On this episode of The O&P Check-in: an SPS Podcast, we are joined by John Brinkmann, MA, CPO/L, FAAOP(D), Associate Professor at Northwestern University, to discuss the complexities of patient hygiene challenges. Brinkmann shares practical strategies for O&P professionals to approach these sensitive situations empathetically.
Read his recent article on this topic on O&P Edge.
The following includes an excerpt from our conversation, edited for length and clarity. Click here to listen to the full interview.
The O&P Check-in: an SPS Podcast unpacks trends and stories from the tight-knit community of O&P professionals. From patient care to technology, best practices, and regulations, this podcast features topics that help you stay current.
How can clinicians avoid biases about patients with hygiene challenges?
In the O&P Edge article, I mentioned Dr. Paul Ekman, a psychologist who started with the communication of emotion through facial expressions and micro expressions. He identified seven basic human emotions, and disgust is one of them. That sounds like a strong word, but it accurately describes what I felt in those situations and probably many others. It was encouraging to read that feeling is not only normal, but also common. There's a purpose for the disgust reaction and response. It’s different when it comes to patients.
Disgust has an appropriate and necessary function. It alerts us to a potential problem. If something smells rancid, we aren't going to eat it. Disgust helps us avoid potential dangers. We would all recognize an emoji of disgust because it's so characteristic—the curled lip, the scrunched nose, and the sort of hunching down.
Dr. Ekman mentions all these different things, and those can be hard to control, especially our microexpressions. I may have an involuntary response to strong smell, for instance. I wanted to look at all that and determine what part I need to accept as normal. It doesn't make me a bad person to feel disgust about a lack of hygiene, but what do I need to do about it? Being aware that could bias me against somebody so that I may make judgments about other aspects of their life and O&P care that aren't accurate.
How do you compose yourself and effectively educate your patient about the situation without showing bias or negativity?
I'm going to assume that my response is normal. Talking to other clinicians, I think we avoid and ignore a lot of these uncomfortable situations, which is not necessarily a bad strategy. I think most of this falls outside our scope. We're there for a specific reason, and overall hygiene is not part of that. That's one strategy—just be aware and don't feel like we must address it.
What often comes up with MSOP students is they know this signals a potential problem, and they want to get to the root of that. We've talked about depression with patients, and we have to be careful not to delve into areas outside of our scope. Don't open a door if you're unprepared to deal with what's behind. It doesn't mean we ignore it. There may be a need to refer.
Say we notice a steep decline in a patient’s hygiene over several months or years. That could be due to a variety of things. They may have had an undiagnosed stroke, a cognitive decline, or the loss of a caretaker. We need to be aware of it to that extent. In terms of therapeutically dealing with their lack of hygiene, I think that's out of our scope, except to the extent that it addresses their O&P care. Most of our devices can tolerate quite a high level of lack of hygiene, but it can cause skin issues. If prosthetic liners aren't cleaned, the patient could develop a skin problem. We have to address those issues specifically.
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Learn more about John’s work at Northwestern University or follow him on LinkedIn.
See also:
Handling Missed Appointments with John Brinkmann, MA, CPO/L, FAAOP(D)
