From the Editor: Inspiring… but Imperfect

  Today’s lesson, Students, is that the world isn’t perfect. It’s flawed. Capricious. Ephemeral. Hold firm, if you must, to all the definites you perceive, but know: At some point, there will be a shattering. A reckoning. And from the gathering of the pieces hopefully will come an acceptance for imperfection and perhaps (Eureka!) something more realistic (dare I say “evidence-based?”) on which to cling, if but for a while.

  Let’s start at the very beginning. Our earliest concept of perfection relates to our parents. As children, we idolize and revere them. Then comes adolescence. I sincerely believe that most teen angst is directly related to the assassination of our innocent belief that our parents are perfect. We go through the five stages of mourning (denial and isolation, anger, bargaining, depression, and ultimately acceptance), finally realizing that above all, our parents are human, not mistake-proof. In forgiving their shortcomings, we give ourselves permission to occasionally screw up and to make the most of ourselves.   We go to school and exalt our teachers, instructors, and professors and their ideologies. We espouse their indoctrination, sometimes blind to its limitations. Respect and admiration for those who teach us endure long beyond childhood. “My Scope of Practice” often includes mention of preceptors and mentors, along with the patient colleagues who take us under their wings.

  But we come to accept, almost appreciate, that the people and tenets that guide us and lead us — ie, inspire to make the most of what we have — are less and less perfect. Healthcare is a microcosm of the Do as I say, not as I do contradiction. Many clinicians appear to ignore good sense about self-care, forcing us to proliferate their teachings but not their lifestyle choices. Laboratory tests such as albumin, once the standard for nutrition assessment, have been proven inaccurate. Basically, we are imperfect people following imperfect modalities for taking care of imperfect people.

  Take, for example, the article by Suen et al in this issue of OWM that addresses the need to ponder the perceptions and knowledge of physicians who provide wound care. Like the authors, readers will question what and how much medical students are being taught about pressure ulcers, which can undermine confidence in the decisions of the supposedly most clinically prepared in the healthcare arena. Yet legislators, regulators, and payors continue to esteem these very clinicians as the decision-makers and care-providers-in-chief, leaving room (despite what the rule makers think) for much error.

  The article by Sakata et al is a study in human imperfection. The authors present the results of an admirable effort to assess a real-world population of patients with chronic lower extremity wounds. Unlike randomized, controlled studies, this research has few exclusion criteria and numerous statistical caveats. Imperfect circumstances, but still something to learn.

  And then there are guidelines. Guidelines (and algorithms) organize what is known and provide care paths to follow to eliminate some of the (imperfect) guesswork. If this, then this. The key to using an algorithm is to understand that it is dynamic, changing, and subject to the subjects to whom it is applied. Beitz and van Rijswijk’s 202-reference article offers (almost) everything we know (and in some cases, don’t yet know) about negative pressure wound therapy, describing the development of three algorithms regarding a therapy that confounds as much as it amazes.

  The most moving article in this issue speaks to one of Nature’s most awe-inspiring “imperfections” — the earthquake — a harsh reminder the earth on which we stand (our foundation, our rock) is an ever-shifting ball of plates and shelves and (pun intended) faults. Sato and Ichioka discuss the increasing occurrence of pressure ulcers in the aftermath of the Great East Japan Earthquake in 2011, offering suggestions for providing more perfect care in the face of disaster.

  I hope you take one key thought from this issue: Be inspired by the people and ideas that float among you, but accept that no one and nothing is perfect. Never is there only one path or one person to admire or count on for the answers you seek. The SAWC (this is its 25th annual issue) is one of the largest of wound care conferences. Sixty-plus sessions are offered; not one of the SAWC presenters would be touted as having the perfect wound care solution. We speak abundant truths when we say wound care is as much art/experimentation as science. Be inspired to find and address its imperfections.
  Southern hospitality
  Y’all love congeniality
  Memories of 25
  Perpetuated as we thrive
  Old and new ways to give care
  So much knowledge we can share
  Infection, moisture, neoplasm
  Unleash your enthusiasm
  Many ways we still can grow
  This is wound care’s place to go

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