Setting patient expectations

Setting patient expectations

We’ve all experienced a complaint from a patient where their orthotics are not doing what they expected it to do or looks different to what they had in mind. Many quibbles can be avoided just by setting the patients expectations BEFORE you prescribe the device.

Your patients should always be informed about the limitations of orthoses as well as the benefits. It is important that they have realistic expectations before making an informed decision to proceed with orthotic therapy.

We suggest the following before taking a foot impression:

• Show the patient a sample so the patient has an idea of what theirs will look like. Here they may comment about bulk, shoes, rigidity etc. It gives you the opportunity to discuss this before the patient has parted with their pennies. You may end up settling for more padding, a more flexible material or simply a different colour top cover! Yes, colour can play an important role in how a patient tolerates an orthotic!
• Orthoses may be only a small part of the overall treatment plan. They must not ignore other elements of the treatment program. For example exercises, manual therapy, weight loss, footwear etc
• New footwear may be required. This is a big one for patients. Expectations need to be set on what shoes will work with an orthotic. More on this in another blog!
• More than one prescription may be required if your patient has various types of footwear or has specific footwear for sport or work. Perhaps a more aggressive approach is needed with day-to-day shoes, but a more slimline design can be tailored for a dress shoe, or a more/less rigid material is required for specific sports etc. For the best therapeutic effect, the patient needs to actually wear them so needs to be designed to fit in with their activities and lifestyle!
• Custom orthoses are a bespoke device and may require adjustments specific to the individual patient and their needs. We all know there are seemingly a million different ways to exert the same therapeutic effect with an orthotic and making the patient aware that there may be more than one way of getting them better is worthwhile. It covers you for adjustments and modifications if needed further down the line.
• The cost of the device generally reflects the time and expertise required to design and manufacture them, not the materials within. Furthermore, Custom made devices do not attract the same consumer rights of return as other mass-produced products.
• Success is not 100% guaranteed - the same as any surgical procedure or medication for example. Put this into perspective for them.
• And this bomb shell… orthoses are NOT designed to realign your foot posture as shown in the below diagram we’ve all seen many many times before! Orthotics are designed to change the kinematics (the stresses going on internally – things we can’t always see). You will always get a patient or more likely, a mother of a patient saying, “but my/their feet are still rolling in”. YES this might be the case, but it definitely does NOT mean that the orthotic is not doing its job.

• Finally, I would highly recommend asking your patients what their expectations are. How do they feel about orthotic therapy, what do they expect from their treatment.

If you highlight and discuss the above with your patients prior to prescribing an orthotic then you will likely run into far fewer confrontations.

I cannot express enough…Patient education is KEY!!