Wound Care Clinic

May 3, 2004
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Send a PM to @tofoo

He could probably give you some good advice. Pretty incredible story too.

 
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Birdstrike

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Hi

Anyone here or know of anyone who has ventured into outpatient wound care/hyperbarics? Need some advice. Please pm. Thanks!
I know of an EM guy who went into this 15+ years ago and still does it, so he must like it. I don't know him personally, but he's a friend of a friend. If you want his name, DM me. He's googleable. You could try cold calling him. I'm not sure if he'd help out or not, but it can't hurt to try.
 
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RoyBasch

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I have some older partners that have started doing wound care part time and some transitioned to it full time as a bridge to retirement. From their perspectives It is low key, banker's hours, satisfying, with good reimbursement because it has a lot of office procedures (debridement). I would say as an ER doc you have a good baseline skill set to do it, but you still need a yogi or a rabbi to is willing to "teach" it to you; as like anything it has a lot of it's own nuance. The management of chronic wounds is not completely covered in our training. I think it does now have an official accredited board certification, but I am not sure if it is required and the majority of people in the field are not officially board certified. There are fellowships, but I think largely unaccredited and the majority of people in the field have not done an official fellowship.
 
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deleted859535

I think we need @GeneralVeers to teach the fine art of "IDGAF" to those at high-risk for burnout.
I'm really working on it. Between the Buddhism and the Stoicism, I'm slowly becoming the hypnotized dude in Office Space.

As am I -- the fine art of IDGAFing when indicated, and GAFing when indicated. I love the **** out of these two posts.

Amen, brothers.
 
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deleted859535

Speak some wisdom.

I can only say what I have found that helps me on the harder days. Whether that's wisdom or not, I leave up to others to decide.

Conversations? Simple and succinct, whether with patients or anyone else. "Less is more" is true. Takes less effort at some point.

It's a job like we keep saying, not a marriage -- though a unique one. The cool stuff about it is for another thread.

Energy is finite. Protect it. Know when to not go down the rabbit hole of bull**** (drug seekers, "I didn't get what I want so I'm gonna whine", abusive psych/substance patients who can't channel their emotions properly, etc). Chart to your tastes, done, next, rinse, repeat. Nothing to get hung up about.

The actual awesome moments? I found seeing them for the awesome that they are helped me realize what isn't worth giving a **** about.

"Customer service" in medicine: about as enjoyable a term as "provider." Nope. There's this fine line between reading the room/knowing your audience and pandering. On one side, it's art and science. On the other, it's schmuckiness. Schmuckiness takes energy, at least for me. Energy is finite, remember? Ain't nobody got time for that.

The old surgery adage of "slow is smooth, smooth is fast" applies to EM in a stoicism sort of way. Always be getting the core things done to protect your mental workload. Corollary: the bull**** or extraneous stuff becomes more obvious and easier to push to the side. I found this reduced my post-shift stays.

I'm not here to pick fights with people, win Pyrrhic victories over debatable z-paks, pursue nonemergent issues beyond due diligence and standard of care, or make everyone else's life easier at my own expense.

Today will end just like all the rest of the days that will follow it. Do a legitimately good job, go home, and remember all the good this, and the blood/sweat/tears spent to get here, allows.

EM makes it easy for us to focus on the **** and lose sight of the good.

Don't let it. Seeing the good for what it is, and the not good for what it is, and what we actually are here to do, makes it easier to identify where no ****s are to be given, at least for me.
 
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RoyBasch

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The old surgery adage of "slow is smooth, smooth is fast" applies to EM in a stoicism sort of way. Always be getting the core things done to protect your mental workload. Corollary: the bull**** or extraneous stuff becomes more obvious and easier to push to the side. I found this reduced my post-shift stays.

Could you expand on what you mean by this a little bit? Maybe give an example?
 
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deleted859535

Could you expand on what you mean by this a little bit? Maybe give an example?

Yeah. I found that I was being too distractable between trying to throw in orders on the belly pain from triage, checking on room 6, seeing the quick sore throat, oh wait need to see that PA patient, etc. At least for me, keeping to a smoother workflow where I sit for 30 seconds, plan a little circuit of steps to most efficiently dispo people, and not feel overloaded and just get it done unceremoniously to keep things from building up on my plate, was helpful. Not so much a GAF/DGAF thing by itself, but seeing how much smoother it made my day had this way of reminding me it's not worth GAFing about some of the things we all bitch about here.
 

DeadCactus

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Bump. Wound care sounds like my way home. How does a early career EM doc switch into this? Courses? Certifications? Or just learn on the job?

I looked into it a bit.

My understanding is that for hyperbaric medicine you need an introductory course to bill Medicare. It's a 40 hour, 1 week course. Plenty of companies offer them. ATMOS in San Antonio seemed high quality when I was exploring it. They also have a course on wound management that might be helpful if you are new to it and want a primer. You can go further and pursue a CAQ in hyperbaric medicine (or a full 1 year fellowship) and there are a few organizations offering "Board Certification" in wound care. The return on those is likely related to the competitiveness of your local market. They are cheap and easy enough (the CAQ and wound care certification) though that advocate for them if you want to make this your full-time job eventually.

Other than that, it's finding an employer or going the entrepreneurial route and learning on the job.
 
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