One of the gratifying aspects of being a wound care physician is the ability to develop such rich relationships with our patients. The frequent and consistent contact with the same provider lays a strong foundation of open communication and trust. I work in an urban safety net hospital’s ambulatory care center, which sees a high volume of high-acuity patients. It is not uncommon for me to see patients with venous leg ulcerations with concomitant uncontrolled hypertension or diabetic foot ulcerations secondary to uncontrolled blood glucose levels. Patient education is a vital part of my clinical encounters, particularly focusing on the systemic nature of wound healing. I always emphasize that while we are treating your wound, it is the full body well-being that is needed for ultimate success.

Coordinating Care Beyond the Clinic

Addressing all the systemic factors that contribute to the development of lower extremity wounds can be a daunting task. I find that the majority of my patient base often has no or very minimal contact with a primary care physician, let alone an endocrinologist or cardiologist. All the health care practitioners in our health system experience the same challenges of a large number of patients with minimal resources to render care. We all share the same mission to keep our patients well and to prevent hospitalization; however, people still fall through the cracks in the system. In terms of patient safety, it is a “Swiss cheese” effect that leaves patients without care, thus resulting in poor outcomes.

So, what can be done? Who is responsible for filling in the gaps where patients become lost in a black hole of no follow-up? Well, in my case, the provider who knows the patient best because of the regular nature of clinic visits seems to be a good fit.

I have and continue to find myself, along with my one dedicated nurse, spending time coordinating care beyond our clinic. It is a regular occasion that while utilizing my electronic health record system to finish my encounter notes, I will also be drafting a request to a primary care physician or other specialist, asking for an appointment for a mutual patient. I am acutely aware that we are all on the same team, so my requests are polite and in good spirit. In most cases, the request for collaboration is well received, and the patients feel that they are valued in many different aspects of their care. As cliché as it may seem, when patients feel that their care team is invested in their success, compliance tends to improve. Care partnerships benefit the providers as well, because they allow for different perspectives to be shared. As the saying goes, “two heads are better than one.”

Making a Difference as a Care Coordinator

The most successful effort of my care coordinator role came after healing an arterial foot wound in a patient who had a history of non-compliance in terms of follow-up. During our final treatment sessions together, she told me she was worried because during a coughing fit a few days before she began seeing blood in her sputum. Knowing this patient’s long history of smoking, needless to say, I recommend that she go to the ER immediately. She politely refused, stating that her granddaughters needed her and she cannot be in the hospital right now.

I was so concerned, I called her primary care physician right away and explained the situation. We ordered a chest radiograph as an outpatient STAT and sent her to the primary care physician for initial evaluation. After her follow-up primary appointment and subsequent referral to pulmonology, our patient was diagnosed with non-small cell lung carcinoma. There was a delay due to her insurance regarding a PET scan ordered by oncology, and both her primary care physician and I called on the patient’s behalf to help remedy the situation.

Finally, she began treatment for her lung cancer and is doing well. She will have more time with her granddaughters and still keeps in touch with me! I nearly cried when she sent me a note that said if it was not for her wound doctor, she might not be here today. Every chance we have to heal someone is a blessing, and I am proudly a wound care physician and a care coordinator.

About the Author
Christine Miller DPM, PhD is a certified wound specialist by the American Board of Wound Management and a Fellow of the American College of Clinical Wound Specialists. She currently serves as the Co-Director of the Limb Salvage Program at the University of Florida, College of Medicine-Jacksonville.