Why Don’t You Get It?

Dear Readers,   What is it about learning and using new information we just don’t get? We spend hours and hours accumulating new information to help our patients, yet we rarely practice what we have learned. Before you say, “That’s not true,” consider the issue of wet-to-dry dressings. We have known since 1963 that wounds heal faster, with less pain, and less scarring under moist conditions.^1,2,3 Yet, wet-to-dry dressings are still used 5 times more than moisture retentive dressings.⁴ We have found the international wound care community is also not immune to this “selective memory loss.” During a recent trip to Ghana, Africa, to provide additional wound care training to hospitals where we had previously taught, we found many clinicians treating wounds the same way they had been for years—with wet-to-dry gauze and povidone-iodine soaked gauze. Why don’t we utilize the good information we are taught so our patients can receive the benefit of the best care currently available?   Five conditions must be met before a person changes a long-held practice:     1. The person must be well-educated about the new practice and how it is better than what was previously done. This education can be done through face-to-face discussions, local or national meetings, reading the literature, or however else a person obtains new information. Unfortunately, most of us are slow learners, and the information must be repeated over and over for us to grasp it.     2. The person must be provided with good information about the new practice. For wound care practitioners, I feel information needs to come from respected, reliable sources. Many will turn to the literature to get new information, while others will only consider something if a respected colleague supports the new approach. Whatever the source, it must be reliable. There is nothing worse that propagating incorrect information.     3. The person must consciously use the information to make decisions. In the case of wound care practitioners, we must be willing to try new approaches or new techniques. If we never try something new, we shall never learn the appropriate use, much less learn if it works.     4. The person must receive clear and rapid feedback. Does the new approach or technique work and, if so, is it better than the “old way?” Feedback is critical in making an informed decision.     5. Finally, after all this deliberate consideration, the practitioner should be able to incorporate the new information in the treatment of patients.   That seems like a lot to go through to realize a new approach may be better than what has “always” been done. It is even more discouraging when we learn from psychologists that the time required for new knowledge to be incorporated into practice and used consistently is about 10 years!⁶ It is amazing anything new ever gets incorporated into practice.   I would encourage wound care practitioners to shorten this cycle. Many new findings are worthy of being used for our patients without waiting 10 years. Besides, since the half-life of medical education is 5 years,⁷ in 10 years everything you know will be obsolete! Don’t be one of those who doesn’t get it.

References

1. Winter GD. Formation of the Scab and the Rate of Epithelization of Superficial Wounds in the Skin of the Young Domestic Pig. Nature. 1962;193:293. 2. Winter GD, Scales JT. Effect of Air Drying and Dressings on the Surface of a Wound. Nature. 1963;197:91. 3. Hinman C, Maibach H. Effect of Air Exposure and Occlusion on Experimental Human Skin Wounds. Nature. 1963;200:377. 4. Ovington LG. Hanging Wet-to-Dry Dressings Out to Dry. Advances in Skin Wound Care. 2002;15(2):79-84. 5. Lowenstein G, Voopp KG, Asch DA. Incentives in Health. JAMA. 2012;307(13):1375-1376. 6. Ericcson KA, Charness N. Expert Performance: Its Structure and Acquisition. American Psychologist. 1994;49:725-747. 7. Emanuel E. A Half-life Of 5 Years. Can Med Assoc. Jour. 1975;112:572.