Why a wound is rarely only a wound
Most long-lasting wounds have a cause behind them. A foot ulcer may trace back to diabetes and numbness. A leg ulcer may come from vein problems or fluid buildup. A pressure injury often follows a stretch of illness, weight loss or time in bed.
That is the case for having primary care and wound care together. The wound care clinician looks after the wound itself. The primary care clinician looks after the conditions, medications and daily health that decide whether the body can repair skin. When the two do not talk, each sees half the picture.
What each team looks after
Each clinician decides what falls within their own care. A typical split looks like this.
The wound care team usually handles:
- Examining and measuring the wound at each visit
- Choosing dressings and writing wound orders
- Watching for infection and stalled healing
- Ordering treatments such as compression or offloading
A primary care clinician usually handles:
- Blood sugar, blood pressure, heart, kidney and lung conditions
- The full medication list, including refills and changes
- Lab work, vaccines and preventive care
- Specialist referrals and overall goals of care
Health problems that slow healing
High blood sugar can slow healing and make infection harder to fight, which is why diabetes follow-up matters so much to anyone with a foot wound. Reduced blood flow in the legs limits the oxygen and nutrients that reach a wound, so circulation and vascular health often needs attention too.
Swelling from heart, kidney or vein problems stretches skin and keeps wounds wet. Poor appetite, weight loss and low protein intake leave the body short of building material. Some medications also affect healing, which is one reason a medication review is useful early in wound treatment.
A dressing does not fix any of these. Our guide on why primary care matters for wound healing covers each one in more depth.
How the two teams share information
Gateway’s part is to keep facts moving in both directions. We do not make clinical decisions. We make sure the people who do have what they need.
With your permission, coordination can include:
- Collecting records, the medication list and recent hospital paperwork before the first visit
- Sending wound visit notes and measurements to the primary care practice
- Passing primary care updates, such as new lab results or medication changes, to the wound care clinician
- Routing each question to the clinician it belongs to
- Keeping family members, home health nurses and facility staff informed about the plan
If you already have a primary care doctor
You keep them. Gateway works with your established physician or nurse practitioner and counts that office as part of the care team.
Tell us the name of the practice when you call. If getting to the office has become difficult, ask about in-home primary care follow-up between office visits.
If you do not have one
Many people with a wound have lost touch with primary care. A doctor retired, a move happened, or leaving the house became too hard. Gateway can help with finding a primary care clinician who sees patients where they live.
Availability depends on your location and care setting, and coverage depends on the treating practice and your plan. We go over those details with you before care is arranged.
Changes to report between visits
Tell the wound care team or your primary care clinician promptly about:
- Spreading redness, warmth, new swelling, pus or a bad smell from the wound
- Fever, chills, or new or worsening pain
- Blood sugar readings far from your usual range
- Sudden weight gain or new swelling in the legs
- A fall, new confusion, or trouble eating and drinking
Gateway is not an emergency service. Call 911 for chest pain, trouble breathing, signs of a stroke, bleeding that will not stop, or a sudden change in alertness.
How to start
Call 314-325-0126 or use the request care form. The form asks only for a name and phone number, so please leave medical details out of it. You do not need a referral, and a family member can call for you.
We will ask where you live, what kind of wound is involved and who is already part of your care. From there we arrange mobile wound care, primary care follow-up or both with Gateway clinicians. The service area page lists the communities we cover in Greater St. Louis and the Metro East.
Common questions
Do I need to switch doctors to use Gateway?
No. If you have a primary care physician you trust, that relationship stays in place. Gateway clinicians who provide wound care do not replace your doctor, and wound updates go to that practice when you give permission. If you have no primary care clinician, we can help you connect with one.
Will the same clinician handle my wound and my primary care?
Sometimes. It depends on which Gateway clinicians are available for your location and care setting, and on what you need. Often the wound care clinician and the primary care clinician are separate people who share notes. What matters is that each knows what the other is doing, and Gateway coordinates that communication.
Why does my wound care clinician ask about my other health conditions?
Because those conditions shape the wound plan. Blood sugar, circulation, swelling, nutrition and medications all affect how skin heals and which treatments are safe. Compression, for example, is not right for every leg. Your answers often turn up something the primary care clinician should check.
Who decides on changes to my medications?
The clinician who prescribes them, or the clinician responsible for your overall medical care. Medication decisions belong to your treating clinician; a wound visit is not a reason to change a medication on your own. If a wound care clinician has a concern, it goes to the prescriber.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.