I have encountered a few “clients” recently who were on the boarder line of
being a candidate for prosthetic usage. It is not cut and dry in our little
town who makes the final decision on candidacy (should be a team approach,
though). MD’s write the scripts and sometimes will start the ball rolling
by writing something like, “Evaluate for prosthesis,” but they rarely just
tell a patient that are simply not a candidate unless they are REALLY
OBVIOUSLY not.
The patient is wheeled into our office and we have about an hour (on a good
day) to evaluate and determine their fate. This is so inefficient when the
medical history is unclear and often communication is not limited or
unreliable. Often, a PT will have been involved through Rehab and can offer
assistance, but they, too, feel that it is not their place to determine
candidacy. If I suggest that we discuss candidacy and state that a
particular patient does not seem a candidate, the PT will often back me up,
but will rarely make the call first.
So, my question to the list members is this: How does it work with you all?
Who makes the call? It seems that it should first come from the doctor,
second from a PT (if they have spent time with a patient) and lastly from
the CP who spends an hour in evaluation and has limited information. After
all, a CP has nothing to lose in making a prosthesis. It’s purely an
ethical decision once that Rx is our hands. I have always believed that
every amputee has at least one chance to prove him/herself- at least with a
low expense temporary. But then I feel awful when I see that it was a total
waste of tax payer money. In a few cases, I have stopped at the check
socket phase and allowed some therapy before continuing. But this sets up
liability issues. It’s never easy.
Thanks in advance,
Joan Cestaro, CP
