Putting the Pieces Together

An ever-increasing amount of emphasis is placed on education in the
orthotics, prosthetics, pedorthics and post-mastectomy care professions, but
that also must take into account the knowledge practitioners gain from
hands-on training. From learning the best ways to speak to
patients to honing fabrication skills, practitioners at any level of their
careers must be open — and encouraged by business owners and managers
— to take what they can from these real-life experiences, and use those
lessons for the future.

Dealing with patients

In most instances, the biggest transition from O&P school to an
O&P career comes with actual patient care. The first point business owners
must consider is that their employees should treat every patient with respect
and dignity, Jon Shreter, CPO, president of Allied Orthotics & Prosthetics,
with six locations in New Jersey and Philadelphia, said. For those new
practitioners who have previous experience in a medical office or with customer
service, the change might not be as drastic.

When it comes to hiring students without patient experience, however,
“the important thing is to get them acclimated to being around people and
serving customers,” Shreter said. “Some of them are pretty good
coming out, and some don’t have a clue because they have been in academia
all their lives.”

  Image: © 2011
iStockphoto.com/Amanda Rohde

One of the biggest lessons Shreter has taught Mark Pitambersingh, BS, a
board eligible prosthetist-orthotist at Allied O&P, is to keep control when
dealing with patients.

“Convey confidence to the patients and they will be more
receptive,” Pitambersingh said.

That confidence applies to his colleagues and other professionals as
well. He stressed that his experience and training provide him with the
credence necessary to present a solid treatment plan, even though he lacks the
30 years of experience shared by some of his mentors.

“When I walk in the room I behave more like a professional and less
like a resident,” he said.

Now a few years into his career, Pitambersingh said that Shreter remains
one of his most compelling motivations to do well.

“Like most bosses, he is much more critical than the patient,”
he said.

Asking the right questions

Another aspect of caring for patients lies in proper analysis and
treatment, including
documentation. Shreter said that it upsets him to see
clinicians asking patients the same questions that have been answered in the
patient care notes.

  Jon Shreter
  Jon Shreter

“If we have good documentation, we shouldn’t have to ask the
same question twice of a patient,” he said. “They shouldn’t have
to spend their time explaining to a new clinician when all [the practitioner]
has to do is read the notes to see what has been done before.”

In order to get the information necessary for those notes, Pitambersingh
has learned to be more direct in his line of questioning. In this way, he
remains consistent with the physicians’ recommendations and ensures a
continuum of care for the patients.

  Stuart Pressman
  Stuart Pressman

“I stick to what is being requested [as treatment] by the doctor
the majority of the time, unless I feel it is relevant to call the doctor to
treat any other condition not mentioned on the prescription,”
Pitambersingh said. “I no longer have that nervous feeling when
approaching patients as I did 2 years ago. I still keep an open mind, but when
I walk in the room, I already have an idea of what I am going to do.”

Jeff Williams, orthopedic shoe technician at Sole-lutions Footwear in
Pembroke Pines, Fla., also found the importance of asking patients the correct

  Mark Pitambersingh
  Mark Pitambersingh

“It’s just like in sales — you’ve got to determine
what the patients’ needs are,” Williams explained. “You
can’t just do that by reading a chart or watching them walk. You have to
ask them questions about their daily habits and get an entire picture.”

Williams said he considers the whole pathological picture because he
wants to not just help the patient, but “help them best for their
foot,” a skill he learned from Stuart Pressman, CO, CPed, owner of
Sole-lutions Footwear and Pressman Orthotics Inc.

  Jeff Williams
  Jeff Williams

His tactic for acclimating new employees is to tell them that “they
are now an expert in foot care,” Pressman said. “Even though it is
their first day, the customer does not know that. [The customer] sees someone
who knows their stuff. So I tell the new hire to act the part, then walk to the
back and confer with me so I can direct you to the proper selection.”

Pressman instructs his employees to then spend more time listening to
patients than talking, since that is the best way to determine their needs.
Once the practitioners have compiled enough information about their
patients’ specific conditions and circumstances, they should briefly
describe options for care — with brevity being the key component to the
conversation, he advised.

“I make sure they don’t go overboard before the customer tries
on the footgear,” he said. “The customer will get lost in an
explanation but will listen more intently when the appropriate footgear is
placed on their feet.”

Sensitivity issues

All patients deserve the courtesy of working with a health care staff
that understands how to deal with patients. Every patient is affected by his or
her condition and the daily effort involved with that circumstance — be it
amputation, stroke, posterior tibial tendon dysfunction or breast cancer —
and all members of the health care staff should be adept at treating that
patient with respect and compassion.

“Everyone learns by watching and doing. By showing a new employee
how to approach a patient, we are best able to teach and reinforce the best way
to approach that patient,” Rhonda F. Turner, PhD, JD, president of the
American Association of Breast Care Professionals, said. “Start with an
understanding that a patient’s behavior toward an employee is rarely
personal but a result of all of her experiences.”

When working with post-mastectomy patients specifically, practitioners
must remember that there is a level of intimacy involved in the disease,
treatment and products that is not present in many other areas of O&P,
because a woman’s breasts are so closely tied to her sexuality and
individuality, Turner told O&P Business News.

Among the skills that she named as keys to a positive outcome is a
practitioner’s ability to:

  • Listen. Part of working with new employees is training them away from
    their own experiences purchasing intimate apparel. Although many
    post-mastectomy boutique owners aim to provide their patients with what feels
    like a luxurious shopping experience, owners and fitters also must acknowledge
    the additional sensitivity issues involved in fitting cancer patients.
    Post-mastectomy fitters should be a source of information for these patients,
    educating them about their options for breast forms and post-mastectomy
    garments throughout the process — but first they must determine what
    patients already know:
  • Empathize. “Unless you are a breast cancer survivor, you may
    never fully understand how a patient feels,” Turner said. Empathy,
    however, reassures patients that practitioners care about their ordeal, even if
    they have not experienced it firsthand; and
  • Be patient and focus on the task at hand. Post-mastectomy fittings
    take significant time and concentrating attention directly on the patient
    allows her to feel respected and important.

Turner urged business owners to ask that their employees treat patients
as they would wish to be treated, with compassion, patience, efficiency and

Patient sensitivity issues affect other areas of O&P as well.
Williams said that his experience fitting shoes has taught him to be delicate
with people’s feelings, as many patients feel self-conscious about the
printed size number of their shoes.

In reality, “it doesn’t matter what the number is —
it’s all about the size [of the shoe],” he said. “The numbers
are not the same across the board.”

Although this may seem like a superficial issue, he said it can be a
real concern for some patients. To combat this problem, Williams fits his
patients with the best shoe for their foot, asking them how it feels before
revealing the size number of the shoe.

Sales considerations

One of the most important factors in properly treating patients is
keeping the doors of the business open. A business cannot survive without
satisfied customers. Pressman’s goal for patients is to fit them with the
best possible shoes and orthotics for their feet. But he also must consider
patient compliance, so he ensures that his staff members take the proper steps
and thoroughly discuss the patient’s options before settling on a shoe
that may be more stylish but less clinically ideal.

“If the customer is dissatisfied with our recommendation or our
assistance, then they will wind up going to another location or on the Internet
and buying an inferior, poorly fitted product anyway,” he said. So he
sometimes compromises and accommodates their requests.

In this way, Pressman is able to both compromise to meet the
patient’s needs and make the sale. He clearly explains this to his staff

Pressman also impresses upon his employees the need to offer their
patients add-on products, further benefitting both parties; patients get
additional items, like in-home sandals to support their feet when not wearing
shoes, or stretch bands to aid their prescribed therapy routines, and
Sole-lutions Footwear gets additional income from the sale.

Williams said he has come to understand this aspect of running a
business from noticing the decisions that Pressman makes on a regular basis.

“A lot of the back end of the business is making sure that we pick
the right [products] to bring in — not the gimmicky stuff, but the stuff
that is actually substantive. It’s supportive, it’s comfortable,
it’s good-looking and it’s not too expensive,” he said.

Down-selling, however, works in much the same way.

“I’ve made a lot more sales by telling them they don’t
need an insert, because that establishes a lot of trust between you. They
realize that you’re not some salesman trying to make a buck,”
Williams said.

Additionally, he said that these direct suggestions help him establish
for the patients that “this is a place they can come to ask questions and
get honest answers.”

Running the business

Post-mastectomy business owners experience the same issues
“balancing the provision of quality medical retail services with the
financial constraints of running a business,” which is difficult, Turner
said. “Ethical practices are always called for. Educating employees is the
best way to help them understand the business goals and how their actions
benefit the bottom line.”

By ensuring fitters and other employees understand product lines,
reimbursement and billing protocol, and proper customer service, business
owners can better serve both the patient and the business, she said.

Shreter said that he has the job of keeping his employees on the same
page as his company.

“The line they have to tread is taking care of the company’s
needs while at the same time giving the patient care that should be
given,” he said.

This issue often arises when O&P professionals — especially
those who have been in the business for many years — fail to comply with
payer regulations. In these cases, patients receive the necessary care, but
reimbursement becomes difficult, which inevitably affects the company. Shreter
said he must make sure that does not happen and, sometimes, he is his biggest

“The newer people coming out of school have been trained in that
highly regulated environment,” he said. “It’s easier to stress
to them that we have to make sure we comply with all regulations and insurance
requests before we provide a service, as opposed to old cowboys like me who
just put their stuff out and worry about the billing later.”

Along those same lines, Pitambersingh said that he has learned to
compare the amount of money Allied O&P will spend to provide a particular
patient service to the amount of reimbursement the company will receive for the
service. If he realizes that the service or product will result in a negative
balance for the company, then he will consult Shreter before committing to the
project. Similarly, if he knows that the patient’s third-party payer will
not cover the treatment, he informs the patient and Allied’s billing
department prior to beginning treatment.

Show, not tell

Not Found in School

Jeff Williams started working at Sole-lutions Footwear when
he was only 16 years old. He needed an after-school job; Stuart Pressman, CO,
CPed, needed the help. But Pressman did more than just offer employment; he
ignited a fire inside Williams, and almost 8 years later, he has turned that
part-time job into a career.

Williams, who recently began the process to become a
certified pedorthist, said that there are several areas of pedorthics that were
not covered in detail in his certification course at the International School
of Pedorthics, since the course is not designed to specifically explain how to
operate within a retail environment. He had to learn that information while
immersed in the information — on the job.

e plantar fasciitis,’ or ‘It sounds like a Morton’s
neuroma,’” Williams said, emphasizing “sounds” as the key
component. “[The patients] are not paying you for the advice. They’re
buying a product that you’re selling based on the knowledge that
you’ve given them.”

Listening to Pressman speak with patients about
reimbursement issues also has been useful for Williams. He said that Pressman
conveys the necessity of the additional paperwork — and the need for
patients to occasionally return to referring physicians for signatures —
as the only way to remain compliant and to continue to provide this service.

“That’s one of the things that he’s really
helped me with — putting [the information] across in a way that the
patient believes you, but your butt is not on the line,” he said.
“It’s a lot about being politically correct, and making sure that
you’re not overstepping your bounds as a pedorthist. You’re not a
licensed medical doctor.”

Handed-down experience

Pressman tells his employees, “We do not sell shoes. We
are not a shoe store — we are a foot-health center. Your job function here
is to represent my passion for helping people biomechanically. Shoes and
insoles are just the fitting tools.”

Sole-lutions Footwear’s reputation has been built on
Pressman’s method of focusing on each individual customer. He told
O&P Business News that he expects his staff members to embody
that spirit when dealing with customers and referral sources.

“It takes years to build a [relationship with a
customer] and only seconds to lose one,” he said.

As much effort as he puts into the business, he also enjoys
his time spent passing on his knowledge to his staff. Pressman has worked with
five employees in the past 9 years who have gone on to become pedorthists, some
directly because of his influence.

“I always believe passion sells, not products. I have a
passion to make a difference in the lives of others and that has influenced
some of my employees because they like what they see and want to do the
same,” he said. “There were others I have trained simply because they
needed a job and had some skill, but it was not long-lived because there was no
heart behind it.” — by Stephanie Z. Pavlou


For Williams, the most helpful part of the learning process continues to
be watching Pressman tackle patients’ issues from the moment they walk in
the door until they come back for a follow-up appointment. He advises
practitioners to allow new employees to shadow them.

“Let them ask you questions. Make them ask you questions. Tell them
exactly what you’re doing, why you’re doing it, why you didn’t
do this other thing,” he said. “Sometimes there will be a very good

Pressman said that he will shadow new employees right back when they get
started on the floor, to analyze their patient assessments. Once they are out
of earshot of the patient, he will comment and offer suggestions on how the
employees handled the situation.

Fabricating devices is similar to handling patients in that both require
a bit of experience before practitioners are able to feel comfortable in their

“When it comes to making orthotics, the biggest thing is having
done it for a long time,” Williams explained. “I can read a slideshow
or watch a video or watch Stuart a million times — working on a mold of
someone’s foot, or recovering an orthotic, trimming the line to make it
look just perfect — but it doesn’t matter, because it’s so much
harder to actually do it.”

Shreter subscribes to the shadowing tactic as well, but also takes his
employee reviews to the next level by creating a plan for each day to mentally
prepare them for their tasks and to analyze the previous day’s work.

“The game plan won’t cover every contingency, but at least
they’ll have an idea in the morning of what they’re going to do, and
if they have any questions they can ask me before [patients] start coming
in,” he said. “[We] have a game review to discuss what could’ve
been done better, what was done well.”

When training new post-mastectomy employees, Turner said she makes sure
they understand that the information they are learning is a moving target.
Research in the post-mastectomy care profession is ongoing, and the development
of new products, surgeries and laws will continue to affect how patients are

“Each new day and new patient offers new opportunities and
challenges,” she said.

Pressman, too, offers his employees the opportunity to become a kind of
artist, using their creativity to make a difference in people’s lives,
with limitless future growth possibilities.

“Do it because you love it. Do it with passion. Know in your heart
you make a difference,” he said. “Treat it well and it will treat you

Williams said that he feels that passionate about his career, and is
learning from Pressman how to harness his enthusiasm to be successful in the

“It’s the mentality. It’s not what the actual medium is.
It’s just about patient care and doing the right thing,” he said.
“Sometimes I will sit and talk to [patients] for 30 or 45 minutes about
different types of orthotics … But I think that’s [why they come
back]. I would love to do that with every person who walks in the door, and you
never know which one of these people is going to end up sending 10 people in.
You just have to treat them all like they’re your best patient.”
— by Stephanie Z. Pavlou

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