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)