Esta entrada está disponible en español
This post is available in english (at the end of the spanish post)El saber escuchar bien es la esencia del arte de la medicina. Es la parte más difícil de superar, es la parte más difícil de aprender a hacerlo bien. Si uno no escucha, las consecuencias serán muy importantes. De hecho, uno de los grandes errores es interrumpir al paciente a los 15 segundos de haber empezado a explicarle al médico lo que le pasa. Hay un aforismo fundamental, y es que “si todo lo demás fracasa ¿Por qué no intentar escuchar al paciente?”, como decía Gregorio Marañón, de cuyas obras me he impregnado gracias a la insistencia y el ejemplo de mi padre, genio y figura hasta la sepultura.
El 80% o más de todos los problemas que plantea un paciente al médico son triviales, es decir, no son cáncer ni ataques al corazón. Son dolencias que se curan con el paso del tiempo, como decía Hipócrates. Por otro lado, Norman Cousins, un gran escritor norteamericano, decía que los americanos creen que van a vivir toda la vida, hasta que se acatarran. Y entonces, cuando esto les sucede, ya piensan que en diez días se van a morir. Conclusión: la salud alcanza su máximo valor sólo cuando se pierde.
Sin lugar a dudas, la información es parte integral de la terapia, y de hecho existen claras evidencias de que los pacientes bien informados consiguen una mayor mejoría que aquellos que están desinformados. Por tanto, una información de calidad, oportuna y accesible, es esencial para apoyar a la lo largo de todo el proceso el tratamiento de cualquier tipo de enfermedad, como constató Ramón y Cajal.
La información al paciente debe de ir acompañada de un admirable trato, de empatía médico-paciente, confianza mutua, respeto, y en fin, de una medicina más humanizada, que son en definitiva los ingredientes principales de la necesidades de los pacientes. La relación médico-paciente es una alianza de estos sentimientos que si los sabemos optimizar podemos ayudar a curar. Además a estos principios éticos, mi mentor espiritual, Tomeu Catalá, le añadiría disciplina y amor.
Otro aspecto esencial del médico es la gestión emocional del paciente y en este sentido, manejar con mucho tacto las emociones del paciente es un aspecto clave que influye de manera decisiva en su proceso salud-enfermedad. Me refiero claramente a la manera de comunicarnos y, concretamente, a las habilidades del médico en informar y motivarle, y basta con leer El Círculo de la Motivación, de mi entrañable colega el Dr. Valentín Fuster, para constatar esta obviedad. Cuando informamos al paciente, se tiene que hacer con un gran rigor, con un diagnóstico claro y aportando a la vez soluciones; es decir, el tratamiento más adecuado, "personalizado" y basado en evidencias científicas.
En este sentido es apasionante recordar a Moliere que en su obra maestra “El enfermo imaginario” se estaba refiriendo al paciente hipocondríaco (el 20 %), que es más vulnerable a la información médica y con el cual todavía hay que ser más delicado a la hora de transmitirle un diagnóstico o tratamiento.
En este sentido es apasionante recordar a Moliere que en su obra maestra “El enfermo imaginario” se estaba refiriendo al paciente hipocondríaco (el 20 %), que es más vulnerable a la información médica y con el cual todavía hay que ser más delicado a la hora de transmitirle un diagnóstico o tratamiento.
Pero el punto de partida para poder curar es la “intencionalidad del médico” ya que es esencial realizar una práctica clínica centrada (con los 5 sentidos) en la curación, siguiendo los criterios de Severo Ochoa, Premio Nobel de Medicina. Esto nos hace ver la realidad, ya que los problemas que traen los pacientes a los médicos, normalmente, son el resultado de la vida misma, de sufrir un estrés crónico por estar en un estado de alerta permanente, por estar expuesto a factores de riesgo, de padecer shocks emocionales, por crisis de pérdida de familia y en muchas ocasiones por no saber cruzar el "laberinto" que te conduce al tratamiento que te puede curar.
Es precisamente en este punto donde pretendo, desde este Blog, ayudar a los pacientes a que puedan conocer los fármacos más innovadores y los tratamientos más tecnológicos que puedan curar su enfermedad, como la terapia con células madre, la inmunoadsorción, las nuevas moléculas, las válvulas cardíacas percutáneas, los robots quirúrgicos, la información genética o a través de la biológica molecular, entre muchos otros, y sin olvidarme, claro está, de algunos remedios tradicionales, como las altas dosis de Vitamina C experimentadas por Linus Pauling, mi admirable sabio y Premio Nobel de Medicina.
Lo que sí puedo asegurar es que hay innumerables avances farmacológicos y tecnológicos que pueden curar pero que no llegan al paciente, por desconocimiento. Sin duda, en esta era de continua transformación de la salud, este Blog va a ser el testigo de cómo la medicina se encuentra inmersa en un momento de grandes posibilidades tecnológicas, y de la existencia de importantes expectativas en torno a los resultados de la ciencia y su potencial contribución a la curación de las enfermedades y a la mejora de la calidad y esperanza de vida, con el horizonte de vivir 100 años como muy bien se constata en el último informe de Naciones Unidas y que ya es una realidad en los longevos portadores del Gen APOB, conocido como Matusalem.
También quiero tener muy presente el Poder de la Oración, su fuerza terapéutica, donde hay una emanación invisible del espíritu del hombre, que es la forma de energía más poderosa que el hombre puede generar. En este sentido, hay evidencias científicas de la influencia positiva de la oración en la mente y cuerpo humano. Y estos son los resultados de investigaciones realizadas por mi "converso" favorito el Dr. Alexis Carrel, Premio Nobel de Medicina, y sobre el que haré en este Blog un punto de inflexión.
Por todo ello, estos avances los iremos descubriendo en este Blog que con gran ilusión inicio hoy con vocación de solidaridad con los pacientes, como he aprendido del Padre Garralda.
Dr. Manuel de la Peña MD, PhD
THE POWER TO CURE
Active listening is the essence of the art of medicine. Doing well is the hardest part to overcome and the hardest part of learning. The consequences of not listening are very important. In fact, one of the great mistakes is interrupting the patient 15 seconds after has started to explain what happens to him/her. There is a fundamental aphorism as stated by Gregorio Marañón "if everything else fails, why not to try listening to the patient?". I have been exposed to his written materials thanks to the persistence and the example set by my father.
80% or more of the problems that a patient tells to the doctor are trivial; I mean they are not cancer or heart attacks. As Hipocrates argued “They are diseases that heal with time”. On the other hand, Norman Cousins, a great American writer, said that the Americans believe they are going to live all their lives until they get flu. Then, when this happens, they think they will die in 10 days. Conclusion: the health achieves its maximum value only when is lost.
No doubt, information is an integral part of the therapy, in fact, there is clear evidence that patients well informed get a better improvement than those uninformed. Accesible and timely information is therefore essential to support the treatment of any type of diseases, as established by Ramón y Cajal.
Patient information must be accompanied by an admirable treatment, doctor-patient empathy, mutual trust, respect, and finally patient-centred medicine, which are ultimately the main ingredients of patient´s needs. Doctor-patient relationship is a partnership of these feelings, if we know how to optimize the feelings we can heal. In addition to these ethical principles, my spiritual mentor, Tomeu Catalá would add discipline and love.
80% or more of the problems that a patient tells to the doctor are trivial; I mean they are not cancer or heart attacks. As Hipocrates argued “They are diseases that heal with time”. On the other hand, Norman Cousins, a great American writer, said that the Americans believe they are going to live all their lives until they get flu. Then, when this happens, they think they will die in 10 days. Conclusion: the health achieves its maximum value only when is lost.
No doubt, information is an integral part of the therapy, in fact, there is clear evidence that patients well informed get a better improvement than those uninformed. Accesible and timely information is therefore essential to support the treatment of any type of diseases, as established by Ramón y Cajal.
Patient information must be accompanied by an admirable treatment, doctor-patient empathy, mutual trust, respect, and finally patient-centred medicine, which are ultimately the main ingredients of patient´s needs. Doctor-patient relationship is a partnership of these feelings, if we know how to optimize the feelings we can heal. In addition to these ethical principles, my spiritual mentor, Tomeu Catalá would add discipline and love.
Other essential physician´s component is being able to manage patient´s emotions and, in this regard, dealing tactfully with patient's emotions is a key aspect that influences decisively in their health-healing process. By this, I mean the physician´s skills on how we communicate, inform and motivate the patient. It can be read in “The Motivation´s Circle” from my close colleague Dr. Valentin Fuster. A diagnosis has to be done with accuracy, clarity and at the same time providing solutions, informing about the most appropriate treatment and based on scientific evidence.
Accordingly, it is exciting to remind Moliere in his masterpiece "The Imaginary Invalid" where he mentioned the hypochondriac patient. Around 20% of the population is hypochondriac. They are more vulnerable to physician´s information than others. The physician has to be more sensitive when giving a formal diagnosis or treatment.
However, the starting point to cure is the "physician´s intention “. It is essential to perform a focused clinical practice (with 5 senses involved), as per Severo Ochoa´s criteria, Nobel Prize in Medicine. This shows us the reality. Usually, patient´s problems explained to physicians are the result of the life itself such as having chronic stress as a result of being in a permanent state of alert, being exposed to risk factors, suffering emotional shocks, losing family members and often not knowing how to cross “the maze" that leads to the healing treatment.
I intend to use this blog, precisely on this point, helping patients to know the most innovative drugs and technological treatments that can cure their disease, such as the stem cell therapy, immunosorben, percutaneous heart valves, surgical robots and genetic information through molecular biology, among many others, not forgetting, traditional medicine, such as high doses of vitamin C experienced by Linus Pauling, a wise and admirable Nobel Prize in Medicine.
Accordingly, it is exciting to remind Moliere in his masterpiece "The Imaginary Invalid" where he mentioned the hypochondriac patient. Around 20% of the population is hypochondriac. They are more vulnerable to physician´s information than others. The physician has to be more sensitive when giving a formal diagnosis or treatment.
However, the starting point to cure is the "physician´s intention “. It is essential to perform a focused clinical practice (with 5 senses involved), as per Severo Ochoa´s criteria, Nobel Prize in Medicine. This shows us the reality. Usually, patient´s problems explained to physicians are the result of the life itself such as having chronic stress as a result of being in a permanent state of alert, being exposed to risk factors, suffering emotional shocks, losing family members and often not knowing how to cross “the maze" that leads to the healing treatment.
I intend to use this blog, precisely on this point, helping patients to know the most innovative drugs and technological treatments that can cure their disease, such as the stem cell therapy, immunosorben, percutaneous heart valves, surgical robots and genetic information through molecular biology, among many others, not forgetting, traditional medicine, such as high doses of vitamin C experienced by Linus Pauling, a wise and admirable Nobel Prize in Medicine.
What I can say is that there are numerous pharmacological and technological advances that can heal, however they do not reach the patient, due to ignorance. Certainly in this era of continuous transformation of health, this Blog will be the witness of how medicine is undergoing a time of great technological possibilities, the existence of significant expectations around science results, its potential contribution to curing disease improving quality of life and life expectancy, with the aim of living 100 years as stated in the latest United Nations report. This is a reality in the long-lived carriers APoB Gene, also known as Methuselah.
I also want to consider the Power of Prayer, therapeutic force, where there is an invisible emanation of the man´s spirit, which is the most powerful form of energy that man can generate. In this respect, there is scientific evidence of the prayer´s positive influence on the human mind and body. These research conducted by my “favourite convert” Dr. Alexis Carrel, Nobel Prize in Medicine, on which we will do a turning point in this Blog.
Finally, I got to these reflections thanks to Dr. Bernard Lown, cardiologist and Nobel Peace Prize. He taught me in 1997 all these principles and values that today constitute the foundation of my professional career and I wish to share with you.
Therefore, we will be discovering these advances in this blog, which I start today with great enthusiasm, with a solidarity vocation towards patients, as I have learned from Father Garralda.
Dr. Manuel de la Peña MD, PhD
I also want to consider the Power of Prayer, therapeutic force, where there is an invisible emanation of the man´s spirit, which is the most powerful form of energy that man can generate. In this respect, there is scientific evidence of the prayer´s positive influence on the human mind and body. These research conducted by my “favourite convert” Dr. Alexis Carrel, Nobel Prize in Medicine, on which we will do a turning point in this Blog.
Finally, I got to these reflections thanks to Dr. Bernard Lown, cardiologist and Nobel Peace Prize. He taught me in 1997 all these principles and values that today constitute the foundation of my professional career and I wish to share with you.
Therefore, we will be discovering these advances in this blog, which I start today with great enthusiasm, with a solidarity vocation towards patients, as I have learned from Father Garralda.
Dr. Manuel de la Peña MD, PhD
