Go into medicine,” my father always told me. “You get to help people and you will always have a job.” Except back when he told me those wise words, treating wounds wasn’t a specialty, and there wasn’t a worldwide pandemic dividing health care into “essential” and “non-essential” providers. As a wound specialist, being essential is not determined by what you practice, but by how you practice. If you practice passive, ineffective wound care focused on picking a wound dressing, then yes, you are non-essential and probably always have been. Maybe this pandemic will serve as a wake-up call to our community. Not only do our patients depend on effective treatments and preventative interventions, our livelihoods depend on it.
Wounds are a symptom of disease. Interestingly, the risk factors for chronic non-healing wounds are also the risk factors for COVID-19 deaths: diabetes, vascular disease, and obesity. A health care official was recently vilified for suggesting that personal health care choices could impact the risk of dying from the virus. Yet, it is likely that the average HgA1C of critically ill COVID-19 diabetic patients will be far above the normal range. Personal choices certainly impact the likelihood of healing a wound and of requiring an amputation. It can be difficult to get patients to comprehend how their behavior today may determine whether they need an amputation 10 years from now. It may be easier to make those associations with an infection like COVID-19. Perhaps one of the lessons we can learn from this pandemic is that some health care choices increase your risk of a bad outcome, and that we are all in this together! A large population of unhealthy people impacts everyone. The mark of true wound specialists is that they are willing to invest personally in their patients and not passively accept their lack of self-care. As the saying goes, we must treat the whole patient, not just the hole in the patient.
“Stop sitting so close to the television,” my father also told me. “The screen is going to melt your brain.” He didn’t realize that going into medicine was going to one day mean sitting in front of a screen for hours treating patients, and that it would be a key to remaining essential. In 2008, my partner Todd Shaffett, DNP, CWS, and I created TeleWound®, the first telehealth program of its kind to treat wounds in the home over the internet. That was back when we had 3G internet and bulky laptops, but we proved that we could improve outcomes dramatically at a fraction of the cost. But it wasn’t the web-based technology that yielded the stunning results. It was the relationships we forged with the patients, their families, their dogs, and the home health nurses that made the difference. Used properly, telemedicine will be vital in maintaining the type of relationships necessary to encourage compliance and achieve lasting outcomes.
As it stands, the barriers to effective telemedicine have been eliminated. The 5G smartphones are ubiquitous, state boundaries are no longer in effect, and the home has been recognized as a reimbursable place of service for telemedicine. If the bureaucratic red tape returns after this crisis is over it will destroy the improved compliance and better outcomes that we are currently seeing. The solution will be to allow a combination of both in-home televisits and in-person clinic visits so that necessary procedures can be performed.
In reality, our fight against a deadly and pervasive disease is nothing new. For years we have watched our patients die slowly from their underlying comorbidities—it is just happening at an accelerated rate because of the virus. When COVID-19 is a distant memory and a scary bedtime story we tell our grandchildren, my hope is that the much more prolific killers behind the pandemic have been conquered by a health care system that has finally learned that provider-patient relationships, including electronic ones, are the key to victory.
Shaun Carpenter, MD, FAPWCA, CWSP is the CEO of MedCentris®, a multi-specialty wound healing organization, and owner/co-creator of TeleWound®.