The Fourth / Company Conference for Patients of the Spanish Society of Internal Medicine

Internists at ICOMEM are thinking about how the doctor-patient relationship is changing and where it should go with a focus on humanity and technical ethics.

The incorporation of technologies into routine clinical practice is causing a “shift in the social relations paradigm as well as in the healthcare paradigm.”

It is necessary to reorient the physician-patient relationship from the perspective of technical ethics without forgetting the humanistic approach to individual-centered medicine and avoiding clinical practice based on data and evidence only

Technology “must not replace the core of the doctor-patient relationship, based on communication, emotion and shared decision-making.” Technological humanity must be advocated in medical practice

Emphasis was also placed on the fact that health professionals are “technically prepared” to face the end-of-life process, but that it is necessary to train future clinicians to “communicate bad news or know how to convey information in a friendly manner and empathize with the patient in joint decision-making”

Internists from the Spanish Society of Internal Medicine (SEMI) discussed how the doctor-patient relationship has changed, what it looks like and where it should go at the “IV SEMI Patient Conference: New Patterns in the Twenty-first Century”, held last Wednesday at the illustrious Official College of Physicians of Madrid (ICOMEM) and organized jointly by SEMI and the Francisco Valles Institute for Clinical Ethics.

During the meeting, patients’ rights, respect for their autonomy, technical ethics, how technology has transformed the doctor-patient relationship, as well as the need to achieve human-centered and humane medicine. In the current context in which we live, it has become clear that technology is a “very useful” tool that has been incorporated into clinical practice so that diagnostic and therapeutic procedures are more accurate, but that it “should not replace the core of the clinician – a patient relationship based on communication, efficacy and decision-making.” joint”.

The meeting was opened by Dr. Jesus Diez Manglano, President of SEMI, and Dr. Arantzazu Alvarez de Arcaia, SEMI Patient Relations Coordinator and Coordinator of the Hospital Medicine Clinical Management Unit at Clinico San Carlos.

In the opening, Dr. Diez Manglano emphasized that for the medical profession in general and for specialists in internal medicine in particular, “the patient’s voice is essential and must be so” and emphasized “the comprehensive and holistic vision that distinguishes the work of mystics”. Also in terms of “more attention and dedication to the end-of-life process from the clinical field is much needed”, and in this sense, he referred to the consensus promoted by SEMI-SPMI regarding good practices in the end-of-life process.

In the words of Dr. Arantzazu Alvarez de Arcaia, SEMI Patient Relations Coordinator: “New technologies have changed the way we treat each other and this is something we must all learn to continue creating high-value medicine based on emotion. The challenge is figuring out how to integrate new technologies to advance medicine. humanitarian.”

End of life process

During the day, they thought of the end-of-life process, the stage in which patients find themselves in a state of “great weakness”, physically, psychologically, and even morally; “Not forgetting family and close friends, they are also deeply affected by the situation in terms of emotional and vitality.”

“The clinician is very prepared to face the end of life technically: how to interpret tests, prediction or anesthesia. However, he will need more training in communication skills as well as more moral training to face the end of life, the moment when difficult decisions are shared with the patient, with Consideration of his social and family environment, with a high emotional cost”, notes Dr. Alvarez de Arcaia, who asserts that “care at the end of life must be medically adequate, but also close, sympathetic and compassionate. In short, humane.”

Human medicine is more than just evidence and data

The importance of humanistic medicine was also highlighted and that clinical practice that focused solely on evidence and data should be avoided. “The clinical relationship must be reoriented towards effective communication between two people. Technology is important and necessary, as is respect for patient autonomy. However, the best thing is for someone to guide the whole process with common sense and clinical thinking, is a good doctor. Otherwise, medicine It will be limited to data and tests only. It will turn into a consumer commodity far from its true foundation: the best healthcare for patients.”

In this sense, Dr. Alvarez de Arcaia repeats that “medicine is the sum of science and humanity. Doctors treat people, and if we want to make medicine people-centred, we must know, in addition to the scientific aspects, those related with psychological and emotional factors and social complexity. This was important Especially in the past two years, during the COVID-19 pandemic period.”

Technical ethics: How do we make technology and human medicine compatible?

Through the various streams, it becomes clear that technology has invaded our lives and modified our knowledge, behavior and way of communicating. And in the environment in which we currently live, close to technology, reflections are emerging such as whether we should do everything we can do, and how to apply ethics to technology (technical ethics). Technology solves social problems and, at the same time, causes the need to rethink how we act, redefine concepts and revise the principles upon which we base our actions. “It’s about avoiding misuse of technology so that it doesn’t interfere with people’s well-being.”

In this sense, it has been emphasized that “a good clinician must be able to integrate scientific knowledge with other non-technical skills necessary to develop what is called ‘medical well-being’, among which are communication skills and managing emotions. Internists as specialists with a holistic vision, we have that ability on integrating all aspects of a person: physical, psychological, emotional and social, all of which are necessary to be able to accompany our patients and their families throughout the disease process, right up to the end of life,” says Alvarez de Arcaia.

However, it was also emphasized at the conference that “these skills should be taught from medical schools. Communication is central to a physician’s work; for example, knowing how to communicate bad news is crucial in helping people reduce the emotional impact of illness; or Knowing how to convey information in an appropriate and friendly way to make joint decisions, and thus, the ability to confront serious illnesses from all points of view.”

Evolution of the doctor-patient relationship

The classic doctor-patient relationship was based on benevolence. That is, thinking about what doctors think is best for the patient, they decide for the patient himself. This created a type of relationship that has been called patriarchy. In recent decades, the change has been radical, because the rights of patients, especially respect for their autonomy, have been introduced. This completely changed the pattern of clinical relationship. An information-based model (informational model or style) has been proposed, in which the physician and patient exchange information and the patient decides. However, this model has drawbacks, because many patients, in addition to information, want the advice of a doctor. The doctor’s recommendation is what is best for him. This pattern or pattern is called trading. In a deliberative relationship, the doctor and patient exchange information, but also their opinions and ratings about the best.