by Marlin Schul, MD, MBA, FACPh, RVT
Educating medical providers regarding two epidemic topics is not easy. The education gap between vein providers and the lay public and medical professionals offers a teaching endeavor that we must pursue to enhance venous health in addition to building awareness of phlebology.
Prospects for educating medical providers about venous disease are seemingly endless. Societies are in the beginning phases of incorporating phlebology science and catheter based procedures into formal curricula, while no formal exposure is often the rule in medical schools. Unfortunately, many medical students may get their only exposure to vein disease through the unfortunate VTE complications that occur on clinical rotations.
Vein disease is commonly trivialized throughout our nation and abroad as being purely a cosmetic problem. The lack of formal exposure in medical school to venous disease and complications of venous stasis lead many physicians to treat superficial thrombophlebitis with antibiotics and trivialize patient symptoms when presenting with bulbous varices and dire requests for advice on what they should do. As there is generally no established curriculum in residencies, medical schools, nursing schools, or other allied specialties, there are plenty of opportunities to enhance awareness of phlebology and in particular, stasis ulcers and thrombotic phenomena.
Despite the abundance in educational objectives, hurdles often exist, impeding access to impressionable students and faculty interested expanding their knowledge base.
Why fight and what is a worthy audience? Let’s face it, phlebology is a new specialty, yet stasis ulcers and deep
vein thrombosis occur now as they have in the days of Hippocrates. The education gap is acknowledged by nearly
every society dedicated to Phlebology. Despite these well established facts, we continue to see medical students, nursing students, residents, and fellows graduate from high quality programs void in knowledge in venous disease. The reason to educate the medical communities and the lay public is simple: to enhance the awareness of common vein problems and preventable complications, while promoting venous health.
In 2005, the United States Senate passed a resolution declaring the month of March as National DVT Awareness
month. The Joint Commissions and the National Quality Forum have been working closely since that same time to develop measures to reduce the incidence of deep vein thrombosis in the hospital setting where it is the third leading killer. Six VTE measures have been created and tested since 2005, and have been aligned with the Centers for Medicare & Medicaid Services (CMS). The VTE measure set is available as a core measure selection by hospitals, and may be used to meet their accreditation requirements. In an effort to curb reimbursement for complications related to VTE after total hip or knee surgeries, CMS has created “never events” suggesting that the complication of VTE is NEVER supposed to happen when proper prevention of VTE is considered and implemented in these select orthopedic cases.
Awareness of the epidemic of VTE is apparent to the governmental bodies; is it also apparent to local hospitals?
Do the local hospitals screen all admissions for risk of VTE? Is there a protocol in place to trigger VTE prophylaxis
consistent with the 2008 American College of Chest Physicians recommendations? To further the relative
importance of DVT prevention, do the local hospitals screen all admissions for VTE risk in your area?
Venous thromboembolic events are fortunate in their ability to be prevented and unfortunate in their life and limb
threatening consequences. There needs to be no horse in the race to build awareness of VTE in the hospital setting and op-portunities to perform better by proactively reducing the risk of VTE with proper screening and appropriate prophylaxis.
Promoting Venous Health
Leg ulcers are still poorly misunderstood. A retiring vascular surgeon at the UIP in Monaco proposed skin grafting
as a first line treatment. We can argue about the ESCHAR trial and comprehensive control of reflux, but does this
statement not expose the clear disconnect between those who understand venous disease and those who do not? The same concern may be applied to the wound centers who fail to recognize the influence of superficial venous insufficiency on stasis ulcers.
Promoting venous health involves an array of issues to include recognizing occupational risks, and the prevalence of venous insufficiency in society. Given the abundance of venous pathology and the epidemic of stasis ulcers, one can share the protective benefit of compression therapy and the wide indications for use. Case presentations of superficial thrombophlebitis could be openly discussed identifying the current
standard of care that fails to identify the utility of antibiotic therapy.
What educational opportunities do we have? The educational opportunities are abundant, and in-
clude many of the following:
• Establishing multidisciplinary teams dedicated to reducing the risk of VTE at local hospitals.
• Participation in established Venous Screening Programs resembling that found with the American Venous Forum.
• inform local primary care providers and referring sources about the importance of VTE risk assessment through problem focused newsletters, and educational hospital functions such as grand rounds, lunch-n-learns, etc.
• Participate in electronic forums, including Facebook, Twitter, industry sponsored blogs, CME webinars, and remote telemedicine round-table discussions.
• Solicit local medical schools for opportunities to educate impressionable medical students, nursing students, and residents.
• Provide timely updates in venous care through the routine communications within a community of physicians.
• Offer clinical rotations for nursing students, nurse practitioners, physician assistants,
medical students, and residents.
• Change ad campaigns to reflect a medical message. Prospective patients will notice.
The audience is public and the message is real. We have thrombotic phenomena occurring in epidemic proportions and a growing population afflicted with stasis ulcers. Every practicing and retired physician can become involved; the question lies in how involved the phlebologist wishes to do so. Participating in VTE awareness/risk assessment and stasis ulcers serves a noble purpose: the principles to enhance awareness of while minimizing complications from preventable VTE, and incidence of stasis ulcers. Grass roots efforts have power, and makes any and every effort put forth – one patient and one physician at a time – worthwhile.
Every provider has an opportunity to participate, and arguably a duty given the largely misunderstood practice we
have chosen. Working together with industry to bridge the education gap will bring a broadened understanding to venous health and the prevention of deep vein thrombosis. I urge you to get involved in your practice, your local hospitals, your communities, and identify means to enhance knowledge of these common problems with your pa-
tient population and your physician network. Working together within a community and across societies
will help us achieve the common goal of optimizing venous health in our populations.