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RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 28

by Michael Miller DO, FACOS, FAPWCA, WCC

As much as I detest bureaucratic oversight and mandates from those above who have no idea what they are doing in their own day to day lest my own, I am coming to the conclusion that a big hammer is needed and fortunately, it seems to be coming. At first, when I heard the whisper that there would be a single amount paid for each wound care case, I shuddered because I was concerned that it would make me look harder at how I spend my patients' money. Diabetic foot ulcer debridements weekly to every other week... going to advanced biologics after the basics have not produced the desired results... tough decisions when economics is the ultimate gatekeeper.

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by Michael Miller DO, FACOS, FAPWCA, WCC

A friend and colleague is going to die. This of itself is not news as the process of dying unquestionably begins from the moment of conception. This case is perhaps a bit sadder and more morose than many. As health care providers, we relish in the success of prolongation of life. The birth of a baby, healing after an illness and returning to our usual lives, the successful healing of a wound of longevity and strife. And yet the measurement of successful healing, like the measurement of a successful life, is one defined by an infinite number of parameters from an infinite number of opinions.

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RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 27

by Michael Miller DO, FACOS, FAPWCA, WCC

We have all seen the use of the term "Entitlement Mentality" in the media. Liberals decry its use by pointing out that the government has a duty to all citizens to assure that all people have the same rights. This argument tends to fall short when there is juxtaposition of families with multiple generations of "welfare" against those who chose to delay gratification to further their educations and become health care professionals and other occupations of service. We have all seen patients whose corpulence rivals that of Jabba the Hut and wondered not only how someone could allow themselves to mutate into such a state but more, how their loved ones could allow it. Of course, in the grand scheme of things, it does make for interesting reality television. Like the 55 year old male who had the equivalent of a '57 Chevy bypassed from him. Let's face it–regardless of how mechanistic you would like to believe we all are, regardless of your occupation, personal feelings always play a role. If not, then why would it matter if there were Republicans or Democrats sitting on our judiciary, as shouldn't the laws be interpreted based on their meaning and relationship to the US constitution and Bill of Rights and not which President appointed you to the bench?

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RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 26

by Michael Miller DO, FACOS, FAPWCA, WCC

Every so often, in my readings of newspapers, articles, and while pleasure reading, or during conversations with friends and colleagues, I come across a word that smacks me right in the kisser. I was listening to a news commentary and this new buzzword nonchalantly emanated from the speaker's lips. It took me but a second before I realized what an insidiously powerful little devil it was. The speaker droned on about the current political scenario, the state of medical care, and then, in Judge Wapner-like reckoning described his presumed foes points as "counterintuitive." This unusual word "counterintuitive" has a definition that is both painfully simple and thought-provokingly powerful. Intuition is simply the perception of something using common sense. Adding "counter" to it moves it into the realm of mystery and suspense. Counter intuitive, something that is unlikely to be found correct when assessed and evaluated.

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RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 25

by Michael Miller DO, FACOS, FAPWCA, WCC

I always wanted to be a doctor. Family and friends cannot remember me identifying myself in adulthood as anything but a medical healer. I am not sure from whence this devotion came. I was not an especially sickly child, nor did I have more than the usual number of medical visits expected from a boy growing up on the East Coast. My family doctor, Marvin Malamut, DO encouraged my dreams but not to the point of obsession. In my medical school interviews, I can report that my answers regarding wanting to be a doctor to help people were genuine.

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RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 24

by Michael Miller DO, FACOS, FAPWCA, WCC

Is there some feature, mark or other identification that assures a patient that caveat emptor is not a concern? Perhaps wearing a scarlet letter “W” identifying oneself as a wound care specialist. In Mel Brooks' 1974 Western, Blazing Saddles, the bad guys, when offered the sine qua non of a do-gooder respond acidly "Badges? We don't need no stinking badges." How then can patients identify helpers versus harmers? Why does the desire to be all things to all people as health care providers so easily usurp common sense? While the specific origin is murky, there is no question that somebody created the credo we all purport to adhere to, "First do no harm". Can ignorance, stupidity, greed or malicious intent for profit mitigate this?

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RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 23

by Michael Miller DO, FACOS, FAPWCA, WCC

And so it goes, the more things change, the more they stay the same. The Accountable Care Organization (ACO), proposed to be the salvation of the health of America, appears to be turning into the Death Star.

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RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 22

by Michael Miller DO, FACOS, FAPWCA, WCC

The movie, The Horse Whisperer, lavishly showed that taking the time to become one with the subject of your attentions has the greatest potential to provide a symbiosis and subsequently, a healing. In the movie, an injured horse appears to be the primary focus but the astute viewer soon learns that this is but the tip of the tip of the iceberg. In fact, the interactions with the horse itself becomes merely a starting point rather than the focal point for the movie. As the story unfolds, we identify complex cross-current personality patterns, events and human frailties that ultimately becomes a soufflé; something involving significant complexity and skill with the highest risk of a catastrophic outcome, that when all things come together in the perfect proportions at the perfect time in the perfect way rise to become a thing of beauty. In the case of this movie, the horse, its owner and her mother all become transmuted for their own betterment and ultimately leave the horse whisperer to do as he has always done.

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RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 21

by Michael Miller DO, FACOS, FAPWCA, WCC

For those of you who cannot remember the now deceased comedian Chris Farley, did not find his humor funny or simply cannot remember any of his memorable performances; I suggest you move on to another, less controversial, "here's how to use scissors" type of blog.

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RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 20

by Michael Miller DO, FACOS, FAPWCA, WCC

Life is 10% reality and 90% perception. There are many conundrums in wound care that may never have an answer. How can one product produce remarkable healing for one caregiver and yet is, in the hands of another, lackluster. Fortunately, one of the unquestionable constants in the vast universe of wound care is that wounds do not heal in the face of abject starvation. For all the hype of the essential nature of nutrition to wound healing, let’s face it, most people pay lip service to the topic and nothing more. Of course, there are entities lurking about in hospitals, long-term care, and high school cafeterias who profess to hold one of the keys to healing. Like many secret societies, their methods and actions are steeped in ancient rituals and secret handshakes passed down from generation to generation. In our society, they are better known by the title, dietician.

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