Editorial Message: “I have no idea what that is!”

Dear Readers,   Have you ever experienced the unnerving feeling of dealing with a patient who seeks your help for a specific problem and you have absolutely no idea what is wrong, much less what to do about it? Apparently, our wound center is the regional headquarters for many of these patients. Rarely a day goes by that either one, or several, new patients are seen with problems that other health care providers have been unable to identify. One of our new patients had been seen by 6 physicians of various specialties over a 4-month period, and not one was able to identify the problem, much less devise a treatment plan. The patient, thinking she had a very peculiar problem for which there was no treatment, was about to give up. Fortunately, after taking a good history and performing a thorough physical exam, I recognized the problem and outlined a treatment plan for her. If all goes as expected, she should be significantly better within a week.   We saw another patient in the wound center today who had swollen hands, fingers, feet, and toes. In addition, there were subcutaneous nodules on the fingers and toes, which were ulcerated. Several physicians had not been able to determine the patient’s diagnosis. One new physician, who has been in private practice for less than a year, asked the right questions, identified the problem, and sent the patient to us for treatment. I was impressed with the diagnostic skills of the young physician. I had not seen a patient with this problem since my medical school days (ie, a long time ago!). We helped arrange a treatment plan, and we are excited to see how well the patient will respond.   How often are you unable to recognize a patient’s problem? I readily admit that, as a vascular surgeon, dermatological problems rarely captured my interest; however, once I became involved in wound care, it seemed that most of what I saw had to do with skin diseases. I spent the better part of 3 years reading and learning about dermatological diseases and talking to my dermatology friends. I am not the world’s best at identifying unusual skin diseases, but I am much better now than I was then. We must not be so focused on the hole in the leg that we forget about the medical conditions that could cause the problem.   We must continue to learn just as we did when we were in our training programs. We must attend continuing education programs of every type, from national meetings to webcasts. We must read books, journals, and other materials that will add to our knowledge base. It is amazing where you can glean bits of information to help your patients. I learned an interesting medical fact in a Robin Cook novel that has been helpful to me through the years. Have you ever read Mental Floss Magazine? It contains some interesting facts that might be of help. One never knows! Another way to continue learning is to associate with those smarter than you, which is what I did to learn more about dermatology—I spent time with smart dermatologists! This also brings us back to reading. Reading a book can be like having a private conversation with the author. It allows you to be carried from his/her initial thoughts about a problem to its solution and eventually to its clinical application. It can be a great shared adventure with those who have gone before us!   The next time you evaluate a patient and silently ask yourself, “What in the world is this?” remember it is your responsibility to educate yourself so you are able to answer the question, not only for your own satisfaction, but also to help your patients.