468

My beautiful 96 year old mother is cooking Thanksgiving dinner for our small family, and even drove herself to the grocery store to do the shopping. Although she is likely to be around another decade, she’s given us all very specific instructions on how to refer to her eventual demise. She has told everyone that when she goes, she will not have “passed away;” she will have died. (She adds that she not be in any way “lost” since she is quite confident as to where she will be.) Life experience has made my Mom clear-sighted about the topic of death but strangely, a lot of clinicians are uncomfortable with the word “death.” I am not sure why, but that is apparently the reason we keep finding euphemisms for it, even when referring to the death of specific tissues.

I am strongly opposed to the term “skin failure” for pressure injuries/ulcers that form in hemodynamically unstable patients. The biggest reason is that it’s an anatomically inaccurate term. Although the skin is the organ we can see with our eyes, it’s not the only tissue that dies in such cases. If the patient survives long enough, it will be apparent that not only the skin but the associated subcutaneous tissue, fat and muscle have also “failed” — sorry, DIED.

I am also opposed to the term “skin failure” for pressure injuries/ulcers because it’s clinically incorrect. There IS a condition of skin failure that is well described in the literature, a good example of which is Stevens-Johnson Syndrome. If you have ever seen a case, you won’t forget it because they can be quite horrific, but the process is limited to the skin.

However, the biggest reason I am opposed to the term “skin failure” for pressure injuries/ulcers in specific clinical situations is that it is a euphemism for “it’s not our fault.” Since we’ve created an alternate universe in which all pressure injuries/ulcers are the fault of poor care, we now need some other term for them so that we can avoid dealing with the plaintiff’s attorney. We’ve gone through the looking glass, but creating a new nomenclature will not get us back to the world of reality.

The skin, subcutaneous tissue, and muscle in specific, well- defined anatomical areas is observed to die under certain unfavorable hemodynamic conditions which may or may not be associated with the death of the patient. The cause is hemodynamic and physiological and the explanation for the pattern of tissue death is anatomical. We can define the parameters under which the death of tissue is medically unpreventable (the term “unavoidable” is reserved for payment policy decisions and is defined by the presence of absence of certain types of care).

If we define medical unpreventability, we won’t need to create politically correct euphemisms. Either we can meet the hemodynamic requirements of the tissues for survival or we cannot. If we cannot, then we don’t need a euphemism for tissue death in order to avoid being blamed. Attorneys should not be needed to figure this out. If we want to stop the tissue death that can be stopped, and stop being blamed for tissue death when we can’t stop it, the answer is not in a new naming convention. Dead is still dead. We should understand the clinical parameters for tissue death, and then create a definition around medical preventability. For goodness sake, even the Mad Hatter knew that if you don’t think, you shouldn’t talk.

–Caroline


Dr. Fife sees patients at the CHI St. Luke's Hospital Wound Clinic in The Woodlands, Texas. For an appointment call (936) 266-2150.



%d bloggers like this: