How would you express your concern for a child in need of an amputation?

Author: Samantha
School: New York College of Podiatric Medicine
Class of 2019

In the experience I have had with the podiatric field thus far, observing patients undergo functional and psychiatric consequences of amputation appears to be one of the most challenging aspects of the job. When a podiatrist must discuss the impending loss of a limb, it is critical that the patient understands the etiology of his or her condition that necessitates the amputation. However, patients who cannot fully comprehend these medical decisions, such as a child, often experience a wake of recognition only after the limb loss has occurred. This poses a unique challenge in addressing both the patient and their family. Not only do physicians need to make sure the patients and families understand the meaning of the amputation but also allow them to cope with such news.

As physicians, we become so fastidiously fixed on a correct medical decision weighing risks and benefits, that often the ethical and emotional aspect of the decision becomes inconsequential. Yet, the recipients of such news suffer from these actions when we approach the medical decision-making so bleakly. Our speech influences how children and their parents comprehend the functional and social impact of impending limb loss. When we are authentic in our discussion, we can make a positive impact on the patient’s and family’s well-being. A bad reaction can be expected, as it is common to alternate between anxiety and depression after receiving devastating news. However, it is how we respond to the concerns of patients and their loved ones that define us as empathetic and competent physicians.

It is important to encourage a child to talk about his or her feelings with both their family and the medical team. This communication is critical to understanding the child’s perception of their condition and the psychosocial impact it will have on their life. As the physician, we can help establish a healthy support system around the child and offer outlets for social support when it is needed. For example, this can be in the form of national organizations that build a community faced with likewise challenges. Additionally, local and hospital support groups may also play significant roles in providing much needed social support for the patient and their family.

Moreover, it is just as important to encourage caregiver resilience. A child’s response to adversity will always be influenced by their parents’ adaptation to their new normal. Not only will the parents positively impact their child’s recovery, but they will also build their capacity to care. Realistic optimism can be discussed and encouraged by the physician. In defining this for the family, we can cultivate a healthy environment that minimizes any caregiver burden and ultimately have a positive impact on the child.

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