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by Dr. Michael Miller

For those of you not as familiar with the Hoosier State as you should be, I used to think it was essentially paradise. Jim Nabors of Gomer Pyle fame is our ubiquitous, tuneful icon with his always well-received “Back Home in Indiana” as a mantra to that source of pride.  Our former Governor “My Man” Mitch Daniels was a genius who, using a combination of intelligence, common sense and the persuasive powers of a midwest Svengali, created an economic model that our neighbors can only lust after. Our medicolegal climate is among the best in the US and well it should be. However, while there are some extraordinary caregivers and facilities here, a recent US News and World Report curiously showed that almost none of our hospitals made their “Best of” lists in any category. That is not to say there is bad care but to not have a single facility in an entire state even achieve an honorable mention gives one pause to reflect. The State newspapers were notoriously quiet on this concerning fact despite their trumpeting of who does what well, when and where. (more…)

by Dr. Michael Miller

There are certain phrases that make the hair on the back of my neck stand up.  Someone telling me that they are a good Jew, a good Christian, a good Muslim or the ultimate in self serving lies, “I ONLY practice EVIDENCE BASED MEDICINE”.  People who are what they claim they are do not need to announce it.  A short conversation, watching them work, others opinions about them all answer the question before it is asked.  Like the RN who asked for a recent presentation on the true science behind NPWT (no, you don’t really understand it).  She made sure to tell me not only that she practiced only EVIDENCE BASED MEDICINE but then gave me several examples which incidentally had absolutely no scientific evidence (save for articles from lots of dabblers doing lots of crazy things to people and writing about them).  I am now awaiting her response as she may have to realize that her version of EVIDENCE BASED is no more real than Kim Kardashian’s celebrity. (more…)

by Dr. Michael Miller

I have several letters after my name.  The two that say “DO” indicate that I have the training of a physician and the requisite education and responsibilities that uphold those letters.  They should mean to patients that my ultimate goal is to offer (and provide when the fates allow) the entire spectrum of medical care referable to what I am good at and what they came to seek solace for.  Nothing less and if I keep my ego in check, certainly nothing more. Patients run the gamut of their perception of the medical field.  But like the old sales nemesis called “Bait and Switch”, what is offered on the sign all too often does not truly match what is seen on the shelves.  Arrogant people are that way because they are good at what they do and not afraid to tell others.  As a child, we are told to let others brag about us but failing to let people know what we can and can’t do is integral to our patients’ survival and our success.  The problem is that the glitz and glamour of being a healer all too often clouds our success.  Some time ago, I blogged about the pseudo-utilitarianism of all those so-called “Wound Certification” Exams.  At first blush, these seem to be the key to health, wealth, omniscience and outcomes equaled only by those wound care management companies. (more…)

by Dr. Michael Miller

I recently saw an ad for a pending lecture at a national conference that piqued my interest much like “deflate-gate”.  The title of this lecture horrifically touted that Amputation need not be considered failure.  As a full time wound care doc, I work to identify those conditions that place patients at risk of all consequences both limited and catastrophic.  We use the catchy title of “Limb Preservation”.  We start the process by engaging in the unusual behavior of making definitive diagnoses, then systematically address them in as comprehensive manner as possible.  I am proud to tell you that while there are occasions in which a terminally damaged digit is lost,  that we have rarely sacrificed the greater part of a foot and more, have had only 3 lower extremity amputations in the last 5 years on patients who’s care remained exclusively with us.  Of course, when a patient for whom we have created and implemented a “Limb Pres” care plan is taken out of our system (usually via a hospitalization for a reason other then the lower extremity problem), the facility forces that be unfortunately but infrequently demonstrate their inadequacy and paranoia by gang-harangueing the patient and family.  They are lambasted with lurid tales of the condition marching up the leg engulfing the foot, knee, torso, and brains much like a flesh-eating PacMan.   The patient’s confidence now neutered has little chance against this persistent onslaught of inadequacy and so, much like the Queen song, “Another One Bites The Dust”. (more…)

I remain absolutely amazed that there are so many people doing the same thing and yet doing it so completely different. Depending on where a patient’s wound care and orders originate from, the care I try to translate from that starting point is always a combination of dressing regimens worthy of computer code in their simplicity. The only thing usually missing is the diagnosis. It’s as though they come from an identical planet in an alternate universe.

The issue is that there is the complete dissociation of what is done for a given wound care problem in one practice setting versus another. Having stayed as far away from hospital-based wound care as possible, I continue to be amazed by hospital wound teams touting their expertise while using two to three times a day dressing changes and therapies that are the antithesis of any identifiable evidence. They actually expect entities receiving their cases (including home healthcare agencies, LTAC, skilled facilities, and others) to copy the identical care scenario regardless of their widely variable situations. In fact, the only constant is the patient and his or her condition. (more…)