Practitioners and Technicians: Beyond Hierarchy

Marv was the first technician I ever worked with. My father hired and trained him shortly after starting his O&P practice, and their working relationship spanned more than 15 years. While in high school, I began working in the facility after school a few days each week and interacted most often with Marv. He was the primary person responsible for my training, and it was under his quiet and patient guidance that I first filled and stripped casts, laminated sockets, performed shoe transfers on twister cables and metal AFOs, and learned other technical tasks. He was patient with my learning curve, and nonjudgmental when I made mistakes. My father was the boss, but there was no question in my mind about my rank or status when it came to technical tasks. I knew nothing, and Marv could do everything, so I was completely dependent on his expertise and guidance. From my perspective, Marv did what he was instructed to do, and I did what Marv instructed me to do.

During clinical rotations in O&P school and my first residency I interacted with more technicians and began to observe common dynamics in their relationships with practitioners. There clearly was a hierarchy, with practitioners responsible for patient care and directing the work of the technicians who fabricated. It was less clear where I ranked. Not only did the clinicians and technicians have technical knowledge that far exceeded mine as a resident, but some of the technicians also understood more about the clinical world than I did. During those years I needed to learn concurrently how to take responsibility for patient management and fabrication decisions, and how to work effectively with technicians who were more knowledgeable about many aspects of O&P practice and more skilled at implementing key steps in the O&P care delivery process.