The art and science of wound medicine

Wound care has relied and relies heavily upon intuition acquired through years of experience. The reason for this is that wound care professionals have to deal with many unknowns in their decision-making. Unknowns forces professionals to rely on experience and intuition, this is often translated as an art. The art of wound care.

Let me introduce Exhibit 1 and Exhibit 2.

Exhibit 1 Girl with a Pearl Earring

Exhibit 2 Girl with an Earring

The question is:  What kind of art are you making? 

Of course, there is a sliding scale moving from Exhibit 2 to Exhibit 1, but the question remains how can you tell what kind of art you are making when it comes to healing patients.

Just like it is impossible to make a painting like the “Girl with the Pearl earring” if the painter does not have a profound understanding of the materials available, but also about composition, light, and texture. It is also impossible to heal all wounds without a profound knowledge of anatomy and physiology, at the level of the intracellular molecular networks right up to the patient’s social peculiarities and all in between.

Sadly, in general, professionals are relying on their intuition, often by necessity because knowledge, tools, or guidelines are not available or even do not exist. The knowledge and training of wound medicine are sub-optimal. So mostly a professional is unaware of available possibilities.

If you are unaware of the skills and knowledge needed to produce a work of true art you might trick yourself into thinking that something as nice as in exhibit 2 is a similar piece of art as the one in Exhibit 1. That would be a mistake … and a costly one for your patient.

The root cause for that mistake would be a lack of education in combination with a lack of critical thinking which causes issues for self-awareness.

But wait, there is more to it. 

Of course, exhibit 2 is also art; beauty is in the eye of the beholder!

But there is a but. But the value of your art depends on its purpose.

The parable continues, if your purpose is as a grandchild to convey to your grandparents that you love them, exhibit 2 is the perfect art for that, far better than exhibit 1. If your purpose is to please a wide group of people who appreciate certain pictural qualities, exhibit 1 will be preferable. But a core concept is that the prevailing art form in any circumstance is dictated by its purposes, not by the art itself.

Similar when it comes to wound care, if your purpose is to make life bearable for a patient with a wound that would have healed anyway, which might just be over 90% of all wounds, simple wound care and (more effective) attention towards the patient will do the job for you. However, the remaining 10%  are wounds that present a sliding scale of increasing complexity. So here your skills and knowledge will have to follow suit.

Therefore, contrary to what you might have been thinking after reading the first paragraph, the question is not as much what kind of art you are making as  “what is the purpose of your art”.  What kind of art are you able to make for treating “your” wounds and which wounds should be treated elsewhere because you lack the skills, knowledge, or tools. What is your role in healing wounds?

The problem is that it is hard to figure out what type of art you are producing. Objective appreciation of your art is hard to get. And appreciation of the answer is similarly hard. Especially if you have good results with your way of working.

But, there is a second but.

But the art of wound care is prohibiting the science of wound medicine.

The art of wound care, as stated above is a combination of experience and trained intuition. If that works well, there’s no need to see if there are tools available that take out some of the guesswork. Normally you may not feel the urge to learn what you do not know, because you get the results you want and no one expects you to score 10 out of 10. And since it is an art to make decisions on limited information, quantitative information on your quality is absent or subjective. This is how art gets in the way of science. If you are happily producing work at the less complex level and everybody around you does not know or understand that there is also another level of skills and knowledge available we are all bound to remain stuck at the level we are.

This applies to all forms of wound care art. And since there is no penalty for not properly educating yourself. Or due to a lack of data, the community at large is also not aware of the impact modern tools can have.

So neither at the level of the professional community or at the level of society at large there is no incentive for improvement.  Yet to be able to provide a high level of wound care using reduced knowledge skills and tools requires years of experience and/or a master/apprentice situation.  Transferring this type of wound care to a younger generation of professionals, or even to professionals in other fields is almost impossible. This practice is fine for the 90% of straightforward wounds, it is detrimental to the other 10%. Transferring knowledge and tools is easier than transferring intuition.

To stick to and trying to pass on intuition prohibits the development of the field.