Early Patient Encounters: Initial Impressions Help Shape Lives

Quincey Brabant, CPO, was relatively new to treating pediatric patients with amputations when a family arrived at the Salt Lake City Hanger Clinic in 2024. The teenage daughter had undergone a Symes amputation as a toddler and her parents now wanted her to be involved in the decision-making process. The parents explained that their daughter had been struggling with her prosthesis and was in severe pain, causing her to lose interest in some of her favorite activities, especially theater. Her pain had become so severe that she was considering bilateral amputations, Brabant says. “They arrived with the request of ‘can you help us?’ Both her parents had taken the day off from work and had dedicated the day to finding some sort of solution,” recalls Brabant, who has been a clinician for about six years and specializes in pediatric orthotic care, scoliosis, and highly active patients. “I remember how many walls it felt like she had up during that first appointment: short replies, rolling her eyes, huffing and puffing. I did not have a ton of experience at the time, but I was determined to find a solution.” Brabant says her education provided her with the knowledge about socket designs for Symes amputations, as well as considerations for bilateral users, and ways to allow for growth in a socket for pediatric patients. “I pulled all that information from the back of my mind while working to connect with my potential new patient,” she says. “That information was necessary and helpful and ultimately led to a successful outcome, but the real success of that first appointment just came from establishing a sort of connection. A feeling of commitment that we will work together to find comfort and success, whatever we deem that to look like.” Almost every O&P clinician can remember meeting their first patient. Practitioners The O&P EDGE interviewed for this story agreed that those early visits with patients helped shape not only their fledgling careers but their lives as well. Intimidating Patient Model Katie Jeter, CPO, Open Bionics, Pennsylvania, became interested in O&P after an unknown illness resulted in the amputation of all her toes in 2009. Her first patient encounter came while she was in school. “We had patient models who came in who we would practice making devices for,” Jeter says. “I had experience with patient care while shadowing and doing internships, but before this never by myself.” Jeter says she remembers looking around the room at the patient models when her eyes landed on one patient. “I was like, ‘Oh, I hope I don’t get him.’ He was an older gentleman with a scowl on his face who looked super intimidating and not very friendly. He didn’t look very approachable.” In fact, he was Jeter’s first patient. “I was petrified,” she says. “I remember walking up to him and not even knowing what to say. I remember being nervous out of my wits. And I knew school was the place to learn and make mistakes, but I wanted to do a really great job and put everything I had learned so far to the test.” The socket for her patient model turned out to be a great fit. Jeter says she was in shock when the patient stood in it comfortably. “It was an amazing feeling, and I remember being on top of the world until the patient looked at me and said, ‘You did great, but you’re not going to learn anything when you don’t make mistakes.’” Jeter says her patient made a valid point. “In O&P especially, mistakes are how we learn best, and fixing and learning from them is how we become the best. This was my first taste of that because he was right. My socket for the next patient model didn’t go as smoothly as the first one, but I am a better practitioner because of it.” Constant First Encounters When it comes to first patient encounters, especially for Ben Banaszak, CPO, A Step Ahead Prosthetics, New York, it is difficult to pinpoint a single defining moment. “There have been many firsts that have shaped my journey to where I am today. Each of them marked a step forward in my growth as a clinician,” he says. There was his first patient interaction in graduate school, while working with patient models. “At that stage, my focus was on learning how to translate classroom knowledge into real-life practice, guided step-by-step by professors,” he says. “There was little pressure, no real-world consequences, and every mistake for me was a learning opportunity.” Then came Banaszak’s first patient as he started residency under the guidance of his first clinical preceptor. “It was day one as an O&P resident, and my primary responsibility was to observe and understand how the clinic functioned and how patient care was delivered,” he says. Not long after, Banaszak had his first solo experience tasked with taking a foam box impression for foot orthotics for a patient. “It was a skill I had seen performed multiple times and now it was my turn,” he remembers. After that rotation ended, Banaszak says he moved to a new site and his firsts continued: a new clinic, a new instructor, another opportunity to observe and adapt. Then came other first tasks, taking an AFO mold, taking a transtibial cast, and fitting a transfemoral socket. “It was the same, over and over,” he says. “First observe, then assist, then lead.” After residency, Banaszak began his first full-time position as a clinician—and again the cycle repeated. “I watched and learned how the team operated, how they treated their patients. I worked to understand how I could fit into their rhythm,” says Banaszak, who then began seeing patients independently. “The skills I had practiced hundreds of times were now mine to preform with full responsibility. It was both exciting and humbling.” A Father’s Touch Isabel Gonzalez, CPO, lead prosthetist, Open Bionics, North Carolina, became interested in O&P in college while working on an engineering design project and shadowing a prosthetist in Houston. Her first patient encounter came in 2017, during her freshman year in college. “We saw a baby girl and her parents who were learning about prosthetics for the first time. She was born without a hand and her parents were apprehensive about what things would look like for her as she grew older,” says Gonzalez. “They wanted to get her a prosthesis as she was learning to crawl.” Since the baby’s parents were having a hard time visualizing what that could look like, Gonzalez says the prosthetist grabbed an infant-size hand prosthesis, made a makeshift socket from a paper cup, and put it on the child so they could see it on her hand. “What I remember most from that day is the dad holding his daughter in one arm and putting his opposite finger through the prosthetic hand as if she was holding it,” Gonzalez remembers. “It was a classic image of a baby holding their parent’s finger and I could see the relief in his face that there would be options for his daughter if she wanted them.” Gonzalez says she was interested in engineering at that time but wasn’t sure what she wanted to do professionally. “Seeing how meaningful this encounter was for those parents was impactful for me and made my career decision easy,” she says. “I don’t know what ultimately happened to that family, but they set me on the path that led me here.” A Patient’s Smile Brent Wright, CPO, was an O&P technician for years before becoming a practitioner. “I had interacted with patients before, but nothing compared to the first time I saw a patient as a clinician during my residency,” he says. It was that patient’s smile that made a lasting impression on him. “I remember feeling excited and nervous. For the first time I was fully responsible for the outcome,” he says. “I wanted that patient to leave feeling genuinely happy with the prosthesis.” The woman had just moved to the area and needed a new clinician. She had a transfemoral amputation and a worn prosthesis. “It still worked, but appearance mattered to her more than anything,” Wright says. “Anyone in prosthetics knows that meeting cosmetic expectations can be one of the most challenging parts of the job.” Wright says he casted her limb and fitted a check socket. “She said it was comfortable, and that gave me the confidence to continue,” he says. Wright fabricated the final socket, and shaped the cosmetic cover while she was still in the office. “I asked for feedback as I went,” Wright remembers. “Once the shape looked right, I pulled a skin over it. She stood up, looked at it, and smiled. That moment made all the stress worth it.” The Art of Listening Samantha Marek, CP/L, has worked in O&P for more than 15 years, and was introduced to the profession at a young age because her father was the executive director of the American Board of Certification for Orthotics, Prosthetics, and Pedorthics (ABC). Her first patient encounters were observations during the ABC certification exams. Her first patient as a professional came in 2020 when she began working as an office administrator at a Hanger Clinic. Job shadowing at the time, Marek and her mentor met a patient with a transtibial amputation. That woman, who had been a patient at the clinic for many years, was encountering prosthetic socket issues due to an irritation on her residual limb, Marek says. “What stood out to me most during that appointment was [the clinician’s] sincere listening to what the patient was trying to communicate,” she says. As the exam continued, Marek says she remembers thinking, “This is more than making a leg. It was about true patient care. Listening to the patient tell their story and how you would come to enable them to live their best life.” If the Shoe Fits The first patient encounter for Drew Meyer, MSPO, CPO, came when he was still finishing his board exams. His mentor was busy with another patient, so Meyer was tasked with starting the process. The patient had the worst case of primary lateral sclerosis Meyers has ever witnessed but had an incredible attitude, he remembers. “She was on a power scooter but was so determined to walk on her own. I’ll never forget how she moved—it was slow, like a sloth, but she was still able to get out of the scooter and walk with a standard walker.” Meyer, who has spent a decade at the intersection of clinical O&P, medical device design, and digital innovation, made her a set of highly customized bulky thermoplastic AFOs with built-in high-walled custom foot orthotics. “We had to find specialty shoes to fit the devices, and they ended up being a ridiculously wide 4E,” he says. “The experience taught me a lot about what not to do for a cavovarus foot presentation.” Cancer Changes Career Course When Seth O’Brien, CP, FAAOP(D), lost his leg to cancer at 24, he experienced several challenges with his initial prosthetic rehabilitation that made it difficult to return to athletics. That experience led to a career to O&P, and he has been practicing for about 15 years. While his first few weeks as a resident were a bit of a blur, he says, he vividly remembers one case and the mixed emotions it left him with. He was working at MK Prosthetic and Orthotic Services, Texas, and he was anxious to prove his worth. “I had been working on what seemed to be a straightforward transtibial replacement prosthesis for a military veteran in his early 60s,” he says. “The diagnostic socket had been a success, and after a week trial period, we decided to proceed with the laminated socket. While at the VA prosthetic clinic in San Antonio for delivery, I remember watching the patient walk back and forth as the chief of prosthetics, physiatrist, and physical therapist all picked apart his gait,” says O’Brien, who said it felt as though he were back in school again with the entire class critiquing his socket. He remembers the patient as a “bit of a cowboy with a moderate genu varum presentation.” But as his patient began to walk back and forth, “My heart raced as the varus moment at midstance in the prosthetic side knee seemed excessive,” O’Brien says. “I remember the chief of prosthetics asking out loud, ‘Is he okay with that varus moment?’” As O’Brien was contemplating his response, he says the patient came to his rescue by quickly chiming in, “Yeah, this feels great compared to my old one.” The patient’s confirmation was enough to put everyone at ease, O’Brien says. “My first transtibial case was a success, mostly,” he says. “My patient was happy, but I don’t think I slept well for a couple of weeks. I would dwell on things like how did I end up with so much varus thrust in the socket? Should I have done something different in the socket design? Or the alignment?” Experience and Perspective With the perspective of experience, what would these clinicians do differently, better perhaps, if they were to treat the same patient today? Marek, now the clinic manager at the Hanger Clinic Integrated Care Center, Illinois, says there is not much she would do differently were she to have the same encounter with that patient today. “Listening is such an important aspect of what we do as clinicians,” she says. Technological advances and the quicker turnaround for socket fabrication would have changed her treatment, though, Marek says. “We can now potentially turn a dynamic check socket the same day and possibly have the patient in a better fitting socket much sooner, allowing us to provide an interim solution and help to mitigate excess pain or further irritation to the residual limb.” If Wright were to treat the same patient today, there’s no doubt that he would build something better, he says. “I did not have access to 3D printing or modern materials back then,” he says. “It was all hand craftsmanship. Now I could offer more comfort and better function while still giving her the cosmetic appearance she wanted.” In Meyer’s case, “I’d recommend shoe modifications from the very beginning,” he says. “If the heel wedges and varus buttresses were built directly into her shoe, she could have likely put on AFOs by herself instead of needing her husband’s help. It would have made the whole process much more feasible and possibly given her more independence.” O’Brien says he still wishes he had a do-over with his cowboy patient. “Even though the outcome was successful, there was so much room for improvement,” he says. “For this particular case, I wish I would have focused on controlling the varus moment with a tighter PML and higher trim lines, rather than trying to mask it by continuing to outset the foot or adduct the socket.” For Jeter’s curmudgeonly patient, she says that day changed how she views people in every aspect of her life, especially in her practice. “If I were to meet him for the first time again, I would treat him like I do everyone who walks into my life or my office now with a handshake and a smile and ask how they’re doing,” she says. “Everyone has a story, a life, that is separate from my own experience, and every single person will be treated with kindness and respect from me, no hesitations.” Brabant wouldn’t change her first encounter with the parents and their teenage daughter. “I was able to provide her resources and information and work toward connecting the patient with peer mentors and others who had personal experience with working through the decision process of an elective amputation. That first day we formulated a plan and talked about goals and the steps to get there. Most importantly, we just made a human connection to build on.” Banaszak wouldn’t change any of his first experiences. “Each one carried lessons I needed to learn, and each helped me grow,” he says. “What I find beautiful about our field is that we often follow our patients through their own growth and journey, just as we grow ourselves. It might sound repetitive, but when you zoom out and look at the full picture of the last decade, it’s hard not to see how much growth has happened and that’s something I am really proud of.” Regardless of the years that have come and gone, and the different patient scenarios these clinicians have experienced, one thing remains the same for each of them—caring for their patients to the best of their professional ability. “My purpose today is the same as it was then,” Wright says. “To help as many people as possible to walk again.” Betta Ferrendelli can be contacted at betta@opedge.com . Both images: Wavebreakmedia/envato.com

Early Patient Encounters: Initial Impressions Help Shape Lives

Poll Results: The Pros and Cons of Prosthetic Covers

Black and Blue: Dark Humor in Clinical Practice

Black and Blue: Dark Humor in Clinical Practice

Get unlimited access!

O&P JOBS

CPO or CO

Join One of the Largest Children’s Integrated Health Systems

CO or CPO

Are you sure want to unlock this post?

Are you sure want to cancel subscription?

The most important industry news and events delivered directly to your inbox every week.

Welcome Back!

Retrieve your password

Are you sure want to unlock this post?

Are you sure want to cancel subscription?

Early Patient Encounters: Initial Impressions Help Shape Lives

Support authors and subscribe to content

Subscribe

Related posts:

Poll Results: The Pros and Cons of Prosthetic Covers

Black and Blue: Dark Humor in Clinical Practice

Black and Blue: Dark Humor in Clinical Practice

Get unlimited access!

O&P JOBS

CPO or CO

Join One of the Largest Children’s Integrated Health Systems

CO or CPO

Login to your account

Reset Password

Are you sure want to unlock this post?

Are you sure want to cancel subscription?

Account Activation

The most important industry news and events delivered directly to your inbox every week.

Welcome Back!

Retrieve your password

Login to your account

Reset Password

Are you sure want to unlock this post?

Are you sure want to cancel subscription?

Account Activation