The technology is so powerful that dazzles us with its practical applications. We move dirt to a machine and are shocked their ability, versatility and mobility. We rode in a car and surprised his "obedience." We attended the video presentation of a machine to cut, able to "walk" in the middle of the woods, and it seems incredible. As unbelievable as a hip replacement, which also implements a robot! Or amazing, as a "simple" needle in such a technological perfection puncture the vein that allows almost painless and, of course, as uncontaminated employ the proper techniques. What about a tetanus shot really achieves its effect? What about the dentist's anesthesia to implant a tooth? Or the material involved a surgeon to a patient with appendicitis? What about the portable ophthalmoscope used in the GP home visits?
Technology is powerful, attractive, somewhat fascinating.
Is it good for the health of the population standardized rates of hip arthroplasty in patients older than 65 years vary according to geographical areas of health in Spain between 10 and 36 per 10,000 inhabitants? This variety of clinical practice, is it due to monetary incentives, or "technological fascination"? In his work, Salvador Peiro and Enrique Bernal blamed on the hypothesis of "technological fascination" such variability. In hospitals with more technology becomes more technological interventions, which reflects a "technological fascination", not the needs of patients
Health technology
Science is a method and a result that allows to generate knowledge. It is technically the application. Of course, science and technology will stimulate each other, but science comes first and therefore social merit consideration today lacks in Spain, as demonstrated, for example, with the ruthless cuts in research.
Health technology is "a group of drugs, instruments and medical and surgical procedures used in health care and the organizational and support systems in which such care is provided." Is the definition of the OTA, the Office of Technology Assessment, an organization that advised the U.S. Congress on science and technology between 1972 and 1995
The OTA advised the U.S. Congress to make decisions on complex issues like health care, acid rain and climate change. For example, on the advice of OTA expanded public health coverage pregnancy as a way of reducing the incidence of low birth weight.
OTA worked for the likes of David Banta, an internist, Dutch, a master of public health from Harvard University, and Tony Holtzman, a pediatrician and geneticist, also of public health at Johns Hopkins. His work provided the birth of Evidence-based medicine and prevention quaternary set of activities that seek the best use of health technology and to avoid, reduce and mitigate the harm the health system.
Hard data and soft data
Hard data are those from machines. For example, the results of a blood (or urine, with strips in the office or the patient's home), or the results of a CT scan, or the patient's weight in the balance.
Soft data are those from people, although the patient and family, either their own health care provider. For example, the history and physical examination results.
Specialists tend to rely more on hard data. Generalists, more soft data. In fact, it is characteristic that defines the general practitioner
The soft data are essential information for medical decision. For example, compared to the values of the patient. Thus, the rejection of transfusions a Jehovah's Witness is a given soft key health care. It is also soft data history of an error in the diagnosis of brain cancer, at first misinterpreted as depression. It is awe soft data in the community to the use of morphine for pain relief.
The sum of soft and hard data can provide quality clinical care tailored to the situation, and specific patient problem.
When presenting clinical cases, almost all information is on hard data. Style: "Patient 61, diagnosed with breast cancer three years ago. Back pain with sudden onset, for bone metastases. At a TAC was also found pleural effusion. Went to his home, treated with morphine and tamoxifen. readmitted within two weeks of intense anorexia and dyspnea. They are liver metastases, lung and brain. He died on the fifteenth day of admission for pneumonia. "
The pale glow of a flame on a wick lowest minimum
Behind this story appalling that classical clinical case, there is a person and a family. It is a life. A wick that is at the center of a family that suffers. He is a person who, like lace in the candle, lights while they are alive. In the whole of humanity is not a missing link that will be lost. "One man, a woman well taken, one by one, they are as dust, are nothing." But their minimum flame was pale glow that illuminated and attracted many. He had family, he had friends, had companions, had neighbors, had joys and disappointments, he felt pleasure and pain, had life.
Where there is no classical clinical sign of people or families, or lives. The clinical case story becomes a dispassionate, mechanical, terrible, distant and cold. All occupied by hard data.
In the classic clinical cases is not usually talk about family structure and impact of disease on it. Not usually talk about the labor situation, and their relationship with the sick. Often lacking the sociocultural characteristics of the patient. Little is said about accessibility. The diagnostic process seems clear and obvious; case is intriguing. The therapy is appropriate. It is invisible the role of health professionals, their experiences and behaviors. The evolution is predictable.
In general, the case is a classic clinical differential diagnosis exercise that raw anecdote, brilliant from the medical point of view. The man who usually paints is discussed shortly. No place to see the pale glow of a flame on a wick negligible minimum.
Let's see a little life, of that pale glow of a flame on a wick lowest minimum:
"A 61 year-old married father of three independent, retired from her job of 40 years as a clerk in a truck factory. After a normal mammogram screening, had a breast lump (found by chance, taking a pain ECG precordial) diagnosed with breast cancer three years ago. After the corresponding low back to work, but had taken his place so he had to change section and head, which led two years of bullying, to request early retirement voluntary. At 20 days of retirement presented tenebrante back pain, which his doctor referred him to the emergency room three times, without reaching any diagnosis. With the results of some tests was sent back to the hospital, where a family, caretaker, managed to call the attention of the oncologist who had treated him, and was admitted for bone metastases. At a TAC was also found pleural effusion. "enjoyed" the Christmas period in hospital, for all the diagnostic process was delayed with staff holidays. Finally, he went to his home, treated with morphine and tamoxifen. Neither the doctor nor the nurse visited her home, her husband went back and forth to keep up to professionals. readmitted through emergency two weeks of intense anorexia, dyspnea and anesthesia chin. found liver metastases, lung and brain. The oncologist considered the possibility of a new chemotherapy. No one spoke to the patient's impending death, and found to still 'fighting cancer 'until the last minute. He died on the fifteenth day of admission, pneumonia. "
