Our CEO recently told me about a wound care patient he still thinks about, even though he hasn’t seen her in over 20 years. Her chronic wound was so infected that she was at risk of a lower limb amputation, but she kept missing appointments. When he asked point-blank why she wasn’t coming in, she admitted she was embarrassed to leave the house because of the overwhelming odor of her wound. She was willing to risk amputation to avoid the shame of being seen out in public.

This is not an unusual story. Though it’s not often discussed in the exam room, many patients with chronic wounds suffer from anxiety, depression, loneliness, and isolation. Some skip appointments or delay treatment because they feel embarrassed or ashamed. And now, some patients are not keeping appointments because of the COVID-19 pandemic, risking life-threatening complications.

As a matter of practice, and especially during the pandemic, it's important to encourage all patients to keep their appointments. Ongoing treatment is essential in order to avoid sepsis and a trip to the ER or, worst of all, amputation. It's important to consistently reassure patients that strict safety protocols are in place - and practiced. In addition to addressing physical symptoms, wound care clinicians should also help their patients deal with the emotional aspects of suffering from a non-healing wound. Common issues include loss of mobility, dealing with pain and altered sleep habits, and contending with a chronic illness, such as diabetes.

According to Christina Le, CNO of Wound Care Advantage, it’s important to create a positive environment from day one and make treatment a team effort, with the patient being a key player. In addition to emphasizing that safety protocols are always in practice before, during, and after appointments, here are some tips to help encourage patient resilience in the exam room:

1. Be a continuous source of emotional support. Tell the patient you’re happy they’re being proactive and coming in for treatment. Be enthusiastic about their commitment to tackling the situation and healing the wound.
2. Encourage the patient to talk about how the wound has impacted their quality of life. Let them express their feelings and listen to what they have to say.
3. Emphasize teamwork. At every visit, encourage the patient to inform you of changes in tissue, drainage, pain level, etc. Share images and measurements as the wound heals.
4. Educate. Offer information, resources, and a dietitian, if needed. Write things down if they’re anxious or forgetful, and encourage them to call if they need help between appointments.
5. If the patient is ashamed of the way their wound looks or smells, offer reassurance. Tell them you've treated all shapes and sizes, and there’s nothing to be ashamed of. In some instances, you may be able to offer items that can help mask the smell of the wound if they are going to be in public.

A few years ago, Pastor Michael Layne of Greensburg, Indiana discovered he was not only a diabetic, but he also had a diabetic foot ulcer. He recalls feeling a great sense of shame when he went to his local hospital's wound center for a consultation.

"My first time going to the wound center...the staff was really wonderful. The one thing I really appreciated about them was that they didn't talk down to me. They didn’t shame me because I let things go so long.”

“You either deal with something or you lay down and die, and I wasn't ready to do that," he said. See Pastor Layne's video here.

It's important to acknowledge your patients' struggles and help them build a sense of resilience. By having more control over their feelings and tapping into their strengths, they'll be more active participants on their healing journey.