The Right Choices: Balancing Wound Treatments with Outcomes
by Aletha Tippett MD
How do you know if you are making right choice for a patient? Or, how do you know if you are even making a choice? This is true in the world of limb salvage. I have witnessed too many patients for which the risk of amputation was too much, and they died. But how do you know what the outcome will really be? You never really know, but you can make your best guess.
Being Aware of the Possible Outcomes
I think of a situation recently where an ambulatory man was admitted to the ICU. According to normal policies, an intermittent pressure system was used on his legs to avoid a deep vein thrombosis (DVT). But this man has peripheral vascular disease and ischemic ulcers on his legs. Isn't that a contraindication to using pressure on his legs? The doctor in charge said he would not stop use of the intermittent pressure because his brother had died of a pulmonary embolism from a DVT when he was admitted to a hospital. So, are we treating the patient to avoid a DVT, but inadvertently possibly causing his ischemic legs to worsen, causing gangrene and maybe ending in amputation? We will never know, but this kind of decision is one we make on a daily basis, balancing one treatment against another possible outcome.
The only thing any of us can do as health care providers is stay aware of the possible outcomes based on our treatment and prevention interventions, and advocate for our patient, no matter what "side" you are on. One of the saddest days of my life happened after I had argued vehemently with a surgeon, begging him not to amputate my patient because the leg was "innocent", but the patient could die. The next morning he amputated, and my patient died that afternoon. It was horrible, standing there and holding crying family members, myself being crushed by the inability to save my patient.
So I think the answer for any of us treating patients is to be aware of what we are doing, and advocate always for your patient. Be happy if there is a good ending, and remember, tomorrow is another day when your outcome is not happy, and you have the sadness to sustain you in the future to keep you focused on the need to stay aware and vigilant.
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.