Overcoming Wound Healing Barriers by Understanding Patient Behaviors

By Ron Sherman MD, MSC, DTM&H

My thoughts today do not center on biotherapy or even wound care. They center on the concept of perspective. But perspective really affects every aspect of life, including wound care. The ability (or, better yet, the habit) of adjusting our perspectives allows us to understand the world in ways that would otherwise not make sense. Let me give an example by explaining what prompted me to focus on perspective in the first place: I just witnessed the most amazing dog trick in the world (since it’s Halloween season, I guess we could call this a trick for treats).

What Wound Care Providers Can Learn From Dog Behavior

Some dogs are stupid and disgusting – they eat their own poop. But to me, our dog Minnie is brilliant; I just realized that she has learned how to make her own currency. She also learned that if she poops in the backyard, the next day it will be hard and crunchy, making it easy to carry and noisy (attracting lots of attention) when she chews it.

I just watched Minnie carry her poop into the house for the 20th time. She sat down in the living room as usual, and began to chew. My wife Julie then offered Minnie a treat in return for dropping the poop – a trade immediately agreeable to the dog. Voila! Minnie has just purchased another treat.

Convincing the dog to give up the poop for a treat makes Julie feel smart. But Minnie undoubtedly feels smarter, for she has just traded poop for a delicious snack! And there's lots more poop in the backyard repository. Indeed, at our current rate, Julie will run out of treats long before Minnie runs out of poop.

So what does this have to do with wound care? Well, by looking at the situation from the dog's perspective, we can understand the motivation (or at least one possible motivation) for bringing poop into the house. And by understanding her motivation, we can recognize that this nasty habit is unlikely to change... especially if we do not change our own habit of "rewarding" her with treats. In order to stop Minnie from bringing poop into the house, we need to change strategies. We need to stop giving treats for poop, we need to make sure she is not carrying poop before we let her back into the house, and we need to remove the poop from the backyard poop bank.

Determining What Motivates Your Patients

Whether we are concerned about the behavior of our dogs, our kids, or our patients who keep walking on their ulcerated feet, one of the best ways to modify behavior is to first understand why that behavior happens, including its triggers or motivating factors. So, to understand our patients' behaviors, we need to put ourselves into their shoes (or dressings, as the case may be). What would motivate you? What would make you change your behavior if you felt or believed as your patient does? Once you understand these considerations from their perspective, you will be in a better position to help them modify their behaviors through education, counseling, psychotherapy, hygiene, financial assistance, or maybe simply by changing your own unsuccessful methods of intervention. Indeed, overcoming an obstacle to healing may not require a behavioral change as much as a change in environment, resources, or treatment strategy.

Do you know anyone like Minnie? Or like Julie? If so, stop to consider their perspectives before you take action.

About The Author
Ron Sherman MD, MSC, DTM&H has led a long career at the forefront of biotherapy, pioneering the development of medicinal maggots for over 25 years. He is now retired from his faculty position at the University of California, but continues to volunteer as Director and Board Chair of the BTER Foundation, and as Laboratory Director of Monarch Labs.

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.