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.
The problem is that the meaning of counterintuitive is usually in the eyes of the beholder or the "be-dabbler" in the case of wound care. There are far too many things done in an incorrect, non-evidence-based, un-best-practice-based manner in the profession that I love so dearly. The problem is that identifying something as counterintuitive means that you have to have some semblance of intuition regarding the issue or in other words, half an idea of what you are talking about. The real issue, however, is that the care you provide needs to be self-scrutinized, self-evaluated, and dare I say it, reviewed by your peers and those you work intimately with who will provide you an honest, unbiased opinion regardless of whether you like it or not.
I received a call from a patient in a long-term care facility to resume care for him. Once at home and doing well, he had fallen into the black hole of the local medical center and then was unceremoniously dumped into a long term care facility. The astute wound care NP running their wound "lack of care" program wrote a War and Peace worthy history and physical and then documented his venous insufficiency, venous insufficiency ulcers, mild secondary lymphedema and his obesity with debility.
Providing Wound Care Under Counterintuitive Circumstances
Of course her treatment orders completely ignored her own hard work in a manner befitting one afflicted with a split personality. To treat the omnipresent infection (never mentioned in her note), she scrubbed the legs and wounds in Hibiclens twice a day. Silvedene was applied around the wounds to reduce bacteria, Santyl to the wounds to prevent slough and for her compression therapy to definitively treat the underlying etiology of all that ailed him, a loosely woven gauze wrap with the mandatory elevation of legs when not active.
As will come as no surprise, my consultation complete with a discussion of the multiple faux pas committed as well as more reasonable orders for his care were reviewed by the administrator and Director of Nursing. They subsequently contacted me and advised me that I should have had the patient come to my office since they did not have a copy of my State License and thus, not only should not have performed the consult on site, but they could not enact my orders unless the facility medical director agreed to do so (which he wisely did). The next week, the patient arrived at my clinic where the identical orders were again written and the patient improved.
And so the regulations were upheld at the cost of an ambulance ride and inconvenience to the patient, rather than simply asking me to send the needed documentation. As far as the peanut butter sandwich the NP wanted to foist on the patient, no comments were made by the regulatory adherent facility management. A place for patient care dedicated to making it inconvenient for them to get that care, recognition of poor care and then not allowing it to occur due to an easily rectified credentialing peccadillo, asking a non-expert to sanction care they probably did not understand... all counterintuitive.
Upholding the Standard of Wound Care
This brings me to what I consider to be the sine qua non slogan for what I see being foisted upon patients in the name of wound care. The sheer genius of a marketing company in creating the newest Bud Light campaign energized me in that the concept applies so extraordinarily well to the wound care arena. The ability to not just observe simple human nature, but to use it to create motivation is epiphany at its best. Of course I am talking about the phrase "It's only crazy if it doesn't work" in the universe of phrases that have meanings as deep as a Miley Cyrus song, this one rates up there with "The enemy of good is better" and of course, my personal favorite, "Did the wound heal because of what you did or in spite of what you did?"
Imagine if you will that "It's only crazy if it doesn't work" becomes the defining criteria for the wound care dabbler. This single phrase could conceivably eliminate the need for any research, journal articles, or wound care conferences since the application of a salmagundi of stuff onto or into a wound that resulted in even the most minuscule improvement would now be considered Standard of Care. Expertise would no longer be defined by how many articles or book chapters you had written, how many lectures you have given, or whether you passed the test given immediately after taking a course containing the answers.
Instead, regardless of your level of skill, knowledge, diagnostic acumen, or training, merely having the same amount of cerebral skill required to push the "play" button on a Las Vegas slot machine could conceivably result in exceptional outcomes. Of course, it would not appreciably change the behaviors of many of the wound dabblers in my area who are reported to meander into the room, authoritatively cast their eyes upon the patient and wound, solemnly pronounce the wound as "better" and then head back to the desk area to observe yet another patient entombed in the metallic oxygen coffin in which they lay.
Be assured I am not the only one lucid enough to think this great marketing coup will not be adopted in the name of a license to kill. Even patients fall for this "Manna from Heaven" mentality like the 85 year old lady whose RN granddaughter could not understand why rubbing a q-tip in a wound would not identify the cause of her grandmothers non-healing wound. Having studied wound care from a readers digest article, she peppered me with questions regarding techniques used by an Indian Shaman to cure tuberculosis and why taking mega-amounts of antifungal pills would not cure her relative's ills.
When she finally in frustration (due to my refusal to start antibiotics just in case) sent her grandmother to another entity for evaluation, I awaited the ultimate showdown. Months went by with no information from the facility until I saw the patient a few months later as I was making rounds there. She told me that she had healed her own wound after reading an article about the healing benefits of powdered sugar which she then lightly sprinkled on her wound daily. She proudly told me that she had recommended this to the other residents at the facility.
My response was a simple "Sweet."
Until we ramble next time.
About The Author
Michael Miller DO, FACOS, FAPWCA, WCC is the Founder and Medical Director of The Wound Healing Centers of Indiana and IndyLymphedema, as well as a clinical consultant, teacher, inventor, and published author.
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.