Dear Readers,

     Have you ever considered operating on yourself? I have a patient who develops occasional abscesses on a below-knee amputation stump. Usually they aren’t too serious but do require drainage, packing, and antibiotics. The patient came to the wound center recently after an absence of a few months. I congratulated him on having a long abscess-free period. He quickly informed me that he had developed about one abscess every month since I last saw him, but that he had “taken care” of them himself. Following the confession, I inquired further regarding the process. He admitted that when each abscess developed, he had taken a “new” razor blade, sterilized it by soaking it in alcohol followed by passing the razor blade through a flame, washed the skin with alcohol, and opened the abscess. After he thought the abscess had been drained adequately, he applied an antibiotic cream and a bandage until it healed. I was impressed. This was field surgery at its best. I wonder how many of our patients (or even us) would attempt such a maneuver?

     Self care is defined as “personal health maintenance. It is any activity…with the intention of improving or restoring health, or treating or preventing disease.”¹ This concept is becoming quite popular as the cost of traditional care is felt to be excessive or as people seek non-traditional care. It is estimated that Americans spend $34 billion a year on alternative therapies, $22 billion of which for treatments or medications not prescribed by physicians.² People say they are trying to take control of their health. I do not have a problem with that if they exercise more, cut back on eating, quit smoking, avoid driving after drinking, and other preventative measures in order to stay healthy. Self treatment is another matter. Do most people have the education and ability to make informed medical treatment decisions? The American Medical Associationdoesn’t even think that physicians should treat themselves. Who better to practice “self care” than physicians?

     In wound care, we depend on caregivers to help manage patients with wounds. They help with daily activities, clean and bandage wounds, and help patients with medications. But we as wound care practitioners do not abandon our patients to manage themselves and call only if they think they have a problem. We see our patients periodically to address any complications, changes in therapy, and other issues that may develop. These are issues that the patient or caregiver is neither educated about nor trained to identify, much less manage. Dr. Hugh Cross of the American Leprosy Mission believes that physicians can educate patients to the point that “people with chronic conditions become their own principal caregivers with healthcare professionals as consultants supporting them in the new role.”^3,4 That is a scary thought. It is unlikely that many of our clinic patients could learn to bandage complicated wounds, recognize complications, and have good outcomes no matter how much I support them from afar. Dr. Caroline Fife and colleagues found that more than 50% of patients with venous leg ulcers would be unable to bandage their own legs resulting in a decreased quality of life.⁵ With cutbacks in medical care on the horizon, I encourage you to find ways to help your patients and not abandon them to self care and probable amputation. By the way, does anyone have a clean razor blade? We may all need one before long.