Professionals are important, but so is good governance

Professionals in health services are important because without their dedication and enthusiasm patients do not receive the necessary care, especially in times of cutbacks. However, we should not forget that for these professionals to work properly they need their organizations to be well governed and I will exemplify this with two publications, the first of which is the last book of the veteran professor of McGill University Montreal, Henry Mintzberg, and the second is an article on this subject in the New York Times.

One of Professor Mintzberg’s best known lessons has been the conceptualization of the third sector as a balanced element of democratic societies. One sector, he says, called to serve as a counterweight between public and private spheres. Its key differentiator is property that is either collective, such as in cooperatives or is diffuse, such as in foundations or associations, apart of course of their altruistic purposes and their natural space: community services. All this makes the third sector is specially equipped to manage health services in a well weighted basis between the despotic temptations of political power and the interests of private companies.

Are we all mentally ill? About Allen Frances

Allen Frances, psychiatrist professor emeritus at Duke University (USA) led the working group that developed the DSM-4 (Diagnostic and Statistical Manual of Mental Disorders). I follow the author’s activity, always critical and always documented, on twitter (@AllenFrancesMD) and, unaware of the framework of psychiatry, a question started spinning in my head. How could it be that someone who had led the fourth edition of the DSM was now the most lucid voice against the excesses of modern psychiatry? If I wanted to know the answer, I had no choice, but to read his latest book: "Saving Normal: An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life".

Saving Blood; Strategies to Shatter Resistance

The evidence is clear: avoiding unnecessary transfusions saves lives and generates savings with clinical criteria. Nature echoes this aphorism in an article that collects research insisting that regarding blood transfusions less is more. This issue of blood is very awkward and contradictory. Not surprisingly, for modern nations, having a system of voluntary donation is a matter of pride. Many people believe it and when there is a disaster, the first reaction of many people is lining up to give blood. And it should be noted that the evidence favours the popular intuition: transfusions work better for the injured with major bleeding and for more complex patients, but can also be harmful for patients with smaller problems.

Transfusion = transplant?

The transfused red blood cells have two problems: the first is that in the storage process they lose flexibility, which can make them less effective in transporting oxygen, and the second is that they are actually foreign cells containing antigens (beyond ABO and Rh) that arouse immunological reactions of varying intensities. On these physio-pathological issues, there is still not enough research, but many believe that the origin of the transfusion problems is in these two points.

When the overdiagnosis is politicized

Rudy Giuliani, the Republican mayor of New York, on that fateful September 11, at an election meeting said: "I had prostate cancer 5 or 6 years ago and I thank God to be an American citizen because here the probability of survival at five years for this cancer is 82%, while in the UK, due to socialized medicine, this value is only 44%." We must clarify that in the US, PSA screening is widespread while in the UK it’s not so. According to Gerd Gigerenzer (I have extracted this case from his book "Risk Savvy"); Giuliani’s words conceal a big mistake, because in reality, although it seems a contradiction, mortality from prostate cancer in the two countries is practically the same. So how is it possible that the survival rates are so different? To explain it, Gigerenzer describes two biases that encourage the intentional error of the conservative politician:

The patient will see you now, according to Eric Topol

Eric Topol, director of Scripps Translational Science Institute, published in 2012, The Creative Destruction of Medicine, and in 2015, The patient will see you now. The future of medicine is in your hands. I had this last book on my reading list for a while and I've finally been able to read it during the holidays. It’s an important book about technology seen from the point of view of a clinical practice with extensive knowledge. I found that this literary piece goes a little too far in some chapters and I struggled to follow the thread of the main thesis, nevertheless I have to admit that the contributions of the genomics professor (and cardiologist) are very relevant and deserve to be discussed.

Physical examination is reclaimed

Acute vestibular syndrome, characterized by dizziness, nausea and vomiting, is often due to a local neuritis of the inner ear, despite the fact that a doctor cannot overlook that with these symptoms he or she must first rule out the vertebrobasilar stroke, a less common aetiology, but obviously a lot more serious. I chose this health condition because the neurologist David Newman-Toker from Johns Hopkins (and the team) have systematized HINTS (Head Impuls, Nystagmus and a Test Skew), an examination that requires nothing more than some basic neurologist’ tasks: a) the patient is asked to move his head while focusing at the examiner’s nose; b) the nystagmus is measured on lateral gaze, and c) one of the patient's eyes is covered with the hand while the other eye will focus at the examiner’s  nose and then the other eye is suddenly uncovered. On the understanding that family physicians and emergency room doctors know how to do this (and they probably do) the essential neurological examination before a persistent vestibular syndrome, should be aware that the study published by the team Newman-Toker in the Stroke journal states that HINTS has shown 100% sensitivity and 96% specificity so that the doctor can rule out the vertebrobasilar stroke in people with acute vestibular syndrome, values exceeding those of nuclear magnetic resonance.

The road to excellence

Antoni Peris

We often ask ourselves whether we are still good professionals or whether we are stagnating; whether our work is good or whether it can be better; whether we treat our employees well or whether they’re taking the Mickey; In this case, can we ask more from them? How do we inspire them to do better?

Whiplash has been one of the best rated films of the season. The story of Andrew, an ambitious young man who wants to become the best jazz drummer, enrols in the world’s best school in New York and has to face a teacher who demands everything he has to offer and a lot more. Whiplash shows us the path to excellence, assumed by teacher and student. However I think it’s very far from what we need to think about in our organizations.