We ask patients to change their habits, but what about us?

Anna Sant

The management of cultural change is one of the most critical factors in the implementation of programs to improve the quality, safety and experience of the patient. The same thing that happens to our patients when we ask them to modify their behaviour to have a healthier life happens to health professionals in our work environment: it’s not easy for us to change the way we do things.

In the process of change, there is a particular moment in which we already know the correct protocols, and we are clear about the systems and behaviours that we must address. Even so, after an initial period of systematic implementation, we tend to return to old routines, those that seem more natural and familiar to us.

Management according to Elon Musk. Tesla, SpaceX and SolarCity

Tino Martí

Elon Musk is one of the trendiest entrepreneurs and undoubtedly the most controversial one at the moment. He is the leader of Tesla, SpaceX and SolarCity, three young, ambitious and dynamic companies that show how far they are willing to go to change the world through the internet, renewable energy and the race to Mars.

In 2018, he made it to the headlines for different reasons. First, proposing technical solutions to rescue children trapped in Thailand and end up insulting their monitor. Second, and probably the most popular, with the announcement via tweet to privatize Tesla for $420. In the American financial and stock market context, privatizing a publicly-traded company means repurchasing all its shares. The action elicited strong reactions, and the board of directors concluded his position. Shortly afterwards, Musk again announced problems in the production of Model 3 and wanted to assure the market that he is giving it everything by announcing his strenuous workday: 120 hours per week. To top it off, in a live radio interview, he accepted smoking marijuana. No one can say that he goes unnoticed, regardless of his apparent privacy.

Narrative, expectations and relevant outcomes for patients

Gustavo Tolchinsky

At the beginning of my medical residency, I used to experience some frustration with some patients whom, despite having gone through a correct assessment and having been diagnosed with a treatable and straightforward pathology, when they were discharged, they were still not satisfied. After some time, I began identifying that at least one of my mistakes was in my approach to patients. Excessively focused on diagnosing a pathology as if I were to “nail it” in an exam, I wasn’t paying attention to what led the patient to visit me, their concern; this couldn’t be solved by giving a mere diagnosis and treatment. When we go through these situations, we find it traumatic, frustrating and disconcerting. On top of that, this may lead to over-acting that only leads to over-treatment due to repeated patient demand at different points of the system. This could be because the clinical solution we offer does not solve those concerns that went unidentified in the clinical interview, or that the patient's expectations are ill-adjusted to realistic results and these, therefore, are unattainable.

The early diagnosis of colorectal cancer, thirty years later

@varelalaf

Health systems have long-planned population programs for the early detection of certain cancers through diagnostic techniques arising from the clinical setting, such as prostate-specific antigen (PSA), mammograms, ultrasound or the study of faecal occult blood that is the case at hand. This issue is generating confusion in society because one thing is to take care of one's health and the other, quite different, is to undergo medical tests to discover tumours in their early stages. On the other hand, discomforts are also generated among professionals, because it’s not the same to treat patients who seek help for health problems, than to propose extensive tests to the healthy population.

How to ensure that healthcare professionals read clinical practice guidelines?

Laura Diego Del Río & Pedro Rey 

During the last decades, there has been a dramatic increase in the clinical information available to healthcare professionals and best-practice reference documents have been established in different areas of medicine. An example of this is the numerous clinical practice guidelines developed by various institutions. Despite the vast amount of criticism bout their limitations; their elaboration implied a great effort to establish quality standards and a significant publication of literature on adoption strategies in clinical practice. However, given this abundance of information, there are certain doubts about whether they are being read and followed through. Let us analyze the main reasons and see what can be done to change this (lack of) practice, under the prism of behavioural economics.

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.

Is it ethical, correct and legal for a family doctor to treat 60 patients in one day?

Salvador Casado

My point of view: No, with exceptions.

Medicine is a highly regulated activity. Its exercise requires a high level of education and academic level, a high code of ethics and deontology and appropriate legislation. In other words, it cannot be exercised in any way because of the potential risk of damage for patients. 

Surprisingly, care overload is not defined, regulated or correctly managed.