What the Baylor Advanced Geriatrics Fellowship in Wound Care Taught Me About Patients With Wounds

Not very many physicians have had the opportunity to complete a year-long wound care fellowship. I am one of the lucky few. I will be the fifteenth graduate of the Advanced Geriatrics Fellowship in Wound Care at Baylor College of Medicine, started by Dr. Aimee Garcia in 2006. Wound care training is more often offered by vascular surgery or plastic surgery, so you may be wondering why the geriatrics section would have such a fellowship. This is a great question. Many geriatricians find themselves stumbling into wound care, at times unwillingly, because we see patients with wounds in skilled nursing and long-term care facilities where there might not be another wound care provider to take care of them.

I managed patients with wounds at a skilled nursing facility during my geriatrics fellowship, and though I had an affinity for wound care, I did not feel like I had adequate knowledge to treat them. I voraciously read the wound care literature and attended wound care workshops at the geriatrics conferences, but I wanted—and needed—more. A quick search of the Internet revealed wound care fellowships for podiatrists, undersea and hyperbaric medicine fellowships, and a few wound care fellowships in surgical specialties. Baylor’s Geriatrics Fellowship in Wound Care was a complete novelty and obviously seemed the right fit for me.

This year has been filled with incredible experiences. My main continuity sites are the Veterans Affairs Medical Center wound clinic, the county hospital wound clinic, and two private hospital wound clinics—one urban and one suburban. These locations are different in terms of their staffing, resources available, and populations served, and each has taught me something different. At the VA, I learned how to appreciate a thoughtful formulary and the on-site orthotics and prosthetics department. At the county hospital, I learned cost savings measures on imaging and inexpensive offloading tricks. At the urban, private hospital clinic, I learned how to order dressings through medical supply companies and work with home health agencies. At the suburban hospital-based clinic, I learned about vascular screening with skin perfusion pressures, the role of nutrition in wound care, and billing and coding for different sites of service and the reimbursement challenges of different payers.

Even the current COVID-19 pandemic brought its own learning opportunities. I quickly learned the new billing rules of video and telephone visits. I experienced the struggle of trying to do wound management over a telemedicine visit. I learned the value of communicating over video with home health nurses while they changed the dressings for our most vulnerable populations. I learned that even when my rotation schedule was completely disrupted, I could still find a way to continue seeing patients in the clinics that remained open and over video in the ones that could not.

The crux of my learning experience was discovering that the approach to patient care I learned in geriatrics was the same one needed for wound management—evaluate the whole patient. As one of my mentors has drilled into my head—wounds are a symptom—it’s up to us to figure out what disease(s) we need to manage better if we are to heal them. Patients with wounds are incredibly complex, even from the perspective of a geriatrician! Multimorbidity, polypharmacy, malnutrition, lack of mobility, psychiatric diagnoses, lack of social support—these are our chronic wound patients.

As I sit down to explain to a patient how diabetes has caused changes to the structure of his feet and try to convince him to take his insulin, I know I made the right choice to become a wound care physician. Our patients need us desperately.

I hope to develop a wound management program at an academic center as I embark on my career, because the field of wound care needs more fellowship opportunities like the one I’ve been fortunate to complete.

Monica A. Stout, MD, completed her Family Practice Residency at Medical College of Wisconsin Fox Valley. She then ventured south and completed her Geriatrics Fellowship at Duke University. She is currently at Baylor College of Medicine for an additional year of training in Geriatric Wound Care. She is board certified in Family Practice and Geriatrics. She is passionate about patients with wounds, as she believes they need physicians who can advocate for them and who can see them as whole persons.