I recently had the honor of teaching a section entitled “Wound Care for the Internist.” at the annual meeting of the American College of Physicians (ACP) in San Diego. ACP is the largest medical specialty organization in the United States with members that include internal medicine physicians, subspecialists, and medical students. My session was well attended by caregivers from across the healthcare continuum including hospitalists, doctors in outpatient practices, and long-term care providers.
In my introductory remarks I asked the question, “How many of you have had a lecture on wound care in medical school.” Looking out on the sea of faces, many of whom were young residents and attendings, only ONE person hesitantly raised their hand.
It is unfortunate and puzzling that wounds are not on the American medical school curriculum, as they are a major public health challenge. Chronic wounds impact over 15% of Medicare beneficiaries and incur over $30 billion in annual cost. Chronic wounds incur adverse outcomes such as pain, infection, amputation, prolonged rehabilitation, hospital readmission, accelerated physical deterioration, and death. Besides the cost of dressings and daily care, chronic wounds are associated with depression, social isolation, and patient and family dissatisfaction. The most common wound types are listed below.
Lack of knowledge by front-line physicians such as internists has serious implications for quality of care for patients with chronic wounds. Lesions often go unexamined and are often not present on the physician’s problem list. When confronted with a wound, the untrained physician will be unfamiliar with diagnostic and treatment approaches or when to utilize consultants. Many wounds are therefore not caught early, not treated correctly, and infection can be missed or undertreated. Kudos to ACP for including a section on wound care in their annual didactic.
Common Wound Types Encountered in Medical Practice
- Pressure injuries
- Arterial ulcer
- Venous ulcer
- Diabetic ulcer
- Postoperative surgical wounds
- Wounds from Sickle Cell Disease
- Wound from malignancy
- Wounds from autoimmune diseases and vasculitis
- Wounds from irritation, trauma and burns
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New Review on Aging Skin, with Considerations for Clinicians
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