The iPatient

  After attending a family wedding in an urban area my youngest son went out for the evening with the wedding party. Early in the morning he was badly beaten and left in the street. I received the call every parent dreads: your son is in the emergency room. For the next 10 hours I sat at his bedside in the level one trauma unit.

  During my son’s time in trauma bay #2, the total hands-on examination time equaled less than five minutes. He received multiple X-rays and scans, copious blood was drawn and tubed, reports were sent digitally to experts across the globe, and three dimension reconstructions were reviewed by leaders in the field.

  Stanford University professor and author, Abraham Verghese, coined the term “iPatient” to describe the care we render to the patient representation that exists in an electronic health record. My son’s iPatient received fabulous care. However, I must admit to certain uneasiness over the paucity of history and peremptory physical examination. The police asked far more questions than the medical personnel. At one point I conducted my own brief exam. Verghese implores the medical world not to forget the real life patient in favor of the iPatient (https://www.abrahamverghese.com).

  Applying this observation to my own world I have to say, Bravo, to my wound care colleagues across the globe. The wound-healing field may be the last bastion of the careful history and physical examination. More than once I have found myself staring at a recalcitrant wound, straining to think of something I might have missed: a clue that would lead me to offer the correct test or choose the treatment that will put the wound on a proper healing trajectory. In today’s medical landscape, Sherlock Holmes would have found his deductive skills far more useful in woundology than forensics.

  In all of our Centers of Excellence across the US, we conduct wound care research. After 75 clinical trials and thousands of patient encounters, we have discovered that, day in and day out, the Placebo Rate is consistently at 23%. Now, to a trained investigator that’s called a clue.

  To date, no one has seriously tracked the placebo effect in iPatient care, but I suggest that a minimum 23% placebo standard should open our eyes to the precarious perch that high tech inhabits in healthcare today. Of course, the latest technology is good and necessary and even life saving. But I am concerned that the hands on, hand holding genuine concern of a dedicated healthcare professional might come to be discarded in favor of electrical ipulses flowing indifferently over the Internet.

  I am writing this article from the Wounds UK meeting in Harrogate. Here, the first point-of-care diagnostic will be launched into the European market with the US to follow shortly thereafter. There is no doubt that diagnostics will drastically change the way Woundologists practice. In fact, it will be a tectonic shift. It is only the beginning: our wound specific electronic records permit us to rapidly gather data and follow trends in wound healing that were impossible just a few years ago.

  Does this auger the advent of the wound care iPatient. I don’t think so. I surely hope not.

  As I reflect on the imminent changes in our world, I hold fast to the hope that we will preserve our focus on the real patient. We will ask questions and listen for the answers. We will roll up our sleeves to poke, prod, ply, and probe our wounds. We will examine our patients. We will continue to take a deep breath no matter how malodorous the ulcer and say, “Ah, proteus, I know him well. I’d recognize that rascal’s smell anywhere.”

  Dr. Thomas E. Serena, MD, FACS, MAPWCA, FACHM, is the founder and CEO of the Serena Group™ family of companies operating wound and hyperbaric centers across the United States, providing point-of-care services for nursing facilities, managing inpatient wound care teams, and consulting for more than two dozen industry partners worldwide. Dr. Serena is the medical director for New Bridge Medical Research, a not-for-profit company dedicated to advancing the science of wound healing. In this capacity, he has conducted more than 50 clinical trials, published over 100 scientific papers, and given more 250 invited lectures across the globe. He is the vice president of the American College of Hyperbaric Medicine, sits on the board of the Association for the Advancement of Wound Care, and is a former board member of the Wound Healing Society. Currently, he serves as chairman of the AAWC Global Volunteers. He has taught wound care and conducted research in Rwanda, Cambodia, and Haiti.