Treat the Patient, Not the Wound Protection Status
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by Aletha Tippett MD

For a physician or nurse in wound care, the primary thing to remember is this: you are not just seeing a wound, you are seeing a person who has a wound. Do not lose sight of this human and their humanity. Always look at the whole picture of your patient, not just their wound. Find out what is important to them and for them. Your patient might tell you, “Doc, I don’t care about the wound, I just can’t stand the smell,” or “Doc, just cut my leg off because I can’t stand the pain.”

For the first case, the response is, “sure, we can help the odor, and maybe this will help the wound too.” For the second, the response is, “I have more pain meds than you have pain,” then “let’s see what we can do to eliminate the pain.” If your patient can’t talk to you, find a family member or close friend who can.

Also, consider where your patient is in their life span. Are they near the end of their life? How long will they live? If your patient with the wound is near the end of their life, they may not live long enough to heal a wound. Your goal for this patient will not be to heal the wound, but to provide comfort — reduce pain, control odor, and relieve the symptoms that cause the patient discomfort.

I recall a hospice patient in a nursing home I was called to see several years ago for wounds. This poor man had ischemic wounds on his severely contracted legs, his heels touching his buttocks. His knee replacement in one leg was totally exposed with gleaming metal. His legs were both tightly wrapped with gauze and he was in terrible pain. I worked for two hours with him and his nurse. We first gave him oral pain medication. We unwrapped both legs, and loosely covered any open wounds. We positioned him for comfort and gave him more pain medication as needed. When we were done he looked at me, smiled, and said, “thank you, sis.” He died two days later. This was not a “wound problem,” this was a pain problem, and a problem of providing comfort for this dying man.

But don’t all patients deserve to be provided comfort? All patients deserve to be free of pain and to not suffer the humiliation of odor. Providing comfort for the patient is in keeping with treating the patient, not just the wound. So please, please remember you are not just seeing a wound to be treated, you are seeing a person who needs your help.

About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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Of course treat the patient AND the wound. In my extended experience as a SCI paraplegic (33 years) with pressure wounds and multiple surgeries, sometimes the well-meaning efforts to provide "comfort" prolong and inhibit wound healing. From a patient's perspective it requires extreme effort to heal these wounds. There is very little that is nice about it, except perhaps the interaction with kind and intelligent caregivers. I prefer aggressive treatment to heal the wound over gentle, cautious treatment that prolongs or prevents and often worsens the wound.

Lying in bed for months and months is no fun and certainly more expensive than the more aggressive approach.

Dear Peter,

Thank you for your comment. I agree with you totally. Treating the patient
first does NOT mean don't treat the wound. It means working with your
patient in a partnership to achieve the desired goal. I am sorry if there
was any implication that treating the patient negated any aggressive wound
treatment. In some cases that is definitely what is needed. On the other
hand, aggressive wound treatment does not always rule out comfort or
niceness. My point is to always put the patient first.

Thank you,

Aletha Tippett, MD

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