A lack of medical training in wound care has left about half a million Australians with festering chronic sores, a research body claims.
The way wounds are treated is so poor, many patients are left with festering sores that don't heal for up to a decade, researchers from the government-and-industry-funded Wound Management Innovation Cooperative Research Centre say.
But the research has already drawn a rebuke from doctors, who deny they are the problem. They point instead to the high cost of best-practice wound management - a cost that is not subsidised by the Pharmaceutical Benefits Scheme.
Chronic wounds and ulcers are skin injuries that refuse to heal. Without proper treatment they can remain festering for decades.
"If I were to show you images of these things, you would not eat your lunch," says Dr Ian Griffiths, the research centre's chief executive officer. "There is generally quite a pungent odour."
Unlike a regular cut which the body will heal, a chronic wound has an underlying cause - often a health condition.
"If they are treated with a simple dressing, the wound will just continue forever," Dr Griffiths said.
While no formal survey of sufferers has been done, researchers estimate there may be about 400,000 Australians with chronic wounds, based on Australian and international incidence rates.
Dr Griffiths believes about 70 per cent of cases aren't getting a proper diagnosis from the doctor, and therefore aren't getting the right treatment.
He points to one small Queensland study indicating that only 6 per cent of patients with leg ulcers receive the correct treatment, and only 31 per cent of patients are properly diagnosed.
Other studies show that less than one in five community-based nurses are using best-practice wound management.
The problem, the research centre believes, is that medical professionals are not being properly trained to spot and deal with chronic wounds. Usually they mistake them for simple wounds, patch the patient up with bandages and gauze, and don't look for an underlying cause, the researchers claim.
"The understanding of wounds even among clinical professionals is very low. Blink and you'll miss it in med school," said Dr Griffiths. The research centre and other peak bodies are calling for medical schools to rewrite their wound-care curriculum to promote better diagnosis and evidence-based treatment.
But doctors reject any suggestion they aren't well-enough trained. Instead, Australian Medical Association Victoria president Dr Tony Bartone??? points to another problem - the Pharmaceutical Benefits Scheme often does not cover wound dressings, meaning doctors have to pass the cost on to patients.
"Some of the more ideal dressings are very costly, and you're not able to charge the PBS for them," he said. "What ends up happening is you bulk-bill the patient, and you use a second or third-best option [because it's cheaper] - or ask them to do the dressings at home."
Curtin University wounds expert Kylie Sandy-Hodgetts said a lack of training for GPs combined with an ageing population presented a "perfect storm", but nobody was taking action.
"I honestly think there has not been enough attention about it because people don't want to talk about it," she said. "Often these wounds might have an odour. It has a stigma to it."
Ron Gardiner believes he is living proof that wound care needs improving. When the 82-year-old developed sores on his legs, his GP patched him up with bandages and gauze. But the wounds stubbornly refused to heal for three months.
"It went on and on indefinitely, it was awful," he said. "And I was having the dressing changed three times a week."
The research centre's nurses swapped the bandage for a pressure wrap, squeezing the excess fluid that was impairing the healing process out of the legs.
"I don't mean to sound patronising. It's not that we're doing fancy treatment - we're just going back to the fundamentals," says Ron's nurse practitioner Dr Michelle Gibb.
The ulcers vanished in three weeks.