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Surgical raises, code of practice


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A customer comes into your shop, they "Think" that following their hip replacement they need the heel raised 10mm but haven't had this confirmed by the hospital what do you do?

 

Well for me any new customer (to raises) who comes in HAS to have a medical professionals letter stating that the raise is required & the exact measurements needed.

 

I copy this letter & record the customers details in an A-Z phone book style database. each time they have a new pair raised I refer to this for the details of the raise & the price previously charged.

 

Some customers get funny about this & I lose them, no letter no modification.

 

Over the years adopting this policy has now meant that a lot of the local consultants & Doctors have become aware of me & have embraced this, even recommending me.

 

There is a government document called the medical devises directive which effectively means that a manufacturer can be held responsible if a device they manufacturer aids to the deterioration of a patients condition & I use this in my defence of requiring a letter (although the directive doesn't directly affect shoe raises)

 

What do you do, what codes of practice if any do you follow?

 

Lee

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I agree with Lee 100%

In today's sue crazy world why in Gods name would you do any lift without a doctors script.If you fill out the script to the letter and the person is messed up worse its not your fault.If they sue they can only get it from the guy who wrote it.I don't know about you guys but I cant charge enough to take a chance like that without a script.

Ray Torcaso

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Local doctors are not qualified to make schematic diagrams giving the detail required to effect a surgical enhancement. (I had one though :D got it off the internet, still waiting for it to work :D ).

It is cost effective for the NHS if they are a self funded practice and can get away with a local fix rather than sending the work to Elfman and his little Elves all over the country. In general they will not give specific instructions, just vauge remarks like 10mm raise on left shoe.

 

This passes the buck directly to you...... be warned.

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I use my expirience and initiative. I think I can tell when a customer genuinely needs a raise.

 

1, They are wearing a raised shoe.

2, You can ask them why they need a raise.

3, How long have they been having raises applied to thier shoes.

4, Has the hospital ever done a raise for them.

 

If you give the customer a writen reciept stating ie.. 3/4 inch raise on left shoe as customer required, due to advice of hospital.

Or words to that effect, and have your customer sign, then that should suffice.

 

I've never had a problem in 32 years.

 

planet.

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You may not have had a problem in 32 years, but what about next year?

 

Our modifications are the grey area in the wording of Custom-made devices designed for individual patients.

 

Should a case ever be brought against one of us, you should be covering your self as best as possible, getting a letter may cost some time & even worse an occasional customer but after “educating” my customers, I give them a letter to give to their consultant explaining my position.

With this professional approach few complain & most come back with the desired paperwork.

 

Once you have that piece of paper you also have a customer for life, because they don’t want to have to get a second copy.

 

I’m sure Elfman could fill us in on the legalities of the work

 

Lee

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Giving the customer the piece of paper aint worth a Carrott unless you have a "Carbon" copy as they will deny you gave them one when the SUE4U clan get their mitts on the case.

 

Copying work that has been done before is not a guarantee that you wont get to court should things go wrong as everyone down the chain may be at fault.

 

Case on TV this evening where someone got £7000 for falling off high heeled shoes.

Still it wont matter to you as you are all insured, but, could the insurers claim negligence and refuse to pay up leaving you with the bill?

 

I would not risk it in this litigation mad world. Nice to have happy customers but they soon change when they have a posibility of a case for compensation.

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planet and i have already have had a brief chat about this subject when he looked at the cork raise i posted on monday. to answer your question lee as far as i am aware there are no legal barriers to you putting a raise on a customers shoes it would be up to you if you wanted to do them, but as i said to planet if someone came in and asked if i could raise there shoe i would ask them on what grounds do you want it raised if they said they had a shortning then iwould ask them for there script if they said no i would ask them to obtain a copy from the hospital if they replied that tehy were no under the hospital tehn i advise them to go to there docters for a referal if they then said i dont want to do that then there are only 2 options left

A refuse the business

Btake the business providing they sign a waver in front of a independent witness absolving you of any responabilaty should it couse any injuries

 

now for the second part of your question if your customer has had a hip replacement the normal proceedure is for the patient to see an orthopeadic consultent who will ascertain there shortning then make the paper work with the required raise for them to take to the appleince officer for the work to be done by an orthopeadic company

now the nhs supplys service says that anraise up to 2 inchs can be done in micro after thatit should be done in cork becouse of the weight factor

the most critical part of any raise is the measurment of the heel and this is always added mid heel were it wieght bears

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You COULD be sued for just about anything you do. I think I am quite capable of making a judgment for myself as whether I should raise a customers shoe or not, beause I am an expirienced tradesman. Being a ditherer because of so called "grey areas" could turn you into a whiter than white moron, frightened of your own shaddow in the pursuit of being a perfect goody two shoes(pardon the pun).

Unless your work is rubbish and you've been wreckless in your approach, I can't see you ever having a problem.

 

Just for the record, I always tell the customer to come back if they feel they need any adjustments

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AH but Planet...... we all know that you are capable fo carrying out the work in an appropriate manner, just like many others who will discuss the work with the customer.

 

BUT..I have seen raises where a customer has asked for 3/4" extra for his shoes to be raised. 3/4" of Micro was put onto the heel, nothing else was done just a flat 3/4" on top of the existing base.

Now I have seen this same scenario many times with varying measurements in several parts of the country, mainly carried out in Heel Bars of the 70s but I'm sure it still takes place. I think that it it time for the work to be done by trades folk that are on a recommended list but who would police or recommend the repairers I do not know. Belonging to a trade body would not be a satisfactory solution to the problem. Perhaps a few test jobs!!!.

 

There are enough rouge traders in this industry without adding to the problems found by those in a less fortunate position who may have to endure discomfort through ignorance of the tradesperson.

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Being a ditherer because of so called "grey areas" could turn you into a whiter than white moron, frightened of your own shaddow in the pursuit of being a perfect goody two shoes(pardon the pun).
I agree but the fact still remains that these areas, be it in shoe repair or H&S are the areas in business most likely to catch you out! dithering on these for just a minute & setting out clear guide lines & creating your own code of practice is the best way to come out of your shadow into the sun light.

 

I for one have built a very strong reputation locally because of the way I handle this particular field of work.

 

Lee

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I agree with both Lee and Hugh. :o

 

But still offer my own code of practice, its served me well and I too have a large customer base in this field, many travelling all a long way for our services. If it aint broke don't try to fix it.

And don't try and put obstackles in your own path, if your work is good you'll not get a problem.

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well gents here is my thoughts on the matter whilst i agree wih lee,planet and hugh that any good competent shoe repairer could do most surgical adaptions without any problems i think its a little more complex than that

there is the issue of being able to identify if a shoe is acceptable for the adaption that is being requested becouse while any shoe can be adapted , not all shoes are suitable for all adaptions.

without being rude to hugh ,all these adaptions were designed for the shoes of hughs era when they were all leather with leather insoles and not todays flimsy insoles ,the amount of shoes i have seen where the rivets used to attach a socket has destroyed the insole and pulled loose or off thus rendering the adaption useless

then there is the raises as hugh said the other day when he has seen 3/4 heel raises were no attempt has bee made to pitch or balance the shoe at all, i recieved an orer the other day where the orthotist asked for a raise as follows 30mm back of the heel 25mm mid heel 6mm on the mets on another order the request was on the right shoe add 20mmto heel 10mmto sole and 5mm to toe add to left shoe add 8mm rocker sole both patients said the shoes were uncomfertable to wear

then there is the polotics of the matter the orthopeadic companys perpretrate the myth that the humble high street repaier cant do the work simply to protect themselves becouse the vast majory of orthotist are employed and paid by these companys in return for getting the work ,now if the orthotists were taken back inhouse and employed by the nhs then things could be different and maybe save the nhs and the tax payer a few bob

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Good post Elfman, one which I agree with wholeheartedly, Except for the part were we need to be able to identify if the shoe is going to be adaptable. (obviously that is part of the competant repairers job)If I refuse a Raise/lift, 99% of the time it is because of this. I recently had a middle aged couple in who wanted a 3" raise on a flimsy slipper with no heel stiffener, just a polyester upper for there aged mother. I refused on the grounds that it would be a seriously dangerous thing to do.

They almost begged me to do the job, but I refused telling them, If your Mother falls off this shoe and breaks her hip, which is a highly lightely situation, and she ends up in hospital and dies through shock which happens a lot with elderly folk without raised shoes.

I don't want to put myself or yourselves in that situation, so for my integrety and your mothers safety I refuse to carry out the work....Sorry.

But they understood, when it was explained, and didn't take off in a huff. I told them she should be taking proffessional advice, under her hospital who would make sure she is fitted with a safe device.

 

But it was out of desparation as they wanted a quick fire solution for there mothers pain. Good old NHS eh...

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that was my point planet you know as well as i do that not every one would operate to these standerds which is where hughs comment about who would police it comes in

as for tofatby fars comment of the nhs taking 6 weeks i have no idea which hospital he is refering to but the nhs guide lines require that on repairs and adaptions to shoes should be a 5 day turn around if this is not being met then its the orthopeadic company thats at fault and the hospital should be chasing them

ps planet now i know where that slipper came from ( i ended up moulding a piece of resin rubber rond a size 6 last then feathering the edges and attaching to the slipper then religning it all this on the insistance of the orthotist these are the peaple i blame for the poor quality of shoes that come in for adaption)

last word for tofatby far i can garentee you that any shoes sent to my old company were turned around in 3 days no matter how many or what adaptions were required and in some cases it was cut down to a daywe would recieve wrk from one hospital on a friday morning and it was on its way back to them by friday evening

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ps planet now i know where that slipper came from ( i ended up moulding a piece of resin rubber rond a size 6 last then feathering the edges and attaching to the slipper then religning it all this on the insistance of the orthotist these are the peaple i blame for the poor quality of shoes that come in for adaption)

 

Some shoes are just not strong enough for a substancial raise. In this case the strenth needed to support the old ladies ankle,the strength would have had to come from the build up itself, ie some sort of caliper, as the Polyester upper is not strong enough to take an adaption and neither is the old ladies ankle. I haven't the set up or expirience for making calipers.

 

Thats why I refused the work, because my expirience tells me when I'm encroaching into someone elses profession, and not being able to give the customer what she realy needs....Except good advice.

 

I know what I should and shouldn't be doing, thats my code of practice "know your limitations"

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my tthoughts has always been that the vast majority of shoes can have a 1/2 inch or 12 mm heel raise without adding anything to the sole so long as they are pitched and balanced as hugh says any more than that then i would advise adding to the sole as well

now as for the time scale as i said the nhs guidelines stipulate a 5 day turnaround how ever there could be good reasons as to why these times are not being met

example 1 there was 5 orthopeadic companys in this city at one time two of which had been in the trade for a minimum 100 years each now thee are none all have folded due to cashflow problems i,e 1 company serviced 52 hospitals 1 hospitalhad a £66000 bebt another had £32000 and a 3rd had £24000

example 2 i had a batch of work deliverd on a friday the following monday i recieved a phone call could i get 2 of there orders ready to be collected on the wednesday along with th others i had ready i said yes not a problem they will be done and ready for collection however unles i recieve a check of at least £3000 of the £5500 you owe i will not release them

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Very interesting reading elfman, already one of your biggest fans I now see a side to your business that I never realised existed. Yes everyone has debtors but not on this scale.

 

I think you may be on the wrong track here elfman, I think the customers are wanting to appear a little taller, hence the raise on both shoes, unless I'm mistaken :D

 

I put half inch inside & half inch outside, this stops me being called "short arse" :D

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