One of the truly great aspects of our profession is that in podiatric medicine, we can offer our services through a wide range of areas. Whether as a provider to our patients or as a consultant to colleagues from other disciplines, a podiatric physician’s value is limitless. This is especially true when one considers the infinite good that we are capable of bringing to the medical community.
A level of expertise in areas such as orthopedics, dermatology, biomechanics, surgery, rheumatology, pediatrics, neurology and infectious diseases places demands on us that can be both exhilarating as well as problematic. Like most podiatrists, you probably feel an obligation to treat most patients who present to your practice with various conditions. It is safe to say there are subspecialties within podiatry that give you more satisfaction and enjoyment than others do.
I always thought I would love working with pediatric patients. A year into private practice, I found my initial enjoyment had turned to a complete dislike of pediatrics. I discovered this was due more to the parenting “skills” I encountered rather than the kids themselves. (Ever wonder why you have to take an exam to get a driver’s license but not to become a parent?)
I digress. The point is that an obligation to treat leads us to the area of wound care and limb preservation.
Not every podiatrist enjoys wound care. Again, it is okay to not like something. I suspect that many podiatrists do not enjoy wound care yet continue to dabble in this area. Whether it is due to the perceived obligation to treat or fear of losing a patient to a competing practice, this mindset is potentially quite harmful to all.
So why do so many podiatrists and primary care physicians feel the need to manage patients with wounds when in reality, they would rather be doing anything else? The problem is widespread. It may be responsible for more poor outcomes than we recognize or realize.
Whatever the reason, if any of this sounds familiar, some self-assessment may be worthwhile. If you are currently in wound care, ask yourself: have I attended continuing education wound care programs in the past two years? Have I considered board certification in wound care?
Ask yourself if your office can offer the same advanced treatment modalities and resources that a center developed solely for wound care can offer. Are you active on the staff at local hospitals? Are you capable of following your patients to these hospitals when the inevitable complication occurs? Do you consult with other physicians, applying the team approach to wound care that not only shares needed expertise, but medical and legal liability as well?
Peter Sheehan, MD, and colleagues published a landmark paper in Diabetes Care several years ago.1 It highlights the importance of time as it relates to the healing of diabetic foot ulcers. He noted a four-week percentage change in wound area as a prognostic value in helping distinguish those who will have a difficult time in healing versus those who will heal readily, when utilizing good standard wound care.
Robert Snyder, DPM, Jason Hanft, DPM, Lawrence Lavery, DPM, and several other noted experts in the field of wound care, including Dr. Sheehan, led a consensus panel, further validating Sheehan’s initial findings.2 The April 2010 Consensus Recommendations on Advancing the Standard of Care for Treating Neuropathic Foot Ulcers in Patients with Diabetes is a comprehensive guide to assist providers in an evidence-based approach to treating diabetic foot ulcers. Among the messages is that “since prolonged healing times increase the risk for morbidities, infections, hospitalization and amputation, expeditious wound closure is the primary goal in (diabetic foot ulcer) treatment.”
Time truly is of the essence in wound care, whether it be the diabetic foot or some other etiology. You will not lose patients to another provider by knowing the critical importance of the team approach and when to make a timely referral to a wound specialist. You may ultimately lose patients to mortality and morbidity by not referring.
One can build rapport by referring patients to wound care specialists. You will probably become a referral source for the conditions you prefer to treat. You may even gain additional respect from providers in your community.
If this sounds too good to be true, why not find out firsthand?
1. Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a four-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003; 26(6):1879-1882.
2. Snyder RJ, Kirsner RS, Warriner RA, Lavery LA, Sheehan P. Consensus recommendations on advancing the standard of care for treating neuropathic foot ulcers in patients with diabetes. Wounds. 2010; 56(Suppl 4):S1-S24.