What should be our attitude toward invisible diseases and elderly? 

Attitude toward exams

"A positive acttitude gives you power over your circunstances instead of your circunstance having power over you." Joyce Meyer

"Las aCtitudes son más importantes que las aPtitudes." Winston Churchill

 

PAY IT FORWARD

I wanted to share with you a video from a scene of one of my favourite films, pay it forward. In this film, a boy of 11 years old is asked in school to perform a work in which he has to give an idea to change the world. The boy comes up with a "chain of favors". His idea consists in starting a chain of favors in which you have to pay it forward. The person who starts the chain has to do 3 important things for someone else, but things which can really help them in their life ( for example, the boy gives a bit of money and clean clothes to a homeless so he can have an interview to find a job). The person who has receives help, has to pay it forward to 3 more people, and so on. Therefore, once a lot of people get involved the favors increase exponentially, and despite this does not change the world the chain keeps improving a lot of people's lives. I strongly recommend you this film, because despite it is a bit of a utopy it teaches you that although there are lot of things in life we cannot change, we can individually improve a person's life greatly if we put effort on it.

I share a scene of the video in which the boy is talking about his school Project.

 

https://www.youtube.com/watch?v=8K9Gg164Bsw

How do you feel?

As doctors we need to a huge amount of knowledge but also it is very important to listen to the patients and also to "listen" to the non-verbal communication...How they really feel?

Artist Marina Abramovic and Ulay started as intense love affair in the 1970s, performing out of a van called home.

When they ended their relationship, they decided to walk the Great Wall of China, each from one end, meeting for one last embrace in the middle...

That was the last time they saw each other...

In 2010, as part of her MoMA retrospective, "The Artist is Present" Marina shared a minute of silence wth each stronger who sat in dront of her.

On opening night, Ulay arrived without Marina knowing...

https://www.youtube.com/watch?v=OS0Tg0IjCp4

October: Breast Cancer Awareness Month

According to WHO (World Health Organization), October is the international month to increase attention and support in breast cancer. It is important to know that breast cancer is affecting by far in developed and in developing countries and the incidence has been increased in both.

Unfortunately, there is not enough information about the causes of breast cancer, but early detection is very important in the control and prognosis of the disease. Because if the cancer is early detected and there is an adequate treatment, it can be cured. For this reason, the majority of deaths in breast cancer are due to late stages and progression of the cancer. In many countries, there is not an adequate program for early detection.

In Spain, Maldita Nerea, a pop-rock group has written a song called "Tú eres la vida" in which describes how a woman feels when is suffering for breast cancer. This song would not be possible with the collaboration of other artists and is part of the concert given by Cadena 100 in which all the benefits will be donated to "Asociacion Española Contra el Cáncer" (AECC) that offers some researching programms in breast cancer.

https://www.youtube.com/watch?v=h9jewnASLjY

The importance of non-verbal communication, time issue and Patients before computers.

We know the verbal communication, in the consultation, need to be concise, easy to understand and useful in delivering the message. On the other hand non-verbal communication is much more complex and, very often, took for granted. 

While verbal communication delivers an information, non-verbal provides that information with emotions, concerns, security. Things like facial expressions, eye-contact, gestures, body position, speech rate, hesitancy or interruptions; may help to give our message more credibility, or on the contrary, falsehood. As an example, telling a diagnosis, looking away patients eyes and with pauses, will probably give a sense of dismissal or distrust.

All doctors should acknowledge and use this to their advantage, because it will not only make you more reliable, but knowing how to recognise your patient's “body language” may also be an advantageous and helpful in the examination process.

This article makes an extensive investigation on body language, an importance of time and eye contact in clinics: [1]

As the “globalised internet/computer society” progress, it had come to my attention the lost of the ability to listen in a productive way, maintain the eye contact, and reassure properly. 

With this statement, I am not demonizing computers, in fact, I find that fast info to be really practical. Imagine a aged patient, in the 1980s, going to a new nursing home, the nurses will have to ask for a copy of the health history; which will be time consuming and not really ideal, and now you can give access to that info with a “click”. Computers in healthcare work have become remarkably useful. 

However, in my short consultation experience, I had noticed how computers and the “extra-inputing-info-time” are creating a kind of alienation on the patient. Looking at the computer, instead of the patient, rushing the conversation in order to have time to input the info, writing while talking, losing the connection patient-doctor, losing the eye contact, losing patient reliability, and blurring the goals of the conversation. A conversation that, in my opinion also has a therapeutic effect on the patient. 

I don’t blame the doctors, it might be a product of medical atmosphere nowadays, where physicians get rewards for the number of patients treated and effectiveness; or as well, it might the result of the small time per patient that the hospital try to induce to practicians. 

In my personal experience, I have seen how in the rural medicine, the times are less restricted and the patients are more relaxed and confident. Whether  in city/hospital medicine the time can go as low as 15 min average per patient in the US or 10 in the UK, what can rush the doctors to force the patients to come to the point, when most times patient want to tell their story. 

There are two truths in here; one, the is a lack of time; and two, even if computerised medicine is useful and necessary; the more we introduce the computers in the consultation, the less we look at our patients. So how to seek the balance?, how to address the issue?

First, time issue. In a consultation, we have a duty to give enough attention to our patient so he will feel reassured and we can get enough info for a diagnosis or at least an approximation to it. But how to do that in 15 min when you have to write it also in the computer and at the same time be attentive? Well I am a fan of simplicity so there is a wonderful three questions rule (of course this only for regular patients, because it doesn’t comprise basic information questions): The I.C.E. rule

Ideas, feelings, symptoms and personal life - What do you thing is going on?

Concerns, fears, worries, effects on patient's life - What are you most worried about?

Expectations, patient assumptions on doctor’s job, their involvement - What are you expecting that I can do?

With that you should get considerate idea of patients life and problems, because: 

"A pair of kidneys will never come to the physician for diagnosis and treatment. They will be contained within an anxious, fearful, wondering person, asking puzzled questions about an obscure future, weighed down by the responsibilities of a loved family, and with a job to be held, and with bills to be paid." - Dr. Philip Tumulty of Johns Hopkins

Second, the computer/patient balance. I will say to things:

One, the computer actually represents a physical barrier between patient and doctor, so it must be keep outside of the frontal range, and i will suggest a position, on the corner of the desk, in which the angling will be faced slightly to the patient, without reducing the direct view of the doctor. That way the computer is separated and at the same time is incorporated into both the doctor and the patient.

Second, a good doctor should know, apart from the already discuss topic of body language, he should know how to structuring the consultation: listen actively to the patients, postponing the input of the records until the finalization of patients words, recognizing the moments to look and not to look to the records; summarizing understanding how to separate listening, from input, from reading.

If we can educate the new doctors to bear in mind those considerations, we could redirect the medicine into a better patient-doctor communication and, therefore, relationship. Because the way to a better health care and a better health status is going to need the participation of both. Especially in a world where the patients, each time, have more and more information, and the doctors have to assure that they are getting the good information.

Bibliography:

Webpage: http://www.medicsmove.eu/docs/cman/en/Chapter3.html#

Articles: [1] Enid Montague, Ping-yu Chen, Jie Xu, Betty Chewning & Bruce Barrett: Nonverbal Interpersonal Interactions in Clinical Encounters and Patient Perceptions of Empathy. medscape, August 14, 2013

[2] Debra L Roter, DrPH,1 Richard M Frankel, PhD,2 Judith A Hall, PhD,3 and David Sluyter, EdD4: The Expression of Emotion Through Nonverbal Behavior in Medical Visits.. NCBI, 2006 Jan; 21

Own personal experience 

Schizophrenia. Thanks Marian!!!

Mario ALONSO PUIG: Thanks, Please and I´m sorry

Amy Cuddy: Your body language shapes who you are

Body language affects how others see us, but it may also change how we see ourselves. Social psychologist Amy Cuddy shows how “power posing” — standing in a posture of confidence, even when we don’t feel confident — can affect testosterone and cortisol levels in the brain, and might even have an impact on our chances for success.

the whole video: https://www.youtube.com/watch?v=Ks-_Mh1QhMc
my favourite part, where she talks about her own experience: https://www.youtube.com/watch?v=6nOfu3MlsIg

THANKS =)

I am a mess.

I lose notes and occasionally my temper too.  I live in the chaos, so if I were a bacteria, I wouldn’t be an aerobic one, I would be a chaotic one. I speak English as an Indian, all I am missing are smoke signals. I have always my head elsewhere, maybe she is in the clouds or in Valencia shopping or recalling an episode of Grey’s anatomy.

But I am lucky to have you. You are my Pygmalion effect, you rely on me and always you transmit me that trust. You are also my mindfulness technique, you stop the uncontrolled bombardment of thoughts in my head and you offer me a walk or a beer. I don’t need to have a super hero posture because I am surrounding by heroes who rescue me every day. You are part of my comfort zone as much as my magical zone because you make that wonderful things happen to me.

So thanks for being there because with you I am still a mess but a really better mess.

Por cierto, si podéis todos los días conmigo... Podéis con tercero, I'm sure of that!

"To live until we are dying"

The World Health Organization defines palliative care as:

“…an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness….” 

I never fully appreciated this statement before being a family member of someone who has received, in the true sense, a palliative approach to their care. A palliative approach to care is all-encompassing and depends on physicians, nurses, allied health and volunteers. A palliative approach to care relies on person-centered care and the philosophy that, no matter how ill a person is or what stage of their journey they are in, they are always a person first. A palliative approach to care is a “philosophy to care.”

In my experience I see this reflected in the nurses, physicians and even the housekeeping staff on a palliative care unit. Everyone continually announce when they enter the room and explain to my grandmother what they are doing, even in these last days and hours when there is no response. As someone who sees the decline of a very strong (and strongly opinionated) woman, this means so much as it reinforces that although she can not voice her wishes, she is still being considered and respected.

These type of cares, offer you more control over your care and a comfortable and supportive atmosphere that reduces anxiety and stress. Your plan of care is reviewed each day by the palliative care team and discussed with you to make sure your needs and wishes are being met and that your treatments are in line with your goals. You can also expect relief from symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite and difficulty sleeping. Palliative care addresses the whole person. It helps you carry on with your daily life. It improves your ability to go through medical treatments. And it helps you better understand your condition and your choices for medical care. In short, you can expect the best possible quality of life

Because being a doctor does not have as an objective only attending to any medical unbalance that our patient comes with and forgetting it once it has been solved, but trying to treat our patients with love. Helping people feel better and live until they can. And palliative care allows patients to do just that.

Wake up and go out from your comfort zone

"Life begis at the end of your comfort zone" (Neale Walsh)
https://www.youtube.com/watch?v=RSUykLfEmVE

How to Pretend to be Confident and Amazing

(related to the 'self-fulfilling prophecy')


Ted Talks: Amy Cuddy - Fake it 'Til You Make it

Grey's Anatomy - Superhero speech

If Amelia and Edwards can be superheroes, so can we!












Vamooossssss!!!!!!

'Mindfulness', the fashionable new technique against stress in Medicine

It has shown benefits in controlling anxiety or cognitive impairment

It is a fashion, and as such may be forgotten soon. However, 'mindfulness' technique has “a great future and a lot of development," explains Maria Angeles Moran, counselor and psychologist, and Cristina Madruga, speech therapist and psychologist, working with children in the IES Alpajés of Aranjuez.

The technique, which actually has more than 30 years in Occident (since Jon Kabat-Zinn's meditation stripping matter their religious component), has already proved its effectiveness in the treatment of anxiety-related disorders, stress symptoms, depression or cognitive impairment, and can expand their field in other areas, such as pain.

It is about keeping the attention on the present, either focusing it on our breathing, an external object, etc. and "without making value judgments." "Not much is known about how the process of meditation act on the brain”. But, over time, "it will produce a change of perspective on the events that occur outside broaden the thinking process."

It is about not to go with "the incontralado bombardment of thoughts", which is known as "the crazy monkey". The point  is not to eliminate it but detached from it. "The 'mindfulness' doesn’t turn off the radio, just turns down the volume."