Dear Editor,
The letter from Dr. Sánchez-Muñoz is an excellent complement to the editorial on the excesses of hospital care.1 Whereas the editorial focused on the excesses in hospital care with the generalisation of low-value practices, Dr. Sánchez-Muñoz’s letter scrutinises the other side of the coin, all those practices that are not implemented in most of our centres despite proof that they improve the quality of care and the health outcomes of our patients. If, on the one part, there is an excess of limitations (diet, rest), prophylaxis or administration-route instrumentation, on the other there is a deficit when it comes to getting patients “moving”, ensuring their night's rest, or promoting more complete nutrition according to the individual’s characteristics.
There are many factors that influence the overuse of certain care practices. I would like to highlight three areas2: a) the care structure, where ‘doing something’ is the only route, or where the fear of prosecution of alleged malpractice or the influence of the pharmaceutical industry is often excessive, b) training, which is insufficient, where continual updates for care professionals is lacking, and are always assigned second place after medical treatments or diagnosis updates. And also, the lack of existing evidence for some care practices should be highlighted, c) cultural pressure, as the perception still prevails that the more that is done, the better the result.
There are also many factors that influence the absence of implementing proactive practices to mobilise our patients, improve their rest, and ensure their nutrition. The factors that contribute to the insufficient use of these care tools include the structure of the services, the lack of professionals dedicated to these tasks, and the resistance to change.3
All these factors undoubtedly have a common need for a multidisciplinary and coordinated approach by the different health professionals who care for patients (auxiliaries, physiotherapists, nurses, doctors), but it seems that this is always placed on the ‘pending’ pile.
The times that we have been forced to live through with the COVID-19 pandemic have made the deficiencies of the care system even more evident. As an example, this reference evaluates the decrease in the end-of-life discussions between the patient and his/her healthcare professionals prior to and during the pandemic.4 It is the perfect opportunity to re-build ourselves by redirecting attention, not only to the treatment of the disease, but also to the best care, centred on the patient, including where possible the recovery of the patient’s quality of life.
Conflict of interests
The authors declare that they have no conflict of interest.
Footnotes
Please cite this article as: Corral Gudino L. Primum non nocere: cuando el cuidado hospitalario no es necesario o es excesivo. Med Clin (Barc). 2021;157:309.
References
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