das magazin / 1 June

    “The attitude of the health services towards wound therapies needs to improve!”

    Interview with Dr. Markus Duft

    CityVienna
    ProfessionSpecialist in General Surgery
    Areas of expertise Diploma in Emergency Medicine, Certificate in Medical Wound Therapies, Chairman of the “Vienna Wound Management Association“
    Practical expertise19 years
    What are the greatest challenges you face in your day-to-day practice?

    Not losing focus and concentrating on the most important issues at hand are the true challenges we deal with on a daily basis. A deluge of new technologies and different treatment options will keep anyone working in medicine on their toes. All too often, the symptoms which are really the cause for concern for our patients are overlooked, and it is these symptoms which really impact on their quality of life. A good example of this is varicose veins. Doctors are often quick to advise patients to have varicose veins removed without looking more closely at the patient’s actual complaints. Are they suffering from a heavy, tired sensation in their legs, or is it purely the aesthetic aspect which is concerning the patient?

    What is your approach to cases where a patient comes to you and already knows what treatment they are looking for?

    I try to dig a little deeper, and find out more about their specific complaints. At that stage, patients often reply with their own diagnosis. The key in this situation is to redirect their attention towards their complaints, and to address these in any treatment plan. The important point here is to differentiate between a chronic disease that a patient can accept and live with, and illnesses which will bring more serious consequences in the long term.

    What do you consider to be important when dealing with patients?

    Making sure that you always take patients seriously, and communicating at the same level. High levels of both empathy and professionalism are paramount. I would never play down a patient’s complaints, nor would I ever paint too gloomy a picture when the outlook is bleak. I try to promote adherence to treatment by giving patients an “intrinsic” motivation, where we can work together to improve their chances of treatment success. 

    You have a reputation as being a wound expert. How is it that you are successful in promoting healing in even the most resistant of wounds?

    My primary objective is not to heal wounds per se. In the case of many wounds, it would be overly idealistic to promise a patient that they will see their wound healing within X amount of time. I prefer to take a collaborative approach with patients, setting mutual, step-by-step goals which we can work towards. Once again, this is about looking carefully at the specific complaints of each patient. For one patient, it might be a restricted range of movement due to a dressing; for another, it can be the smell which bothers them; and for another, it's exudate. These are the specific points which I can work on in a more targeted manner. I try to place the focus on the health-related issues which are impacting on the patient’s quality of life. In turn, patients’ adherence to treatment is significantly increased, which then has a positive effect on the healing of even the most troublesome of wounds.

    What would you identify as the most common errors when treating chronic wounds?

    When due diligence is not followed, one of the many obligations of a doctor. We can use road traffic as an analogy here. We all know the basis rules of how we are supposed to behave: when I encounter X, I have to respond by taking action Y. The same goes for medicine. We have certain guidelines which should guide the treatment actions we take. Unfortunately, the recommendations from these guidelines are not always followed. The use of compression therapy for the treatment of venous leg ulcers is a good example. This treatment approach is overlooked all too often as doctors focus more on different dressing materials, despite a compression therapy’s huge potential to improve outcomes.

    In your opinion, are there any indications which require entirely new solutions for treatment?

    There is already a very broad assortment of products available for treating wounds in localised areas, with each product adapted to a great variety of different wound types and conditions. In the case of patients suffering from diabetic foot syndrome, for example, I would quickly look into solutions to address footwear issues with a focus on reducing any pathological pressure points applied to the foot. It often takes months until a diabetic patient gets the right footwear solution. I would imagine that nowadays a solution should be possible using a 3D printer, for example, which would speed things up considerably. We also need new solutions for wheelchair users who suffer from pressure sores. In this case, it would make sense to look into whether a certain sitting position distributes the person’s weight evenly, or whether an orthotic seat solution might be indicated. The technologies are there, but we need to know how to put them to good use, and for these types of investigations we also need the right kind of funding from the different health insurers.

    Can you also see a need for changing the framework conditions which are applied in our healthcare system?

    I believe that attitudes towards wound therapy need to be changed in our current system. Even medical practitioners often disregard wound-related issues, seeing them as secondary. Improvements could be achieved through far more intensive collaboration between the different disciplines, e.g. internal medicine, surgery, dermatology and orthopaedics; they all have something to contribute. For this reason, I would like to see more centralised priority units, for both out-patients and in-patients, which would act as a single contact point for collaborative follow-up using an interdisciplinary approach. I also consider it to be of great importance to put more emphasis on specialist investigations, such as vascular examinations, measurement of pressure-sensitive areas, foot examinations, or out-patient procedures such as ulcer debridement with sedation, or providing materials for patient education.

    Of all these different challenges, which do you enjoy tackling the most in your day-to-day practice?

    The thing I have always valued the most is how patients express a great deal of trust in doctors, often without having got to know them. This trust, for me, is a truly special expression of human gratitude.

    Dr. Duft, thank you for talking to us today!