Healthcare must be imbued with value

Paco Miralles
 

The 22nd National Congress of Hospitals and Health Management featured an organizational success that augurs a certain post-pandemic "normalization"; many congressmen and a program with a significant presence of value-based medicine. I take this opportunity to congratulate the organizing committee for the great work done.

Much has been said about the paradigm shift in the healthcare system, about the need to do things differently, about value as a solution for humanization, for the cohesion of professionals, for the alignment of funders and providers, and for the sustainability of a system in which without value everything is much more expensive.

Shared decisions at the end of life

Paco Miralles

Maria was an endearing lady clinically that I have supervised for more than two decades, time enough to know each other well. We had commented several times on how we would act (speaking in the plural) if she was ever diagnosed with an incurable or terminal illness. She would not like to spend the end of her days, if possible, in a hospital. She preferred to be at home surrounded by her folk. She was a religious person and wanted to receive spiritual assistance before leaving this world. The time has come for her to be 88 years old. She was on home palliative treatment for a few months. In the last month, it began to decline without improvement. A few days before the end of her life she asked me to see a priest. I was surprised. Did I have to take care of this if her family was there? It was a lesson for me. She had agreed to her last days with me, it was part of her treatment. Just as I was asking for a dose increase for the pain, she wanted to seek spiritual relief. For her, it was perhaps more important than physical discomfort(1).

Technology helps us to be more human

Paco Miralles

"Learning to read is the most important thing that has happened to me in life," acknowledged Vargas Llosa in his speech at the reception of the Nobel Prize. I share his discernment, although I have had some more important achievements. This task is something inherent to the doctor, one of the weapons that help the indispensable humanistic aspect of medicine.

"Our" patient experience

Paco Miralles

In a recent friends meeting, we discussed the issue of health and the quality of health care services. My friends, as users of the health care system, both public and private, related their real patient experiences, experiences that on many occasions were far from the parameters that we strive for. Once again I thought that we do many things for patients, but without counting them in (the patient in focus?).

Exercise as a clinical management tool

Paco Miralles
 

In the consultation of any internist...

• Mr Sebastián (68 years old), your glycated haemoglobin is in adequate parameters. Your diabetes doesn’t appear to have affected your kidney because you are not losing albumin. The tension controls are correct and I do not notice hypoglycaemia in the provided tests. Your diabetes is under controll.
• Do I continue with the same treatment?
• Yes, let's review the treatment. With insulin, we will maintain the same scheme that has worked so well. I remind you: from the basal, the long-lasting, you put 24 units, with a fixed guideline in meals of 8 units and correct it with the scheme written in the report (I don’t reproduce it so as not to bore you more). The rest of the treatment will stay the same.
• And I continue with the exercise?
• Sure! Keep walking for at least 45 minutes along the promenade (those of us who are lucky to live in a coastal city, especially Malaga).

With Amazon, there is no going back

Paco Miralles

A winter desert. The author discusses his post with friends: "The future of medicine is changing daily, but the point of no return will be when Amazon enters the healthcare market ..."

I noticed the smile on my friends' faces when I made these comments to them. I do not have enough scientific relevance to lavish myself in informative talks, so my remarks were in opinions of the same level as those referring to what Atletico will do if it does not qualify for the Champions League. They thought it was an exaggeration and that the medicine was indeed changing a lot, but no so much.

Medicine must be value-based

Paco Miralles

Many of us believe that medicine in general and doctors, in particular, should direct efforts to provide patients with value services. This approach would leave even the profane flabbergasted: but do doctors not do for their patients that which gives them value?

It's important to know the past to understand the present and outline the future. For a few decades, we have acted based on evidence-based medicine, a movement that led to the transition to a methodologically neater practice. Assistance based on tradition and empirical experience would succumb in the face of well-structured studies. This revolutionary concept led him to be nominated as one of the ideas of the year 2001 by The New York Times.

Please let me see my lifelong doctor

Paco Miralles

If you are a reader, likely, you will always go to the same hair salon, and surely you will like to be attended by your usual hairdresser. If you are male, you probably also appreciate finding a familiar face for cutting your hair, avoiding having to explain the type of cut you want every time. It’s even possible that on some occasion people delayed their visit a few days when they learn that the person who usually serves them is on holiday. This tendency is present in other sectors. We generally like our hair, our nails, our fish or our fruit to be dispensed by "our" trusted person and we are not often willing to change stores.