As I am sure we have all experienced, communication between specialists can frequently be fragmented and incomplete. While this is certainly not intentional, given busy schedules and passive patients, it happens.
Here is an example. One of my diabetes patients came in with a mixed neuropathic-ischemic ulcer under one of his metatarsal heads. After evaluating the patient, we determined he needed an arteriogram and, hopefully, a distal bypass operation in order to heal the wound. At this time, the wound was a full-thickness ulcer but had not penetrated to bone, capsule or joint. We debrided and offloaded the wound, started appropriate wound care and referred the patient to a vascular surgeon. The plan was, after restoration of adequate perfusion, he would need a more aggressive debridement.
The patient underwent a successful distal bypass and was aggressively walked postoperatively in order to try avoid the possibility of postoperative complications such as blood clots. Unfortunately, due to a communication breakdown, there was no offloading of the wound and the only wound care orders were a cursory “cover with a dry sterile dressing.” Although we would like our patients to be proactive in their care, they assume that the doctors are communicating. The patient developed osteomyelitis and when we could have healed this patient less aggressively, it took a ray resection to save his foot.