From the Editor: A Prevention Parable

Mensch tracht, Gott lacht (Man plans, God laughs). — Yiddish proverb

  Statistician and soothsayer I am not. What I am is a worrier. Thus, the term prevention carries great weight with me. Anything that can be done to forestall a problem not only keeps you safer, but it also saves time, money, and agida. Notice I wrote forestall — there are no guarantees your efforts won’t be in vain. But at the very least, there is peace (if not a good outcome) in knowing you anticipated the need for precautionary measures, even if it’s just the thought that without your efforts things could have been a great deal worse.

  Wound care clinicians increasingly are becoming experts at prevention. This is somewhat ironic because if we could prevent most wounds, these professionals would have little to do (side note: I struggle to avoid thinking a manufacturer might not develop a preventive product if it already manufactures the far more lucrative treatment). Numerous devices and strategies are “known” to prevent wounds, especially the chronic variety: support surfaces that redistribute weight and reposition the patient, compression bandaging, strict sugar control, prophylactic diligence in acute wound care. However, success in these endeavors is a factor of statistics — ie, we rely on retrospective information that had these approaches not been applied, the chances are that a pressure, venous, or diabetic foot ulcer would have occurred. In playing the odds, we celebrate each poster and conference presentation (not to mention articles in this journal) as testament to the fact that good products, and even more important, good preventive care, can reduce the prevalence and incidence of chronic wounds.

  If I were queen of the forest, prevention would be the true priority of any health reform package Congress considers. Statistics and underwriters be damned, any action that can be construed as preventive should be fiscally (and if necessary, litigiously) covered by insurance. To some extent, this may already be in practice for those with insurance; I mean everybody, regardless of insurance status. The Barbara Plan would include all well-visit care, all prenatal care, and all product and labor costs involved in maintaining skin integrity. As a codicil, this strategy would hold both patient and provider accountable — eg, coverage should be questioned for a patient who has been documented to blow off glycemic control and then develops a foot ulcer, just as reimbursement for services might be denied to providers who do not assess and address ulceration risk.

  To personally underscore my prevention convictions, I was first in line for vaccinations — childhood and adult booster shots (side bar: interestingly, our son, as a vaccine specialist for a major drug company, also has become a vocal advocate of preventive inoculations). We didn’t wait until our grandson could reach them before we plugged the electrical outlets. To me, one risk factor is enough to swing into action. Certainly, military surgeons operate in less-than-ideal conditions and sterility may take a backseat to more urgent concerns; that doesn’t stop physicians from judiciously scrubbing and pretreating surgical sites with betadine to prevent infection in the most pristine operating suites. Anticipation is key.

  There is also the superstition factor. Call it fate or chance or coincidence or serendipity, but those who believe it plays a role in precluding a problem will find all means of reason to support their claims. Personally, I keep my nails short because every time I grow them long, someone in the family gets sick (okay, they get sick when I have short nails, but at least I tried). The idea is to do whatever you can to prevent a bad thing from happening. To me, guilt by association holds weight far beyond our legal system.

  Perhaps I should have quoted fellow Pennsylvanian Benjamin Franklin, who wrote, “An ounce of prevention is worth a pound of cure.” I might consume fewer Tums® if I were to turn a blind eye to the fact the despite our best efforts, we cannot always outrun the eccentricities of the gods or Mother Nature (whatever your beliefs). I have returned happily to the days of baby gates and kinder locks and lower kitchen drawers filled with Tupperware as I try to outguess our grandson’s next move and prevent an accident; then he will move close for a kiss and we’ll clonk heads and both end up with bumps. Athletes and everyday Joes who are fastidious regarding diet and exercise repeatedly keel over on basketball courts and treadmills. Japan took all necessary measures to ensure their nuclear power plants were safe in the event of an earthquake, but had to apply desperate measures to counter the effects of the subsequent tsunami. Alanis Morrissette would have a field day with such prevention ironies.

  Still, despite the availability of and our dependence on innovative treatments and advanced products that manage and heal what was not prevented, we cannot abandon the hope of and effort to stop wounds from occurring. We may not always be the masters of our fate but as sixteenth century philosopher Erasmus Desiderius wrote, Prevention is better than cure. Think about it.

Spring is bustin’ out all over
Yellow flowers, fragrant clover
Making plans for CEU-ing
Picking brains and product viewing
Options for assessment, care
Science, art — it is all there
In case you may never have been
Unleash the curiosity within
Make sure you go and take your friends
The learning season never ends!

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