60-second interview with Bruce Ruben, MD13th February 2014
Bruce Ruben, MD, is the Medical Director at Encompass HealthCare in West Bloomfield, Michigan, USA
Q. When did you first become interested in wound care?
I first became interested in wound care at the height of my infectious disease practice in 2002. I was treating patients with pelvic osteomyelitis emanating from stage 4 pressure ulcers and infected long bone fractures with large soft tissue defects and I became passionate about healing their wounds in order to complete what I call 'the circle of healing'.
Q. Who has impressed you most since working in this field — your wound care hero?
Jeffery Niezgoda, President and Chief Medical Officer at WebCME.net is the consummate clinician and academic. He is moving the wound care field closer and closer to becoming a recognised discipline with the US Medical Board of Medical Examiners. Integrating the highest level of medicine and surgery arising from emergency medicine, Dr Niezgoda has demonstrated clinically, and through tireless teaching, that healing wounds involves expertise in nutrition, circulatory disorders, orthopedics, medicine, pharmacy, infectious disease, and hyperbaric oxygen therapy.
Q. If you could change one thing in wound care, what would it be?
I would change the world’s nomenclature of wound 'care' to wound 'medicine'.
Wound care implies a wound-focused approach to healing and has stimulated the explosion of topical wound management products and strategies. In my experience, the essence of healing wounds lies in reversing the underlying circulatory disorders, infections, repetitive trauma, malnutrition, neuro-sensory and motor diseases. Wound care, with all the advanced products that attempt to improve the hygiene and environment of the non-healing wound will rarely accomplish healing without the attention to underlying host factors.
Q. Where would you like to see yourself in five years' time?
Professionally, I hope to advance the field by demonstrating how to integrate the multiple disciplines necessary to treat non-healing wounds. At Encompass HealthCare, our delivery of care model is unique today but will hopefully serve as a model for all wound care in the future. The way we manage non-healing wounds includes all the necessary diagnostic tools and we provide them on-site. Also on site, we provide all IV antibiotics, hyperbaric oxygen therapy, venous ablation, nutritional support and off-loading orthotics. The entire office is completely accessible and barrier-free to the disabled. We have an ambulatory surgery centre right down the hall, making us totally outpatient-based and eliminating any need for hospitalisation.
Q. What annoys you most in wound care?
I am most disappointed by the recurrence of new ulcers in patients who have worked so hard to heal. Once patients understand their risks and the common wound-causing hazards of moisture, shear and friction, they are then better armed to avoid suffering new ulcers.
Q. What one technique or intervention do you find the most useful in your practice?
The single most helpful intervention in my practice would be the readily available IV antibiotics from our in-house pharmacy, which can be administered within minutes of a presenting acute infection. Often, patients are referred to us with rapidly advancing cellulitis and abscesses on the toe or foot. They may also have accompanying systemic symptoms like fever, chills, and profound weakness. This intervention saves lives and limbs.
Q. Do you feel that industry and clinicians should work together more and, if so, how?
Clinicians sharing data directly or through research publication best demonstrates a willingness to improve patient outcomes. Intellicure is one noted electronic medical record that is used by multiple wound centers. Improved patient care is achieved through sharing and analysing data on patient outcomes while publishing their results in peer-reviewed journals.
Q. What advice would you give a young nurse or practitioner starting out in this industry?
Since this industry is in its development, I would strongly recommend observing the various specialised practitioners working at as many centres as possible. Since wound 'care' is practised by surgeons, infectious disease specialists, podiatrists and many others, each discipline contributes a different and valuable perspective to wound 'medicine'.