A Nobel Prize in Economics for health interventions that alleviate extreme poverty

Pedro Rey

The recent 2019 Nobel Prize in Economics has been awarded to three academic economists: Abhijit Banerjee and Esther Duflo of MIT and Michael Kremer of Harvard "for their experimental approach to alleviating world poverty." His research has revolutionized the way of studying how the economic development of the more than 700 million people living in extreme poverty can be stimulated. It enunciates the prioritization of small interventions in pilot tests and based on the knowledge of why those affected do not make optimal decisions that could contribute to their prosperity. It also forwards a more macro and institutional approach that depends on large programs that "should" work in theory, but in which the cause-effect relationship of its effectiveness has not been empirically established in all cases.

Arrogance, condescension and indifference in communication with patients

Glòria Galvez

In traditional society, men have had an authority role and women a secondary and subordinate role. As a result of this form of behaviour comes the term mansplaining, a combination of the words man and explaining. The term appears for the first time in a text by Rebecca Solnit “Men explain things to me” to define the habit of some men to express their opinion with authority, condescension and a paternalistic tone on all kinds of subjects, even if their experience is little or non existent.

John Launer, in the article published in the Postgraduate Medical Journal, talks about medical condescension or "docsplaining" that, like mansplaining, has to do with paternalistic and condescending behaviour. In this case, it’s the professionals –men and women– who, to maintain control of the conversation with patients, address them with a certain arrogance exercised from parental ambiguity.

À la recherche du temps perdu

Alexandre Lourenço 

Portuguese studies from different entities have showed excess mortality from causes unrelated to COVID-19 since early April 2020. Entities like the National School of Public Health, the Faculty of Medicine of Porto, or the Faculty of Medicine of Lisbon have warned about this trend. Later, the Portuguese National Statistics Institute has confirmed it.

The response to COVID-19 has limited the regular provision of healthcare and the postponement of elective healthcare services has led to significant losses in the health and well-being of populations. In April, we called for creating conditions for resuming the regular health services in an organised and coordinated way, through a dual-track NHS. By this time, tens of thousands of surgeries and hundreds of thousands of consultations have been cancelled.

Clinical competences hidden in the curriculum and in coding

Gustavo Tolchinsky
 

José, 85, has a fever again. His wife is no longer worried; she knows that what has always worked is taking her husband to the emergency room. On the way she writes in the family chat that they are on their way to the hospital, but no one should move until she’s told if he gets admitted or remains under observation. Her children live in the suburbs and they always volunteer so that she doesn’t have to spend the night with José. Dementia has taken its toll on José and everything is more complicated; his urine infections, which previously warned with recognizable symptoms, have now become something abstract, but the fever is what always alerts the family. In the last year, José has been admitted several times for processes similar to this one, that started with urinary infections due to the underlying urological pathology. This time, on arrival at the emergency room, his wife thinks he is worse than ever, although his vital signs are OK and the Labs are quite anodyne, except for a slight worsening of kidney function. Again, as always, José is prescribed antibiotic treatment (guided by the latest available antibiogram) and fluid therapy, fever control and nursing care. But on this occasion, despite the fever disappearing, he is exhausted, probably due to delirium, he doesn’t cooperate with the care, the peripheral line is removed several times, he refuses to eat and the fever reappears. The family doesn’t cope well with this situation, José either. Family members are informed that imaging test could be performed, to asses  again with the urologist, and even to perform a procedure such as placing a urostomy could be considered if they suspect that there is an obstructive process. However, Jose's deterioration is not solved by treating only the current episode. The family and the healthcare team agree to make one more attempt with some changes in the treatment and, if he doesn’t improve, assume that only palliative treatment will be carried out.

Cyberchondria: improper use of the internet increases healthcare waste

Andrés Fontalba

The growth of the internet has made health information more accessible than ever. Increasingly more people are obtaining health information on the internet, which has probably become the most popular method of gaining knowledge in this field. The internet has brought great benefits and opportunities, such as offering instant answers about the nature, cause, prevention and treatment of any disease, as well as recommendations to maintain healthy habits, with more and more applications in the health field. We can connect to the internet with multiple devices (tablets, smartphones), in such a way that in Spain 93% of the population currently has an internet connection. However, people who are distressed or anxious about their health can access the internet for self-diagnosis and thus allegedly to calm down. This search for content on diseases aims to alleviate anxiety, but produces precisely the opposite phenomenon, increasing stress and worry. And this is even worse if the information obtained is inaccurate, incomplete and erroneous, as it often happens.