Shelly S. Harkins, Chief Medical Officer, St. Peter's Health
As a hospitalist in Illinois in 2012, I decided to expand my expertise into wound care by agreeing to spend a week in Florida to train in Advanced Wound Healing. As a hospitalist, I certainly cared for my share of wounds, but I did not truly understand the detailed pathophysiology of wounds nor the depth of available treatments to heal them. I had no real concept of the social implications of chronic wounds, nor the magnitude of the problem from a more global perspective. In all honesty, I wanted a little extra money. And so I went. And I’m so glad I did. Now, as a Chief Medical Officer, I am privileged to serve to better the overall wellness of an entire community and to ensure the long-term viability of my healthcare system. And can you believe it? It still comes back to wounds.
"Wound care clinics are more than a specialty clinic. They are a second chance at life for so many people"
The week in Florida training was quite eye-opening from a medical perspective. Wounds should be debrided every week? I couldn’t believe it. The hyperbaric oxygen chambers I only knew of as a scuba diver in my youth could heal wounds? How fascinating. I could learn to perform extensive debridement and use cutting edge therapy to visibly heal people as a primary care physician. What an opportunity! After a week of fibroblast and collagen pathophysiology refreshers and memorizing the appropriate uses of advanced wound care products, I was hooked. I was beyond excited about the work from a medical perspective. But I still didn’t really get it.
We opened our wound care clinic. We had a wound care EMR to capture all the right components for billing. We had our cabinets stocked with a few of each category of product, and our protocols and algorithms (to make sure we kept our costs down) were posted on our pin boards. We were conveniently located on the bottom floor so our patients could get to us easily. We had promoted our services to all primary care docs and surgeons, marketed the new clinic in church bulletins and newspapers, and had flyers sitting all around the town. We were ready. The doors opened.
And the patients came. They came in droves. Some patients were sent from primary care physicians with diagnosed wounds but a shockingly large number of patients who had been hiding their wounds from friends, family and doctors came in with their heads hung looking for some hope. One woman had been dealing with her wounds secretly for several years, using OTC products and bandages to control the drainage. She admitted she would often get a fever and knew her wound was infected but was too embarrassed to tell a doctor or anybody for that matter. She said she would take Tylenol for the fever and soak her wound in a vinegar bath to kill the infection. She admitted to passing out in the tub from the burning pain once and almost drowned. We had one man with diabetes explain that he was able to control the odor of his wound with kitty litter so that his family wouldn’t know. When we unwrapped the wound, the litter was embedded deep inside it. He had actually applied the litter directly to the wound. We got a nearly identical story from another man with the use of coffee grounds for odor. We cared for a woman with vascular insufficiency wounds who had been told by a friend to pour fresh morning urine in her wound once per day and was able to keep the secret from her husband for nearly a year. Another man kept his chronic wound wrapped in an ace wrap and told his doctor that he burned it on the muffler of his motorcycle but that it was healing nicely. He made the story up. He had this diabetic wound for years. And this was all in week #1 of our new clinic.
I started to get it. Our patients, thousands of them, are suffering a decreased quality of life and mental anguish from wounds and are too embarrassed to address them. Why? Perhaps it is because chronic wounds are different from the chronic diseases that may cause them. They are worn out loud. Perhaps these patients believe wounds are visible indicators of a life poorly lived or a hand poorly dealt. It seems for some people with chronic wounds, they feel they have failed, and they now have a physical blemish, a scarlet letter per se, to represent that failure. They believe they now must bear the burden of physical pain, putrid smells, and unsightly wounds. I had one man tell me he felt his leg wounds were a punishment by God for his marital indiscretions in the past. He had always wore shorts and thought he had good-looking legs. He admitted he was a little bit vain about his legs. This was God’s way of “shaming him where it would count,” he said. He no longer wore shorts. These wounded patients continued to pour into the clinic. They continue to pour in to wound care clinics across the nation. And with those wounds comes isolation, depression, drug and alcohol abuse, and suicidality.
Our specialized wound care clinics are sending these patients the message they need to hear; that it’s common and acceptable to have wounds, and they can be healed. These patients are given hope and courage to come in and get help because these clinics are specifically for this single problem. Our advanced wound care clinics are giving them permission, a second chance, a safe place to share their suffering. Through the opening of a wound care clinic, we are telling these patients that their wounds are not a punishment, that we recognize and care about this specific problem, and that we can likely fix it.
I have heard it quoted that 5-7 million people suffer from chronic wounds related to chronic disease. With a new diabetic being diagnosed every 19 seconds, and knowing the stories we’ve heard from patients in the wound care clinics, it stands to reason that these numbers, while impressive, are probably not reflective of how many wounded people there truly are. We know many of these patients are hiding their wounds, suffering for weeks on end, even years, trying to keep their secret. Meanwhile, their mental health is deteriorating. Wound care clinics are more than a specialty clinic. They are a second chance at life for so many people.
Now, as my team is working on starting a wound care clinic in a community in Montana, I realize this is so much more than another service line. It is not just a bricks and mortar investment with a good ROI. It is not just a place where docs can make a little extra money one day per week. It’s not even just a place where chronic wounds get healed. It is a mental health treatment service line, whereas wounds are visibly healing, so are the souls of these patients. This is a community wellness initiative. We all are trying to figure out how to get our arms around the concepts of population health and community wellness. Where do we begin? These wound clinics are part of the answer. I know that when the doors open, they will come. And the health and well-being of our community will improve.
Hesham Abboud, MD, PhD, Director of the Multiple Sclerosis and Neuroimmunology Program and staff neurologist at the Parkinson’s and Movement Disorder Center at University Hospitals of Cleveland, Case Western Reserve University School of Medicine