Doctors are rubbish at wound care
Inspecting her brother-in-law’s hip, she lifted off the wadded dressing to reveal the red, raw, gaping hole 2 cm in diameter where the doctor had removed an abscess. My sister briskly listed the unguents, ointments, and dressing that she would need before declaring that “doctors know nothing about proper wound care”.
My sister does.
My sister works with bed sores and post-operative wounds and all sorts of sticky problem on patients who can’t move around – the elderly and the post operatively incapacitated – sometimes both. She knows that a lot can go wrong after the first intervention – infection must be controlled, necrotic flesh needs to be dealt with and skin knitting must be encouraged; mobility of the patient must be supported and the overall health of the patient must be stimulated.
A few weeks ago I went to the doctor with a sore toe. The nail had been half lifted off while out running on New Year’s Day, up hill and down slippery slope and through ankle deep mud, the 10km Resolution Run on the Town Moor. That was more than a month before, and the toe really hurt. (I should wear a sign that says “I have a high pain threshold so if I say it hurts then it really really does”).
The doctor did not look at my big toe and its damage very closely. On the other foot he examined a little raw spot which had not healed either, and for that he wanted to give me antibiotics, but he could not give me practical advice for The Toe.
So while the raw spot got nicely sorted out with topical anti-biotic,The Toe did not get better – the nail had thickened and become hard and was acting like a hinge, irritating the flesh and skin every time my shoe pushed it. It hurt. I went back for a second appointment and tried to get referred to a chiropodist but I am not in a risk category. I can’t get cared for by a chiropodist on the NHS. My doctor could refer me and it was a relief to pay. To go to someone who knows feet and toes because that is what she has been doing for absolutely years, someone who other people recommend. She cut and snipped away the dead nail and trimmed and scalpel-ed. She knows how deep to go.
A week on and the toe was even more painful because what had been happening under the horrible nail was that the skin was cracked and the source of the pain – a deep split – was now visible. I went back to the chiropodist who assessed the hurt, got me a small iodine and paraffin wax dressing (for the infection and to moisturise the skin and allow wound healing) wrapped the big toe in a toe sleeve, strapped it down with a kidney shaped big toe collar plaster. By this next morning I was pain free for the first time in 44 days.
Yay for experienced practitioners, yay for hands on experts.
The experienced practitioner (this may be a tautology) knows what needs doing and when it needs doing.