I am sure everyone is familiar with the above saying. Parents, coaches, educators, and employers have preached it to us so much that we are tired of hearing it. I think everyone would agree that to improve at any task, one must do it over and over. Unfortunately, repetition to learn, improve, and even maintain skills is a life-long endeavor. There is a story of the famed cellist, Pablo Casals, when at age 95, was asked by a young reporter, “Mr. Casals, you are 95 and the greatest cellist who ever lived. Why do you still practice 6 hours a day?” Mr. Casals answered, “Because I think I‘m making progress.” Practice makes perfect no matter what age one attains, and without continued practice, skills are quickly lost.

  Unfortunately, the same is true in the practice of medicine. All would agree that the best surgeons are the ones who are the busiest. Surgeons performing operative procedures over and over, improving their skills, and striving for perfection are the ones who provide the best possible care for his or her patients. The surgeon to avoid is the one who says, “I think I can do this procedure for you.” It is my opinion that this also applies to treating patients with wounds. As a vascular surgeon, I thought I was knowledgeable about treating wounds. Little did I know! As one who has treated wound patients exclusively for more than 12 years, the amount of knowledge I have gained from being constantly immersed in wound care surprises even me. The ability to see many patients with many different wound problems, to follow them throughout the treatment course, to see how each patient responds to each therapy, and to see the successes and failures of treatments has shown me that I can never stop honing my wound care skills.

  If I feel this way while practicing wound care every day, how must those feel who only see patients with wounds on a limited basis each week? To see patients with wounds only 1 or 2 half-days per week would make it virtually impossible to become proficient in managing these patients. In addition, if one has a full-time practice of any medical specialty and treats wounds only 1 or 2 half-days per week, will the practitioner think wound care is enough of a priority to spend the amount of time required to read and learn all that is needed to provide reasonable, much less, good care? I shall truthfully say that I could not. When I was practicing vascular surgery, my reading and studying was devoted to vascular surgery, as it should have been. When I began seeing more and more wound patients, I quickly saw that I could not do justice to both disciplines—I would either stop reading about vascular surgery and learn about wound care or I would ignore wound care and continue studying vascular surgery. I don’t think I am the only one with this problem. A large wound care center management group recently told me that the centers with the best healing rates were the ones that had three or fewer physicians. Those who do something the most, do it the best.

  I hope each wound care practitioner will take time to evaluate his or her situation. Are you spending the time required to become proficient, even “expert” in the treatment of patients with wounds? Dr. James Peck stated it the best when talking about surgery.

  “The art of surgery [wound care] is learned. Insightful understanding of the patient is not genetic. It is an achievement that can be learned. It is a capacity that can be activated. It is not an inheritance. It is only by experience that we learn the art. It is only by practice and by persevering that one becomes an expert at this art.”

  I hope everyone feels the same.