Dear Readers

At some point in your life, you may have heard someone say that a particular thing they did was not perfect; they had done a good enough job, but it did not make a difference. How much does something have to be off before it does make a difference? For instance, if a pharmacist was mixing a compounded medicine and the measurements of the ingredients were just a little off, do you think it would make a difference to the patient? I would suggest that in everything we do, especially in medicine, any little omission or commission that is not correct has the potential to make a huge difference. 

There is the story of a world-class rifle marksman who was shooting in a competition. During the competition a rainstorm had started, and because the prevailing thought was that shooting in the rain would cause no problems, the competition continued. The marksman was doing very well, but suddenly one of his shots at a target 600 yards away nearly missed the entire target while the other shots he took were in the bullseye. He was mystified as to what had happened. After the competition, he approached researchers at New Mexico Tech to see their thoughts on the matter. The consensus was that the bullet hit a raindrop and was deflected! That seemed strange since the general opinion of shooters and even the military was that a bullet would not hit a raindrop, and even if it did, the bullet was moving so fast nothing would happen. Being researchers, they wanted to investigate the problem of shooting in the rain with highspeed cameras. The first question: how do you shoot a raindrop? They devised a system that created an artificial rainstorm through which they could fire a gun. Hitting a raindrop was another issue. Interestingly, the bullet hit a simulated “raindrop” on the third shot from the rifle. The highspeed photos revealed some remarkable information. Without going into the physics of the impact of the raindrop on the bullet, the conclusion was that the bullet hitting the raindrop was deflected enough to make a significant difference in the flight of the bullet. The further the target was from the point of impact of the bullet, the greater the effect a single, small raindrop had on the course of the large, highspeed bullet. The findings showed that at 50 feet the bullet could be deflected about 4 inches, and at 100 yards the deflection would be about 30 inches. It appears that something as small as a raindrop getting in the way of a bullet can make a significant difference in the outcome of the shot.1

As we see a patient, evaluate a wound, devise a treatment plan, and carry out the plan, we must be aware that one little detail that is overlooked or ignored can make a huge difference in a patient’s outcome. Most of the time, we may be like those mentioned who think that just a little oversight or error will not make any significant impact to treatment outcomes. That may be true, but there is always the chance that whatever is ignored or overlooked could be a major issue in wound healing. Imagine thinking: Will the patient be okay if I do not drain that abscess? Surely just giving antibiotics will be good enough. Perhaps you may have considered the following: I do not really have the time or desire to debride that wound today. It will be fine to wait until the next visit, I hope. These are just examples of overlooking or ignoring clinically significant problems that can lead to major issues. I have seen diabetic foot ulcers become infected and progress in a short time to where an amputation is the only treatment. It is hard to live with the thought that if only I had seen the patient sooner or done the right thing when I did see him/her, the amputation could probably have been avoided. Just remember that you may be able to get away with shooting in the rain without hitting a raindrop numerous times, but when you do hit the raindrop, the outcomes for the patient may be severely influenced.