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How do I discuss this case with the Doctor?

As a physician involved in wound care, I rely on the skills of the nurse or therapist to warn me about any changes that may occur in the wound. The home health care nurse or therapist may treat this patient on a daily basis. Small changes in the wound's condition can be identified, discussed and treated before more severe complications occur. On the other hand, I have had the unfortunate experience of being notified that the wound is gangrenous when there is only a superficial hematoma present.

Before you can intelligently discuss the case with the doctor, you must first understand what you are looking at. You should completely familiarize yourself with the following sections of this Internet site: How to Document Wounds and Staging of Pressure Ulcers.

I recommend that you routinely contact the physician to notify him / her of the patient's progress. Even if the wound is unchanged, it is a good way to let the physician know that you are attending to this patient in a vigilant manner. When you do contact the physician, make sure you identify:

• The patient
• Vital signs
• The wound's location - (using proper anatomical terms such as anterior, posterior, medial, lateral)
• The wound's dimensions - (in centimeters, proximal to distal, medial to lateral)
• Condition of the surrounding tissue - (ex. hyperkeratotic rim, macerated, normal)
• Condition of the wound base - (ex. beefy red, fibrotic, necrotic, eschar formation)
• Any indications of infection - (see the Infection section of this guide, Level 2)
• Does the wound look like its healing, worsening or remaining stagnant?
• Current treatment and a review of the past treatment

What do I say if the doctor is not familiar with the principles and products of moist wound healing?

You may want to begin by educating this physician with the AHCPR guidelines. Get a copy of these pamphlets and send them to the doctor (see the AHCPR section in Level 1 of this Wound Care Guide). Tell the physician about this online Internet teaching tool. In addition, pass on any relevant information you have on products and protocols and have a product representative contact the doctor for an inservice. Now that there are governmental guidelines stating that solutions like povidone iodine, Dakins and hydrogen peroxide should not be used, this physician should be grateful that you have taken the time to further his or her knowledge.

Remember, wound care cases can be very difficult, possibly leading to devastating complications. Medical legal issues can quickly arise, especially if the patient becomes septic or undergoes an amputation. It's important that the new standards of care are implemented followed.

Authored by Dr. Allan Freedline and Dr. Tamara D. Fishman. 

Copyright 1995 - 2008