We all think we know what a bruise looks like. Black and blue, brownish around the edges. But depending on the circumstances, the same bruise can look different from one person to another.
To a well-loved child who skinned her knee, a bruise might look like a bad memory of an epic tree-climb attempt. To a patient with diabetes, a similar bruise might look like the onset of a life-threatening emergency. To the concerned family of a nursing home resident, a bruise might suggest elder abuse.
Understanding the underlying factors that cause skin failures or skin breakdown is critical, since the treatment approach may be different, to keeping patients healthy, safe, and whole. It is our goal to train doctors in the community to better understand the underlying causes of wounds so that they can work to treat them more effectively.
Recently, our team published an article in the scientific journal, Wounds, with the hope to move the medical community’s mindset from assuming that all wounds from skin breakdown are preventable to understanding that certain underlying conditions – such as diabetes and vascular problems – require physicians to incorporate wound care in their chronically ill patients’ treatment plans.
For many nursing care facilities, wounds labeled “bedsores” often lead to lawsuits. That is due to the inaccurate assumption that the patient was neglected or mistreated. While that might be true in some cases of bedsores, it’s probably untrue in all of them as bedsores and other wounds are often associated with other health complications. Better training and informed care decision-making can greatly improve in preventing these types of wounds from happening, and elevate the quality of care for those patients.
We believe the conversation about wound care also has to change on a national level to give policymakers and the health care industry a common language to evaluate, diagnose, and treat wounds. For example, Medicare and insurance companies view wounds with one lens: as an injury. If we could better understand the etiology of wounds, we could move from penalizing nursing homes to the more patient-centric focus of properly recognizing, treating, and even preventing wounds.
We all think we know what a bruise looks like. But without a deeper understanding of underlying factors and effective prevention strategies, doctors, hospitals, policymakers, and patients might be looking from a “wounded” perspective.
Michael A. Bain is a plastic surgeon, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.
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