My Scope of Practice: A First-hand Appreciation for Wound Care

“If I could be you, if you could be me for just one hour/If we could find a way to get inside each other’s mind…” –Joe South, Walk a Mile in My Shoes

  Janice Smiell, MD, received a BA in chemistry with math and biology minors from Seton Hill University (Greensburg, PA) and an MD from Drexel Medical School (Philadelphia, PA). During her surgery residency at Morristown Memorial Hospital (Morristown, NJ), she suffered a chronic wound as a result of vasculitis.   The experience may have been what drew her to wound care. The unintended insight — what it is really like living and working with a chronic wound — gave her a perspective many wound care clinicians never experience and ultimately influenced how she approached care.

   “It seemed so simple to my colleagues,” Dr. Smiell says. “In their eyes, the patient did a dressing change a few times a day, and over a few office visits to check progress, the wound usually healed. But for the patient — in this case, me — those office visits were a month apart and those dressings were large, complicated assortments of gauze, tape, and ointments that were difficult to keep in place. Plus, rashes often developed around the wound. Healing the wound was a stressful, extended period of concern, fear, discomfort, and embarrassment. Those few doctor visits occurred over several months, much longer than I thought it should have taken to resolve a seemingly routine complaint — that is, a ‘boo-boo’ on one’s leg. In reality, it hurt, it smelled, it swelled, and it dripped day after day after week after month.”

  Dr. Smiell worked for several years in private practice, served as the Medical Director of the Wound Care Center at Morristown Memorial Hospital, and took trauma calls at the level one trauma center. During her time in private practice, Dr. Smiell learned to listen to the patients and the nurses — not always in that order — and to treat everyone as an equal. As the medical director at the wound care center, she also experienced the joy and gratitude of patients whose chronic wounds healed.

  After the birth of her second daughter, when she made the difficult decision to leave private practice and transition to industry, Dr. Smiell knew she wanted to concentrate in wound care, a field not well-studied at the time and with few experts. She started off her career in industry at Johnson & Johnson (New Brunswick, NJ), directing clinical research for the development of REGRANEX® gel for diabetic foot ulcers. After the launch of that product, she moved to Celgene Cellular Therapeutics (Summit, NJ) to develop biomaterials and stem cell products. She then served as the head of clinical research and medical affairs for biologic meshes in plastic and reconstructive surgeries for LifeCell (Bridgewater, NJ).

   “It was exciting to meet the people who did the research and wrote the key scientific papers on factors that affect healing, the pathophysiology of chronic wounds, and the physiology of healing,” she says. “I was able to have academic as well as practical discussions with these ‘gods’ and involve them as advisors or investigators in well-designed clinical studies. We learned together and sought to teach our colleagues how to better serve their patients who had frustrating chronic wounds. I was able to play a small part in the growing field of wound care. No matter what areas I’ve served in research over the past 18 years, my path always led back to wound healing.”

  In 2014, Dr. Smiell began work at Alliqua Biomedical (Langhorne, PA) as its Chief Medical Officer. “At Alliqua, as part of the management team, I again am making patient care decisions, not for one patient at a time but for hundreds or thousands who potentially could use one of our wound management products,” Dr. Smiell says. “I make it my personal responsibility to investigate each of our current and potential products. I want to be able to ensure benefit without significant risk for every patient whose wound is treated with our products. The team often hears about my personal experiences with our human tissue and silver and hydrogel products, because my family members and I serve as subjects in my personal trials before I start other clinical trials.”

  Whether in private practice or industry, Dr. Smiell’s goal remains the same: to help people suffering with wounds. As a chief medical officer, she sees herself as the person who is responsible for protecting the safety of each and every patient who will or has used the company’s products. Her understanding of the patient perspective to further wound care continues to shape Dr. Smiell’s scope of practice.

This article was not subject to the Ostomy Wound Management peer-review process.