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Wound Care
Centers
Recently,
I found myself in the middle of a wound care clinic debriding a
diabetic ulcer, thinking, "I'm the attending physician. I'm no
longer the resident." You might ask why I'm writing about working at
a wound care clinic. For many podiatrists around the country this
has become a significant patient and income source, and many of you
will have this opportunity when you graduate. by Jarrod Shapiro, DPM As a new practitioner, working in the wound care center affords me several advantages. First, from an intellectual standpoint I have always enjoyed this facet of podiatry. Each patient and wound is different, whether it's the etiology or patient needs, so each wound requires a different treatment. This is also the closest podiatrists come to general medicine in that we're dealing with the entire spectrum of patient health issues, whether it's peripheral arterial/cardiac disease, diabetes, or rheumatologic disease. This is additionally a great chance for me to interact with a variety of local physicians, demonstrating that podiatrists function on par with all other specialties. Here's an example. An ER physician who also works in my wound care clinic consulted me to see a patient in the hospital. This doc had applied an Apligraf to a patient with a decubitus heel ulcer, which proceeded to fail. I was consulted for a failed skin graft. As it turned out, this physician didn't appreciate the need to offweight this ulceration. I politely educated the doctor, and the patient is improving. Situations like this help to build rapport with local physicians and referral sources. An additional and very significant advantage is the reimbursement. Patients seen at the clinic often receive weekly debridement, which pays well. As a new doc, income is an important consideration. Wound care centers, though, aren't all kicks and giggles; there are some disadvantages. These are high-risk patients with an increased chance of complications and litigation potential. Just as this type of care allows for global treatment, it also requires a global appreciation of the many issues involved beyond the podiatric/wound issue. Can the patient perform and adhere to your treatment protocol? Are they malnourished? How's their diabetic control? Additionally, these patients can be very frustrating; diabetic ulcers are often caused from noncompliance with past instruction. Treating these wounds with the additional noncompliance factor can be very difficult for the clinician. However, regardless of the disadvantages, the feeling of success when you heal that difficult ulceration is worth every bit of trouble! I highly recommend pursuing this as part of your post-residency career. Talk to me,
***Conservative care; a vanishing art*** Surgery is what we all strive to do, especially after 3 grueling years of residency, but conservative care is slowly becoming a vanishing art. I have spoken to numerous physicians practicing 5-30+ years, and they all have said to remember to work up a patient thoroughly and know all the options. If not it can come back to kill you. It is mindful that litigation is not the only fear but death or harm to a patient is of the utmost concern.
Qeena C. Woodard, DPM ***Legal Issues*** Legal mumbo jumbo is something strongly worth considering. In fact, I find myself thinking of legal matters at times when important medical decisions arise. Don't know if that is due to the failure of the medical profession or of the attorneys. For example: patients who want time off work. When should they go back? If you deny them time off or deny the extension of time off, how will this affect your relationship? Will this anger your patient? This comes up often in my residency experience, and as part of the educational experience, it is my decision to make. I don't take it lightly because I want everyone to be happy, be safe, and resume a better quality of life. It's also important, not bring about a lawsuit. Zach Cane, DPM Editor's Response I agree that the legal risks/issues are always of concern to physicians, especially being in the surgical arena. However, you can't run your practice afraid your patients will sue you. You do have to be somewhat defensive nowadays, but if you do the best you can, keeping your patients' best interests in mind, I think you'll do well. One thing I would caution against, is not to make decisions based on whether or not a patient will be happy with you and keep coming back. If they don't like your treatments or your denying them time off, disability, or another script of Vicodin then they should go somewhere else. You can only do what you feel is best in your medical judgement. If the dreaded lawsuit follows at least you can feel confident you tried to serve your patients' best interests. - Jarrod
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