Doctor, give me a checkup and make it a full one.

Xavier Bayona
 

The need to reduce anxiety due to the uncertainty of the possibility of getting sick and dying is one of the most frequent reasons behind the demand for a "preventive" health study, popularly known as a checkup. The purpose of the checkup is to detect the disease early, prevent it from developing, and/or provide reassurance. General health studies (checkups) involve multiple tests on a person who doesn't feel ill and is a common element of medical care in the Western world.

Five-point plan to increase the value of clinical practice

Jordi Varela
Editor

In an article recently published in Clinical Medicine, Five recommendations to increase the value of clinical practice, I proposed a plan with a view to a more valuable clinical practice and, given the timely topic, I allow myself to partly reproduce in this post. You should note that this plan does not support pilot tests or halftones, but should be implemented with a perspective of in-depth organizational change, aiming to generate an institutional profile of value and excellence.

High blood pressure: please don’t lose your head

Xavier Bayona
 

Although I am sure that we well know the difference between a risk factor and a disease, I allow myself the license to start this post by defining them. Risk factor (hypertension, hypercholesterolemia...) is that situation that has been related to the development of a disease (maybe the disease never develops despite having one or more risk factors), while the disease is the alteration in the organism's state or of any organ that interrupts or disrupts vital functions, affecting the state of health (ischemic heart disease, embolism...).

Since Julian Tudor Hart, in an article published in the British Medical Journal in 1993 after following a cohort of hypertensive patients for 21 years, concluded that the basis of treatment is the detection of hypertension and that the most important measures are hygienic-dietary and working from the community, countless articles have been written. But the essence of management remains: detect it, decrease sodium intake, increase physical exercise, abandon toxic habits and if they do not achieve the desired objectives, start pharmacological treatment.

About the bicentenary of the stethoscope

Xavier Bayona

If there is a universal symbol of the health profession, besides the white coat, we certainly find it in the stethoscope. Laennec, in 1816 at the Necker Hospital in Paris, began his first studies in auscultation by means of an instrument he gave the name of stethoscope, derived from the words στηθος (chest) and σκοπεω (examine). Until that moment the auscultation was performed with direct listening placing the ear on the chest (already performed by Hippocrates). This direct listening had its practical limitations both in the transmission of sounds and for issues of modesty related to the gender of the patient if she was a woman (the doctors were mostly men) or for hygiene.

Improving the emergency and territory services: defragmenting the system

Xavier Bayona

In several articles of this blog you can read that one of the challenges to overcome in our and in most healthcare systems is the excessive fragmentation in health care that inevitably leads to duplication of tests and other dysfunctions that create pockets of inefficiency and malfunction. Several proposals to improve the continuity of care and reduce fragmentation have been presented with the aim of improving the quality of citizen attention, increasing the effectiveness and efficiency of the system.

Fragmentation is also present in emergency services. So if we look to the NHS, we can find a report published by the Royal College of Emergency Medicine with the Patients Association (Time to Act-Urgent Care and A & E: the patient perspective) published in May 2015, which concludes that primary care emergency services should join with those of hospitals. In this regard, as early as 2013, Bruce Keogh, medical director of the NHS, made the same recommendation. it’s commented within 2015 report that joint placement services should include emergency physicians, family physicians, nurses, frailty care, palliative care and mental health teams. It’s also commented that pharmacists and dentists could also contribute to the efficiency and effectiveness of the service.

More value for primary care

Xavier Bayona

A British Parliamentary report on primary health care in the National Health Service (NHS) was published at the end of April 2016. This report reflects the most relevant aspects of primary care such as the experience of care (satisfaction, accessibility, labour conflict and quality), new models of care, the construction of a new work team and financing. As you read the report, leaving aside some differences that exist between the primary care model of Great Britain and ours, the first thing that stands out is the ability they have to make a self-critical assessment and publish it. In our environment, it’s quite uncommon for self-critical assessments that engage and align professionals, managers and politicians in the improvement of services to be published.

Justice and equity in the health system

Xavier Bayona

Should we review the principle of justice from an ethical perspective? If so, we’ll notice that it’s a principle of minimums (of coexistence) faced with the principle of happiness – a principle of maximums ("individual justice") and, unfortunately, we’re often erring by thinking we speak of justice when in fact we speak of happiness (or individual convenience). Similarly, from the bioethical standpoint, justice can be defined as the fact of treating each one appropriately, in order to reduce situations of inequality (ideological, social, cultural, economic, etc.). On the other hand, equity is defined as giving each individual no more and no less of what they need. Following these definitions, when we speak of justice and equity, deep down, we are doing a reiteration, because they are synonymous.

Primary health care perspective of clinical management: The legacy of Barbara Starfield

Xavier Bayona

Six years ago, the magnificent Barbara Starfield left us (December 18 1932 - June 10, 2011). She was a paediatrician and a major promoter of primary health care at the international level. Virtually her entire academic and professional life was tied to Johns Hopkins University. Since 1994 she directed the Department of Health Policy and Management of the Johns Hopkins Bloomberg School of Public Health in Baltimore (United States). From 1996, she was the co-director of The Johns Hopkins Primary Care Policy Centre (PCPC).

Those who had the opportunity to enjoy any of her conferences can say that she never left us feeling indifferent and she always allowed us to reflect on what we were doing and encouraged us to bring sanity to our workplaces as part of the health system. She was a great advocate for improving health systems by strengthening primary care and making sense of what is happening in the world by focusing health care on people and their needs. I still remember how in the conference room of the Catalan Oncology Institute (ICO), a few years ago, she told the audience that we were wasting time and resources with a lot of the screening we did and that we had to improve our orientation.