Effectively Managing the Patient Not Just the Problem

Dear Readers,

“Why is that patient so noncompliant?” How many times have you asked this question half in wonderment and half in frustration? Compliance with wound care instructions can be a difficult concept to understand for both patient and caregiver. To be compliant, the patient being treated for a chronic wound must be willing and able to follow our directions. One major issue facing caregivers is devising a care plan without asking if the patient understands it and is able to carry it out. A recent issue in our wound center has involved some patients with diabetes not wearing the recommended offloading footwear. One particular young man was seen repeatedly for treatment of his diabetic foot ulcer and was making minimal progression toward healing. When asked if he was wearing his offloading footwear, he repeatedly said that he was not. His chart was covered with the word “noncompliant.” Finally, when asked why he was not wearing the recommended footwear his answer was simple—at his construction job any time off from work would have been without pay. His job requires he wear steel-toe boots to work. If he did not or could not wear his boots, he could not work. If he did not work and wore his offloading boot, his family suffered. If he was “noncompliant,” then he could work and provide for his family. I understand the argument we as caregivers would make about making sacrifices in the short-term for potential long-term benefits, but many of our patients, including this young man are concerned about family obligations today—tomorrow is another problem.

It is our duty to be healthcare providers for the patient and not just the healthcare provider for the diabetic foot ulcer. We must work to help the patient continue to meet his family obligations while still receiving the best medical care within the limits we as healthcare providers are given. Did you know that you can get custom diabetic insole inserts for steel-toe boots? Well, you can. This is what we did for this patient, and his diabetic foot ulcer is doing better. It may not be the ideal therapy from our standpoint, but it is one with which he can comply.

Why are your patients “noncompliant?” I would suggest you ask them. It is our responsibility to manage the entire patient and not just the defect in the skin. As a result, you may be surprised at how many more “compliant” patients you are seeing.



Terry Treadwell, MD, FACS