable experiences in your career so far? John - I’d have found it hard, sat there once, thinking that one day in the future, I would go on to run my own artificial limb company, employing up to 35 people. I'd have been blown out of my mind to think that as humble a person as a technician could have achieved that. I had visions. I was dissatisfied with how the industry was reluctant to change, for example, from old systems of metal working and taking measurements, and I was determined to make a move to the future with individual casting. We took a risk and sufficiently inspired the board and got a contract. But I was absolutely sure I could make a success of it because of how passionately I felt. I guess I've always felt passionately, and I would say that achievement was as great as I could ever possibly have imagined it. It's a personal achievement that I'm still working in the industry, and people must think, ‘you're absolutely barmy’, but it's a value to life. I feel valued by people and I think that's immensely important. Towards the end of my career in prosthetics, I still feel that I can contribute to society and I feel that my patients, they appreciate that–and that as an outcome to me, is success. Gary - One case, going back years ago. One of the top orthopaedic surgeons in New York called me up and said “Listen, I have Patient X, and I know you don't come here and we don't use you, but I want you to see them.” It turned out that the patient’s father was one of the top journalists and pretty famous. The patient was four years old, so we designed a leg for them and their father was ecstatic, the child was ecstatic. The doctor ended up calling me and then writing me a letter, and I still have that letter saved somewhere. It said, ‘you're the only one that ever helped this child adapt to their lifestyle.’ The child went off to college, went to medical school and is a top psychiatrist now on the West Coast and has a family of their own. The last time I touched base with them, they said “Gary, I remember you, and I’ll never forget what you did for me as a child.” There were a couple of other patients from Europe that used to come here every couple years to get a new leg made, and I asked one ‘Why do you come to me?’ because whenever he came, I’d literally have to work on him for like 2 or 3 weeks because I knew he was going to go back. But he said ‘You don't understand, you’re the only one who ever got it right”, and that was that. It’s been fun. I’ve actually met a lot of people as far as practitioners from different parts, from the West Coast, the South, New York, everywhere, and I keep in touch with them. Thanks to Gary and John! Thank you Gary, thank you John and thank you to you for joining us. We hope that through following Clinicians Insights, you feel part of an ongoing conversation, furthering understanding of digital technology and research supporting O&P practitioners in providing our patients with the best comfort, fit and socket fitting experience. If you’ve got thoughts, opinions or insight to share we’d like to hear from you; please feel welcome to get in touch at jenny@radiidevices.com. We’ll see you soon for Episode 2 in December.

Clinician Insights, Series 3, Episode 1

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