The Pursuit of Good Judgment

This has been the season for intellectual pursuits and learning. I have just returned from the Symposium on Advanced Wound Care Fall and the combined Canadian Association of Wound Care/Canadian Association for Enterostomal Therapy meetings. These were great meetings with high levels of wound care information provided by some of the best speakers in North America on everything from basic wound care to stem cell therapy. The entire spectrum of topics on caring for patients with wounds was available to learn from. I was so very excited about the topics and the interest of all those at the meetings and their level of knowledge when learning about these advanced wound care issues. Then I returned home to open my mail and find an evaluation form for a talk I had given on basic wound care at a small, multispecialty medical meeting. I had been honored to be the first speaker on wound care issues in the 19 years the meeting had been held. As part of the evaluation form, all were asked to list 2 changes they would implement in their practices as a result of my talk. Of the attendees, 4 were not going to make any changes because their practices did not deal with wounds in any way, but the remaining 18 physicians and 5 nurses intended to make changes. Of the 18 physicians, 12 said they planned to avoid leaving wounds open to air dry or to avoid using wet-to-dry dressings. Four of the five nurses (three of whom worked in the wound center) said they intended to stop using wet-to-dry dressings. Sixteen out of twenty-three practitioners, essentially 70%, were still using wet-to-dry dressings as their standard of care for open wounds, both acute and chronic! My heart sunk to a new low.

  I know we have been fighting the battle to get information about modern wound care to all practitioners for years, but I am saddened to see we are making so little progress. The information that wounds heal better when kept moist has been around since 1962,¹ yet, by a margin of 5:1, wet-to-dry dressings are still the preferred dressing of health care providers.² I thought we had been making some progress teaching the benefits of modern, moisture control dressings.

  The other topic that more than 50% of the 23 respondents mentioned wanting to incorporate into their practices was compression therapy for the treatment of venous ulcers and edema. In 2011, I conducted a survey targeting wound care providers who were unlikely to attend a wound care meeting; of the 195 wound care providers at the grassroots level surveyed, only 32% realized that compression bandaging was the standard of care for patients with venous ulcers and edema (Treadwell, unpublished data, 2011). Even the government admits that compression therapy is the standard of care for patients with those problems.³

  Where have we gone wrong with our educational efforts and information sharing? We have to realize that just providing extraordinary wound care meetings is not the entire answer to educating people. It appears that we must take the information to where the people are practicing. In many cases this means trying to get basic wound care information to non-wound care specialists at their specialty meetings. Under the direction of Dr. Vicki Driver, the Association for Advanced Wound Care (AAWC) is working on a program of basic wound care information for the non-wound care specialist. As this comes to fruition, help will be needed to spread this program to those who need to see it. More importantly, all of us must be willing to share information about good wound care practices with our colleagues. I know this can be difficult and result in unwanted reactions, but we should continue to try. Trying to convince a health care provider of a better way to treat a patient is not done to prove wrong-doing, it is done to help the patient. I think all of us have our patients’ best interests at heart or we would not be doing what we do.

  We shall keep you posted as the AAWC develops instructional materials that can be made available to colleagues to help them understand what modern, basic wound care entails and how it can improve the care they provide to their patients. Without your help we shall never succeed in this effort. As Carl Sagan implied in the quote above, we want all wound care providers to be knowing, but also to demonstrate intelligence and good judgment.

“Knowing a great deal is not the same as being smart; intelligence is not information alone but also judgment, the manner in which information is collected and used.”
–Carl Sagan, American astronomer and scientist