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Editor`s Opinion: On Being a Healing Coach
"Some substances were applied to make the wound cicatrise, others to make the flesh grow, others again to make the growing flesh firm. The modes of treatment were more or less directed to making wounds heal."
With these words, Elliott1 summarizes the art and science of wound treatment during the early and medieval periods. She also observes, "These ideas have persisted and have been advocated - though not so consistently - down to recent times, even though some protested that the actions of nature were choked." Today, 38 years after her book was published, the conclusion that certain ideas have persisted to present time could be drawn again without hesitation. Indeed, in all areas of science and nature, our desire to make things happen has been at an all-time high for a long while. Wound care is probably just catching up.
In the area of chronic wounds in particular, changes during the past 100 years have been quite dramatic. We went from a time of "therapeutic nihilism" (a term used by Parish, Witkowski, and Crissey to describe the state of pressure ulcer care when these wounds were considered "unavoidable"2) to today's paradigm that subscribes to the fact that not only are the vast majority of these wounds considered avoidable, but also that if they do occur we will make them heal.
Why would anyone want to sit around and wait for a person's nutritional status to improve when you can apply the latest gadget? Besides, isn't it much more difficult (and time consuming) to explain that reduced glucose levels will help healing - not to mention educating the patient on how to achieve those levels - than to hand out a prescription for a topical treatment? The latter option is also what patients have come to expect, which is one reason why it has been so difficult to curb the use of antibiotics, leading some clinicians to revisit treatments like honey and ultraviolet light to prevent or treat infections.3,4
Following the observation that clinicians felt compelled to make things happen, Elliott writes, "The tendency of the wound to heal itself was almost entirely lost sight of."1 Neither our education nor the expectations of society makes it easy for us to realize that there is a time to step back and let the body do what it is programmed to do (indeed, does almost continuously): Repair itself.
To assume the role of a healing coach, instead of the person who makes it happen, is not easy. By definition, a coach is someone who teaches, instructs, and demonstrates "intensively." A coach can help lead a person to an optimal state of repair but cannot make a wound heal. Being a coach, not a much-revered healer, is not, and has never been, easy. Lest we think these issues are new and novel, note that Hippocrates felt compelled to remind those practicing "the noble art of medicine" that "people rather admire what is new, although they do not know whether it be proper or not, than what they are accustomed to, and know already to be proper - and what is strange, they prefer to what is obvious."5
Certainly, we encounter wounds that need all the help they can get. But if what constitutes "proper treatment" remains questionable, it behooves us all to remain humble coaches of people with wounds instead of healers who will make it happen. In so doing, we capitalize on, and hopefully strengthen, each individual's natural ability to heal. As Hippocrates reminds us: "When Nature opposes, everything else is in vain."5
1. Elliott IMZ. A Short History of Surgical Dressings. London, UK: The Pharmaceutical Press; 1964.
2. Parish LC, Witkowski J, Crissey JT. The Decubitus Ulcer in Clinical Practice. Berlin, Germany: Springer-Verlag; 1997.
3. Molan PC. Re-introducing honey in the management of wounds and ulcers: theory and practice. Ostomy/Wound Management. 2002;48(11):28-40.
4. Thai TP, Houghton PE, Keast DH, Campbell KE, Woodbury MG. Ultraviolet light C in the treatment of chronic wounds with MRSA: a case study. Ostomy/Wound Management. 2002;48(11):52-60.
5. Adams F. On fractures. In: Hippocrates. The Genuine Works of Hippocrates. Baltimore, Md.: Williams and Wilkins Company; 1939.
