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.

"Carried me with you": the objectives of integrated care are a matter of more than one

Mònica Almiñana
 

This song from the Onward soundtrack, one of Disney's latest animated productions, bring about a good mood because, in addition to having a country touch, I have always liked lyrics that speak of how important it's that they accompany you, guide you and help you achieve your goals.

Is there an ideal primary care team?

Jordi Varela
Editor

Have we ever heard that there are health centres in Finland that work as a multidisciplinary team, or that in Alaska there are groups of professionals who do admirable work with indigenous community health, or that in Scotland health and social services already they work in a very integrated way? And the question that comes to mind is: does the ideal primary care team exist?

Shared decisions, evaluate to advance

Jordi Varela

Editor

The progress of shared clinical decisions is being almost negligible and, for this reason, attention should be paid to the results of the clinical trial by Víctor Montori's research group, an evaluation that was carried out with almost a thousand patients with atrial fibrillation. which ones had to decide if they wanted to take anticoagulants and, if they did, which one they would choose. In the trial, the intervention group of patients tested a shared decision support instrument, while the control group followed the usual clinical pathway.

Initiatives to define a patient-centred research agenda

Glòria Galvez
 

By Society of Hospital Medicine

Despite the strong impact that the results of clinical research have on the health and quality of life of patients, the contributions they make remain anecdotal and do not go beyond participating as passive subjects in clinical trials. This, together with the practice of opportunistic strategies such as calling patients at the last moment to give their impressions of their participation, makes it necessary to move towards a new model of biomedical research in which, in addition to carrying out pharmacological studies, it seeks to respond to unresolved questions that would undoubtedly improve the patient experience.

Humanism and literature in every area of healthcare

Marco Inzitari
 

Oliver Sack

Luckily, the person is regaining a central role in health care and his/hers perceptions, experiences and values are gaining importance at all levels: care, research and management. This is especially important in addressing the complex health and social issues with which we are increasingly surrounded.

Why is the integration of services not encouraged?

Jordi Varela
Editor

 

@varelalaf

Health and social services are fragmented between various institutions, levels of care and a lot of specialities and each one of the fractions of the system provides a service that makes sense in itself, such as a three-hour weekly service of a family worker for lending a hand at the home of an elderly person who lives alone, or angioplasty intervention for a woman who has just suffered a myocardial infarction and, according to this system, funders pay differently for each activity.

A new recipe for teamwork in primary care

Jordi Varela
Editor

 

Primary care teams in Spain are under pressure from the schedules of daily visits, which sends multidisciplinary teamwork to the background. To understand each other, the sessions are held whenever possible and the level of attendance and participation is often irregular, given that nothing encourages them. The core aspect of a primary care centre today is that each doctor and each nurse is assigned a contingent of citizens -presumed to be patients-, who, when requested, must be attended to as soon as possible.

Empathy training

Andrés Fontalba
 

Communication is the most important skill for healthcare professionals. Efficient communication occurs when the therapist feels sure that he or she has listened to and registered the user's needs and, thanks to this, can provide personalized attention. Empathy is the ability to perceive, understand and share the feelings, thoughts and emotions of others, based on the recognition of the other as a person similar to ourselves, with a mind of their own. Both parties benefit from this empathy, and patients who experience empathy during their treatment obtain better results and greater chances of recovery. In turn, professionals with higher levels of empathy work more efficiently and productively and express greater satisfaction with their professional development.

How to inform, persuade and remind about COVID-19 vaccination

Pedro Rey
 

@varelalaf

After a year in which the fight to control the transmission of COVID-19 has set the agenda, the debate is now focused on how to get a sufficient percentage of the population vaccinated to achieve the so-called "group immunity" as soon as possible. The objective now goes to the supply side: it is about establishing the sequence in which different population groups should be vaccinated (and with which vaccine each one) and making sure that the prioritization is fulfilled. We must also resolve as soon as possible how to eliminate bureaucratic obstacles so that vaccines are more easily accessible, more operational from a logistical point of view and can be purchased by the states at a reasonable price. However, solving the supply problem will be futile if we fail to stimulate demand so that the effective vaccination rate is as high as possible. For this, it is essential to understand both how the potential vaccination subjects behave ‒guided by their beliefs, their perceptions about safety and risk and by their cognitive biases‒ and in what way we can influence that behaviour to guide them towards the socially desirable direction that allows the reduction of disease incidence. 

Risk-based medicine, a hieroglyph full of traps

Jordi Varela
Editor

 

Gerd Gigerenzer, Director of the Harding Center for Risk Literacy at the Max Plank Institute for Human Development in Berlin, was featured in this blog in 2016 following the publication of "Risk Savvy. How to make good decisions." Gigerenzer's crusade against risk manipulation and its consequences are consistent and tenacious, and that's why we should use more of his materials to help overcome the traps of malicious numbers if we want to practice proportionate medicine to address the real risks to peoples health. The following video which was edited in February 2020 by the Gigerenzer factory,  turns out to be essential in differentiating between absolute risk and relative risk.

Care for chronic patients during the pandemic. 5 proposals from hospitals

Nacho Vallejo

Image by Parentingupstream from Pixabay

Faced with the difficulties of a third wave of the pandemic, clinicians again need to express their concerns. And not only because of the exponential increase in the number of COVID-19 patients but also because of the feeling of once again leaving behind the care of patients with chronic health problems. It’s a situation sadly favoured by the collapse of primary care and hospitals.

The pandemic of medical errors

Salvador Casado

George Ștefănescu - Cosmos, 1992

The death of a young person from undiagnosed cancer often comes as a shock to those around them. In recent weeks there has been a lot of controversy on social networks following the death of the journalist Olatz Vazquez, who documented her illness to the end with photos, which has encouraged me to reflect on medical error, to be self-critical of my own and to try to make proposals from a broad vision that includes all the actors. The Sarscov2 pandemic has caused another pandemic of unavoidable medical errors both by action and, above all, by omission, because the collapse of health systems around the world has caused them to stop attending sufficiently to other pathologies for many months. In the following text I approach the subject from the point of view of a healthcare professional who tries to explain it to his patients and colleagues and not from a technical approach, for which I provide a list of suggestions for further reading at the end.

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).

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.

Caring for complex patients in the community requires a radical change

Jordi Varela

Editor

The pandemic has highlighted the need to protect, even more, if possible, people suffering from clinical complexities and some of them, in addition, family, economic or social difficulties. For this reason, some primary care centres have set up nursing teams to more proactively care for the most vulnerable patients. These groups of nurses have taken the initiative and now organize their tasks, most of them at home, in an autonomous way, according to a fine balance between coordination and effectiveness. The historical medical-nurse binomial of primary care, then, is beginning to show cracks that give way to advanced organizational models with more nursing skills.

Trust, an ingredient needed to innovate

Mònica Almiñana

"One, the citizenry will not forgive the president for hiding health information that can help save their lives. Two, in a crisis, people must feel like a soldier, not a victim. Three, telling the truth generates trust, silence generates fear. "

CJ Creck, The West Wing. Season 3, Episode 9 (2001-2002)

When Aaron Sorking wrote these sentences for his character, the White House press chief in the series The West Wing, in a chapter where a health problem was addressed, came up with some of the keys needed to manage the communication of this type of crisis. In a recent article in BMJ Leader, "Leadership during the COVID-19 pandemic: building and sustaining trust in times of uncertainty," Susannah Ahern and Erwin Loh also outline some of the keys to leadership in times of uncertainty. And one of those keys is trust. The authors themselves define it as "The expectation or belief of an individual, often in vulnerable circumstances, that another person's actions or motives will be honest, fair, and based on integrity (following sound ethical principles)." (1)

The pandemic in healthcare professionals

José Joaquín Mira
 

The COVID-19 pandemic represents an unprecedented challenge for healthcare systems around the world. To the initial uncertainty, the scarcity of equipment and the difficulties in maintaining the supply chain were added the constant changes in instructions, the interruption of all non-delayed care, the isolation of hospitalized patients (many dying alone) and unprecedented acute stress on healthcare staff, particularly those dedicated to direct care of COVID-19 patients. The term second victims of SARS-CoV-2 have been used by our group, and by others, to describe this experience.

Does anyone think about “the day after”?

Joan Escarrabill

It's all over. It's the way of life, as my grandmother would say. Health problems can end in different ways: a very specific treatment (the magic bullet), changes in the environment (sewerage and sanitary control of water), adaptation and coexistence with the disease (now there are people with tuberculosis, but we don’t need sanatoriums) and, for sure, we would still find others. The same thing will happen with the COVID-19 pandemic. Perhaps we will mitigate the impact of the pandemic with vaccines, perhaps we will have better diagnostic tools, and perhaps we will be better organized to follow up on cases or a combination of all of the above. It’s likely that, in the end, we will carry on living a long time with a highly contagious disease that, in some cases, has very serious consequences. What is certain is that this tension caused by the successive waves of the pandemic will end.

Remote visits, are they always the best option?

Glòria Galvez

By Healthwatch Dorset 

The coronavirus pandemic has had an explosive and profound impact on health care systems, especially concerning traditional care. Presently, in addition to caring for patients affected by a coronavirus, it’s necessary to continue caring for the "invisible patient", who is still there, affected by other pathologies evolving at their usual pace, some of them potentially severe. Remote visits, which in a short time has gone from being a rare modality to being the usual form of interaction with the patient, are presented as the best option to carry out their follow-up, thus avoiding crowded waiting rooms and the risk of infection.

Primary care gaps: what's failing and how can we fix it?

Pere Vivó

The health crisis is placing unprecedented strain on the health care system and in particular on primary care. Saturated agendas, disorganized demand and forced abandonment of some functions to assume new competencies, all added to the social crisis and the extra demand on the part of some users have as a result a generalized discouragement and psychological exhaustion of professionals.

The power of conversation, according to Danielle Ofri

Jordi Varela
Editor

 

Danielle Ofri, an internist at Bellevue Hospital and professor of medicine at New York University, is recognized for her work on the emotional aspect of clinical practice and its impact on the diagnostic process and the effectiveness of treatments. Danielle Ofri has already deserved the care of our blog on several previous occasions and now we return to her with her latest book, What Patients Say, What Doctors Hear.

What have we learned in Primary Care during the pandemic?

Salvador Casado

Illustration @72kilos

1. Prioritise. 
2. Team and patient safety. 
3. Self-organisation. 
4. Coordination with the community, society and NHS. 
5. Resilience. Fatigue management.

The Covid19 pandemic has been one of the hardest tests both for the health system as an institution and for its professionals. From a rural health centre, it seemed important to me to open a reflection within the team on what we had learnt in Primary Care over these months. I share the ideas that emerged from this process, which was carried out in a non-systematic way in small group or corridor conversations. The experience of a team is not exclusive to it, nor does it end with it; it is undoubtedly shared with many other professionals and is likely to be enriched by that of other groups with other socio-demographic circumstances, or from other areas of hospital or mental health organisation. The intention of this paper is none other than to extend this reflection and allow the reader to add to it in the form of a commentary on the text or on social networks (twitter: @doctorCasado).

Parallels between pandemics and the bystander effect

Cristina Roure
 

I remember how, just a few weeks before the declaration of the state of alarm, we looked first at China and later at Italy with astonishment and disbelief, as if what was happening there was not with us, as mere spectators. Perhaps we thought that borders could protect us, or at least give us time to anticipate and do better than the Chinese or the Italians. When we took action, our still fresh health contingency plans were pulverized in less than 48 hours by a tsunami that drove us straight to the ground of improvisation.

Do financial incentives work to improve treatment adherence?

Pedro Rey
 

Laura Diego del Río & Pedro Rey

The effectiveness of a treatment depends as much on the prescriber's correct diagnosis and recommendations, as on whether the patient complies with the treatment guidelines that have been indicated. Lack of treatment adherence is one of the major problems related to medications, as it has a direct effect on both the effectiveness of the treatment and the healthcare costs. It’s estimated that in the group of patients with chronic diseases, adherence does not exceed 50%, with non-compliance being even higher in certain diseases, such as psychiatric diseases, in which it’s considered that only 25% of patients follow the treatment prescribed.

Rebellion in companies: it's time for professionals

Jordi Varela

Editor

Joost Minnaar and Pim de Morree, in the book they have just published, Corporate Rebels, make work more fun, explain that, in the summer of 2015, having a beer on a terrace in Barcelona, they decided they were tired of being treated like children in the companies where they worked. They hung up their habits and set out to travel to see how the companies that had opted to rely more on the capabilities of their workers than on process control worked. As a result of the inspiring Barcelona beer, they not only left their jobs but also created a blog, Corporate Rebels, and generated a list of innovative companies, both from an organizational and labour point of view. That said, do not assume that the initiatory journey of the two young Dutchmen is about promoting start-ups, but about how companies can be transformed from below.