tag:blogger.com,1999:blog-40603785449670049412024-03-29T11:15:23.247+01:00La consulta del doctor CasadoBLOG DE SALUD, CONSCIENCIA y COMUNICACIÓN (ISSN 2792-8985)La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.comBlogger2702125tag:blogger.com,1999:blog-4060378544967004941.post-88538233836867938442024-03-17T08:17:00.000+01:002024-03-17T08:17:33.543+01:00Empezar. Start.<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNm_xbcvenyKvKwsedF1QilxdsiXQEO-g3kTFllkaFN3UHB_ukKob93aZ6Oz6oXIxJzFg2-2HOl7arGb04TwA33hFBJ0OuVcGl9IZoN-dIfLbI31Env2mK7FqE4Rks6qYtpMT68Q2Uyp0mYMceCoMaDt7oC_BrofPM0ctBkBwDSSpgB9d12MEtc56RMKA/s1290/IMG_5460.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="979" data-original-width="1290" height="304" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNm_xbcvenyKvKwsedF1QilxdsiXQEO-g3kTFllkaFN3UHB_ukKob93aZ6Oz6oXIxJzFg2-2HOl7arGb04TwA33hFBJ0OuVcGl9IZoN-dIfLbI31Env2mK7FqE4Rks6qYtpMT68Q2Uyp0mYMceCoMaDt7oC_BrofPM0ctBkBwDSSpgB9d12MEtc56RMKA/w400-h304/IMG_5460.jpeg" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Cada semana hago unas 14 ecografías. Son ecoscópias rápidas, no me suelen llevar más de 6 minutos. Es verdad que motivan profesionalmente al aumentar la capacidad diagnóstica y poder afinar más y que también lo hacen a nivel personal al desvelar un poquito más esa zona invisible que se oculta al otro lado de la superficie del paciente. Esa posibilidad de mirar más allá siempre me ha fascinado y probablemente sea lo que me ha llevado a elegir ser generalista. Aunque si me paro a pensar, he de reconocer que lo que me sigue dando más satisfacciones es otra tecnología mucho más antigua que el ultrasonido. Para ello sólo necesito un par de sillas y algo de tiempo para escuchar. Cuando le pongo la suficiente atención, los años de experiencia y capacitación me abren puertas a mundos sorprendentes, los que mis pacientes me traen a consulta cada día. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Quizá debería ser más crítico conmigo y reconocer que sigo quedándome fascinado con la tecnología y esperando más de ella de lo que realmente da. Tratar de reconocer la energía y el tiempo de más que dedicó a quien menos lo necesita y lo que realmente ofrezco a los más necesitados. Pero no es fácil, lleno como estoy de traicioneros sesgos cognitivos que, a fin de cuentas, son lo que constituyen lo que llamamos identidad. Por eso, si tengo que empezar a replantearme lo que hago es necesario regresar a la preguntas fundamentales, ¿qué sentido tiene todo esto?, ¿para qué lo hago?, ¿para qué sirve?. Y al mirarlas de cerca sonreír al comprobar que son pura filosofía. Al final todos queremos encontrar el camino hacia una buena vida y un buen ejercicio profesional. Lastima que hoy la niebla informativa nos entorpezca encontrar referentes de calidad que guíen nuestros caminos. Aunque quizá buscar excusas o defendernos con la queja no sean más que fútiles intentos para intentar renegar de nuestra responsabilidad. <b>Pese a las circunstancias es posible desarrollar humanidad</b>, como nos enseñan tantas personas sometidas a las más penosas situaciones. Esa posibilidad es la que siento con fuerza que debo transmitir a mis pacientes. Para ello es fundamental que yo mismo la encarne ante mis propias dificultades. Por eso he decidido detenerme estos meses y hoy acometo esta reflexión. Es verdad que sigue siendo fundamental la denuncia de la injusticia o el error dentro del mundo profesional, pero he acabado agotado de tanta protesta en un medio que es muy difícil de cambiar. <b>Si he de centrarme en algo elijo la relación medico-paciente que sigo considerando lo más valioso que esta profesión puede darme. Lo demás es secundario y como tal lo he de manejar.</b></span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Dado que en mi nuevo destino tengo la posibilidad de ser docente para estudiantes de medicina y residentes creo que puede ser buena idea reorientar este cuaderno virtual en esa dirección. A fin de cuentas uno empieza a comprender algo cuando es capaz de enseñarlo y compartirlo con otros, sea esa la intención que guíe mis pasos.</span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheKPk8qCA0P6tPCYV4HQ5aj5Sp2nyAsZY1DpqhXpz7gMz2yZeZNul5MKOrfz17kKjZ8FvL0-yOuS8qgYttc8FFfE5viixsUcVVOi4LhoDPOPJ0zBR96DLlpQ8B1dUFKJN5NNK8NwimUFwT-WZJpMrgFPgeXhmSvT2pMazfWUgyBmynum5uFFGaieE5CjY/s800/IMG_5459.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="533" data-original-width="800" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheKPk8qCA0P6tPCYV4HQ5aj5Sp2nyAsZY1DpqhXpz7gMz2yZeZNul5MKOrfz17kKjZ8FvL0-yOuS8qgYttc8FFfE5viixsUcVVOi4LhoDPOPJ0zBR96DLlpQ8B1dUFKJN5NNK8NwimUFwT-WZJpMrgFPgeXhmSvT2pMazfWUgyBmynum5uFFGaieE5CjY/w400-h266/IMG_5459.jpeg" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Start</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Every week I do about 14 ultrasound scans. They are quick ultrasounds, they don't usually take me more than 6 minutes. It is true that they are professionally motivating as they increase my diagnostic capacity and allow me to be able to refine my diagnosis, and they are also motivating on a personal level as they reveal a little more of that invisible area that is hidden on the other side of the patient's surface. That possibility of looking beyond has always fascinated me and is probably what led me to choose to become a generalist. But if I think about it, I have to admit that what still gives me the most satisfaction is another technology that is much older than ultrasound. All I need is a couple of chairs and some time to listen. When I pay enough attention to it, years of experience and training open doors to amazing worlds, which my patients bring to me every day. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Perhaps I should be more critical of myself and recognise that I keep getting fascinated with technology and expecting more from it than it actually delivers. Try to recognise the extra energy and time I devote to those who need it least and what I really offer to those who need it most. But it is not easy, filled as I am with treacherous cognitive biases that, in the end, are what constitute what we call identity. So if I am to begin to rethink what I do, it is necessary to go back to the fundamental questions, what is the point of it all, what am I doing it for, what is it good for? . And when you look at them closely, you can smile when you realise that they are pure philosophy. In the end we all want to find the way to a good life and a good professional practice. It is a pity that today's information fog hinders us from finding quality references to guide our paths. Perhaps, however, making excuses or defending ourselves by complaining are nothing more than futile attempts to try to deny our responsibility. In spite of the circumstances, it is possible to develop humanity, as so many people who have been subjected to the most painful situations teach us. It is this possibility that I feel strongly that I must pass on to my patients. In order to do so, it is essential that I myself embody it in the face of my own difficulties. That is why I have decided to pause for a few months and today I am undertaking this reflection. It is true that it is still essential to denounce injustice or error in the professional world, but I have become exhausted by so much protest in an environment that is very difficult to change. If I have to focus on something, I choose the doctor-patient relationship, which I still consider to be the most valuable thing this profession can give me. The rest is secondary and I have to handle it as such.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Since I have the opportunity to teach medical students and residents in my new position, I think it might be a good idea to reorient this virtual notebook in that direction. After all, one begins to understand something when one is able to teach it and share it with others, be that the intention guiding my steps</span><span style="font-size: 13px;">.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><br /></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><br /></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><br /></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><br /></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><br /></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-5315372257920289962024-01-23T12:03:00.003+01:002024-01-23T18:22:55.126+01:00Tomar de tu propia medicina. Take your own medicine. 自己吃药。<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAzaM4oK_rGlx7UuOVj5m9RvtTRSg2paEWu0wgboLEJVQu8zjqzOd-psRZFDYSNwDrXn4X38KvbXtkMu9fdNTtSb0WzuDJq_CeT6H-06Fz-0BlZhvweIozNGUnoWx0v94YbyEX4oVVHVlZPvYoFaYTSMWlDekcExszBGNJRwESEwHIyHaudml8dGUea0M/s891/GEdGIp0XkAAFZbJ.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="891" data-original-width="736" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAzaM4oK_rGlx7UuOVj5m9RvtTRSg2paEWu0wgboLEJVQu8zjqzOd-psRZFDYSNwDrXn4X38KvbXtkMu9fdNTtSb0WzuDJq_CeT6H-06Fz-0BlZhvweIozNGUnoWx0v94YbyEX4oVVHVlZPvYoFaYTSMWlDekcExszBGNJRwESEwHIyHaudml8dGUea0M/w528-h640/GEdGIp0XkAAFZbJ.png" width="528" /></a></div><br /><p></p><br /><div>Me llaman loco/<div>Por no abarcar el mar/</div><div>Con estas manos./<br />
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size: medium;">Cuando uno tiene que tomar de su propia medicina no suele
gustar. Esta semana muchos médicos de familia se han indignado por una pregunta
del examen MIR que expone el caso clínico de un médico de familia sobrecargado
al que las respuestas tratan de diagnosticar de un trastorno de la
personalidad. El dedo se ha metido en una llaga muy sensible, porque en estos
momento un gran número de consultas de pediatría y medicina de familia sufren
un nivel de sobrecarga crónica que exprime a quienes las ocupan
independientemente de la personalidad que tengan. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: medium;">A los médicos de familia se nos programa para diagnosticar y
luego tratar. Solemos ser malos pacientes porque no nos gusta beber de nuestra
propia medicina y ser diagnosticados. Tan es así que pese a la situación de
maltrato institucional que padecemos la mayoría seguimos en el puesto en lugar
de huir que quizá a día de hoy sería lo más sensato. Es verdad que nos quejamos
y lloramos de vez en cuando, pero hasta la fecha no ha habido un reconocimiento
público de maltrato institucional por ninguna organización ni grupo de
facultativos. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: medium;">El verdadero escándalo es seguir tolerando una situación que
no es mantenible. Si oyéramos los gritos de la vecina y sospechásemos una
situación de violencia y malos tratos lo correcto como vecinos sería actuar. En
nuestro caso no es posible porque la mayoría calla su situación o la sobrelleva
como puede. Y la sociedad tampoco dice nada, padecen el aumento de los tiempos
de espera y también se quejan, pero nadie toma conciencia del drama de un
médico que tenga que ver, además de los propios pacientes, de otro facultativo
ausente.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: medium;">En la hermosa película <b>Perfect Days</b> se nos muestran quince
días de la vida del protagonista de los que consigue salir bien librado
catorce. El día que toca sobrecarga laboral no le sale bien al pobre. Imaginen
que la sobrecarga es permanente…<o:p></o:p></span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJG4qdyUeFeMs34nPpbWW9ShqeaFYLV3JBcesbEe86wVyRqqxWFzQTpBkpBA4pZq9WRbHuA_N5jFtfjkdem6LbUyMmQyeOQ9YYY_TrMfwhJZ7NoE2J_i7VwEcH4dGmP5Py4qtZAai7r_Z5FRE7tCycgJEqsMIcPixj0QGgnrDhr2awt0tAEUvLA1zMLj0/s1200/Perfect_Days-351113356-large.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="790" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJG4qdyUeFeMs34nPpbWW9ShqeaFYLV3JBcesbEe86wVyRqqxWFzQTpBkpBA4pZq9WRbHuA_N5jFtfjkdem6LbUyMmQyeOQ9YYY_TrMfwhJZ7NoE2J_i7VwEcH4dGmP5Py4qtZAai7r_Z5FRE7tCycgJEqsMIcPixj0QGgnrDhr2awt0tAEUvLA1zMLj0/w264-h400/Perfect_Days-351113356-large.jpg" width="264" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><b><span style="font-size: medium;">Take your own medicine.</span></b></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;">When you have to take your own medicine you usually don't like it. This week, many family doctors have been outraged by a question on the MIR exam that exposes the clinical case of an overloaded family doctor whose answers try to diagnose a personality disorder. The finger has been put into a very sensitive sore, because at this time a large number of pediatric and family medicine consultations suffer from a level of chronic overload that squeezes those who occupy them regardless of their personality.</span></p><p class="MsoNormal"><span style="font-size: medium;">Family doctors are programmed to diagnose and then treat. We tend to be bad patients because we don't like drinking our own medicine and being diagnosed. So much so that despite the situation of institutional abuse that most of us suffer, we continue in our jobs instead of fleeing, which perhaps today would be the most sensible thing to do. It is true that we complain and cry from time to time, but to date there has been no public acknowledgment of institutional mistreatment by any organization or group of physicians.</span></p><p class="MsoNormal"><span style="font-size: medium;">The real scandal is continuing to tolerate a situation that is not maintainable. If we heard the neighbor's screams and suspected a situation of violence and abuse, the right thing as neighbors would be to act. In our case it is not possible because the majority remains silent about their situation or copes with it as best they can. And society doesn't say anything either, they suffer from the increase in waiting times and they also complain, but no one is aware of the drama of a doctor who has to deal, in addition to the patients themselves, with another absent doctor.</span></p><p class="MsoNormal"><span style="font-size: medium;">In the beautiful film Perfect Days we are shown fifteen days in the life of the protagonist, of which he manages to get away with fourteen. The day that comes with work overload does not go well for the poor guy. Imagine that the overload is permanent...</span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqqxyhqfHBV8l5_O8xO_4G50oDI4iVu9QBszCDA15gbUtFdG0eTs7GI5DMHNukJPbReqzXptiJ9SIB9M1WrO86UUl00PgJLLiYx0k-ETJaI5ZPR83-Bry0c9l17lof_vDV9ig-QZWESGfHsMsic0p4cbhVX-XANhsbfdGwqhDsx136tyesWm8LVrLlfIA/s2048/GEeX1QzWIAAHZvc%20(1).png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1613" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqqxyhqfHBV8l5_O8xO_4G50oDI4iVu9QBszCDA15gbUtFdG0eTs7GI5DMHNukJPbReqzXptiJ9SIB9M1WrO86UUl00PgJLLiYx0k-ETJaI5ZPR83-Bry0c9l17lof_vDV9ig-QZWESGfHsMsic0p4cbhVX-XANhsbfdGwqhDsx136tyesWm8LVrLlfIA/w504-h640/GEeX1QzWIAAHZvc%20(1).png" width="504" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;"><b>自己吃药。</b></span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;">自动翻译,如有错误敬请谅解。</span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;">当您必须自己服药时,您通常不喜欢它。 本周,许多家庭医生对 MIR 考试中的一个问题感到愤怒,该问题揭露了一名家庭医生超负荷的临床案例,其答案试图诊断人格障碍。 手指已经被放入一个非常敏感的疮处,因为此时大量的儿科和家庭医学咨询都承受着一定程度的慢性超负荷,这挤压了那些占用它们的人,无论他们的性格如何。</span></p><p class="MsoNormal"><span style="font-size: medium;">家庭医生的职责是诊断然后治疗。 我们往往是坏病人,因为我们不喜欢喝自己的药和被诊断。 正因如此,尽管我们大多数人都遭受了制度虐待,但我们仍然继续工作而不是逃跑,这也许是今天最明智的做法。 确实,我们时不时地抱怨和哭泣,但迄今为止,还没有任何组织或医生团体公开承认机构虐待。</span></p><p class="MsoNormal"><span style="font-size: medium;">真正的丑闻是继续容忍一种无法维持的局面。 如果我们听到邻居的尖叫声并怀疑存在暴力和虐待情况,作为邻居,正确的做法就是采取行动。 在我们的例子中,这是不可能的,因为大多数人对他们的处境保持沉默或尽力应对。 社会也没有说什么,他们因等待时间的增加而痛苦,他们也抱怨,但没有人意识到医生除了病人自己之外还必须与另一位缺席的医生打交道的戏剧性。</span></p><p class="MsoNormal"><span style="font-size: medium;">在美丽的电影《完美的日子》中,我们向我们展示了主角十五天的生活,其中他成功地度过了十四天。 对于这个可怜的家伙来说,超负荷工作的日子并不好过。 想象一下超载是永久性的......</span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrNiCVYSWdpwADanRPfILucYd2lUbA-ELTjPoTrdDwV5X3NOa8qEptQ9a87GRd3zWHz8ZQdx0zL3NlvOV9wesdSzzjgiFC2tQ4fTQEZpsPJ0crFWyv0XSX2c3LFhHQdIGQ0AFtT5ojWd1FfUEg9_X_lTlmwoX4G45mjtYy-v_5P-FFqehjYmbL9SVr7WI/s1480/c93e2720-ac8b-4c7e-a9f3-044d1aed86e5.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1480" data-original-width="720" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrNiCVYSWdpwADanRPfILucYd2lUbA-ELTjPoTrdDwV5X3NOa8qEptQ9a87GRd3zWHz8ZQdx0zL3NlvOV9wesdSzzjgiFC2tQ4fTQEZpsPJ0crFWyv0XSX2c3LFhHQdIGQ0AFtT5ojWd1FfUEg9_X_lTlmwoX4G45mjtYy-v_5P-FFqehjYmbL9SVr7WI/w312-h640/c93e2720-ac8b-4c7e-a9f3-044d1aed86e5.jpeg" width="312" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p></div></div>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-76696263802696359992024-01-13T12:37:00.004+01:002024-01-13T12:37:34.745+01:00La concha. The shell. 贝壳<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigK8dOgE4iKoNcOcHOdnpadPAb4h8NK2E9s8Yws3X73l1AjNIXttyVMXtQ8HnGsj1tdjpqCqw-wJX346u0gwei_yJs4uqLyQojye8A9G6MvevhY8YapOMLkqmUyEObsNOjA885gO185VEnrJqzv8h8Y9q0fFn1sTynJMFeDHdlFywVXTTN0EvOrZopiEM/s1310/IMG_5411.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="1310" data-original-width="1080" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigK8dOgE4iKoNcOcHOdnpadPAb4h8NK2E9s8Yws3X73l1AjNIXttyVMXtQ8HnGsj1tdjpqCqw-wJX346u0gwei_yJs4uqLyQojye8A9G6MvevhY8YapOMLkqmUyEObsNOjA885gO185VEnrJqzv8h8Y9q0fFn1sTynJMFeDHdlFywVXTTN0EvOrZopiEM/w330-h400/IMG_5411.jpeg" width="330" /></span></a></div><span style="font-size: medium;"><br /><br /></span><p></p><p><span style="font-size: medium;"><br /></span></p><p><br /></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Los bivalbos son seres acuáticos de carnes blandas que tienden a vivir protegidos de las adversidades dentro de una concha calcárea que mantienen cerradas y a ratos abren para aspirar las partículas que las corrientes les proveen. Creo necesario poner un momento nuestra atención en ellos para mirarnos como en un espejo, pues al contemplarlos vemos millones de años de evolución biológica en un diseño simple y robusto capaz de sobrevivir meteoritos, maremotos y cambios climáticos, algo que quizá nuestra sofisticada especie no consiga. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">De alguna forma en nuestra sociedad de la información nos estamos convirtiendo en bivalvos, seres metidos dentro de una burbuja rígida que pese a poder vivir rodeados de otros muchos pierden la habilidad de compartir el mismo espacio. Quizá aspiremos las mismas aguas y partículas parecidas, aunque cada cual sienta que su menú de contenidos es exclusivo. Lógicamente es una falacia, las compañías que nos proveen de información la trocean según nuestro gustos pero con un poco de distancia queda claro que es la misma sopa para todos. De esta forma cada cual pasa sus días filtrando litros y litros de agua salada para al final conseguir un puñado de migajas que nos permita seguir con vida digital. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Hoy escuchaba a un adolescente decir que se había quitado de Instagram, harto de consumir la misma dieta insípida. Recordé la que tenía yo con su edad a base de los primeros videojuegos que llegaron a los primeros ordenadores y consolas, un alimento terrible que nos encantaba a todos y que consumimos hasta el hartazgo más absoluto que nos hizo retornar poco a poco al mundo real. Me temo que hoy la situación es más complicada y pocos tienen la autentica capacidad de apagar definitivamente sus aparatos electrónicos. Lo que veo más bien es que las burbujas que nos rodean, que inicialmente eran plásticas, transparentes y flexibles, se van convirtiendo en conchas rígidas que remedan la del mejillón. Y es que lo que escuchamos cada vez es menos diverso y más rígido, áspero y moral. Las redes sociales nos etiquetan y de este modo nos clasifican y dividen. Azules frente a rojos, amarillos frente a morados, listos frente a tontos, morales frente a amorales, y así hasta el infinito. La plaza digital es pues una bronca permanente que genera ruido y peleas infinitas que se terminan pegando al exterior de nuestras conchas añadiendo una capa de un apestoso chapapote que nos anima a mantenernos más cerrados si cabe. De dialogar nos estamos olvidando, de abrirnos a la diversidad también. Esta pérdida de tolerancia a lo distinto es de gran toxicidad, perdemos la capacidad de pensar por nosotros, sin las ideas no propias no podemos seguir construyendo nuevas propuestas. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Los que tengan la protección de una familia o comunidad humana alrededor y quizá la suficiente cultura y sensibilidad quizá puedan defenderse de la marea negra que aparentemente nos rodea. Nunca habían sido tan necesarias las viejas narrativas de la literatura, la música, las demás bellas artes, la historia y la filosofía. Necesitamos recurrir a todos esos sabios que nos legaron desde antiguo las cartografías de la mente y el corazón humanos. La sabiduría en piedra de aquellos templos, las pinturas al fresco o en vasijas, los objetos, la arquitectura, todos sus intentos de hacer perdurar un mensaje que sigue siendo válido porque sigue hablando de la dificultad humana. Queremos ser dioses y no damos la talla. Queremos desear como dioses, consumir como dioses, ser honrados como dioses. Y al final nos comportamos como un puñado de monos agresivos enseñando los dientes o golpeándonos unos a otros con garrotes. Al final terminamos metiendo nuestro orgullo dentro de una concha, y cerrando la puerta, sin imaginar que al hacerlo nos morimos en vida. </span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><b><span style="font-size: medium;">The shell</span></b></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Bivalves are aquatic beings with soft flesh that tend to live protected from adversity within a calcareous shell that they keep closed and at times open to inhale the particles that the currents provide them. I think it is necessary to pay our attention to them for a moment to look at ourselves as in a mirror, because when we contemplate them we see millions of years of biological evolution in a simple and robust design capable of surviving meteorites, tidal waves and climate changes, something that perhaps our sophisticated species cannot achieve. .</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Somehow in our information society we are becoming bivalves, beings stuck inside a rigid bubble that, despite being able to live surrounded by many others, lose the ability to share the same space. Perhaps we inhale the same waters and similar particles, although each one feels that their menu of content is exclusive. Logically it is a fallacy, the companies that provide us with information cut it according to our tastes but with a little distance it is clear that it is the same soup for everyone. In this way, everyone spends their days filtering liters and liters of salt water to finally get a handful of crumbs that allow us to continue with our digital life.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Today I was listening to a teenager say that he had quit Instagram, tired of consuming the same bland diet. I remembered what I had at his age based on the first video games that came to the first computers and consoles, a terrible food that we all loved and that we consumed to the point of absolute satiety that made us return little by little to the real world. I fear that today the situation is more complicated and few have the true ability to permanently turn off their electronic devices. What I see rather is that the bubbles that surround us, which were initially plastic, transparent and flexible, are becoming rigid shells that mimic that of the mussel. And what we hear is less and less diverse and more rigid, harsh and moral. Social networks label us and in this way they classify and divide us. Blues versus reds, yellows versus purples, smart versus stupid, moral versus amoral, and so on ad infinitum. The digital plaza is therefore a permanent fight that generates noise and infinite fights that end up sticking to the outside of our shells, adding a layer of stinking chapapote that encourages us to remain more closed if possible. We are forgetting to dialogue, to open ourselves to diversity as well. This loss of tolerance to what is different is highly toxic, we lose the ability to think for ourselves, without ideas that are not our own we cannot continue building new proposals.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Those who have the protection of a family or human community around them and perhaps sufficient culture and sensitivity may be able to defend themselves from the oil spill that apparently surrounds us. Never have the old narratives of literature, music, the other fine arts, history and philosophy been so necessary. We need to turn to all those wise men who bequeathed us from ancient times the cartographies of the human mind and heart. The wisdom in stone of those temples, the fresco paintings or on vessels, the objects, the architecture, all their attempts to make a message endure that remains valid because it continues to speak of human difficulty. We want to be gods and we don't measure up. We want to desire like gods, consume like gods, be honored like gods. And in the end we behaved like a bunch of aggressive monkeys, baring our teeth or hitting each other with clubs. In the end we end up putting our pride inside a shell, and closing the door, without imagining that by doing so we will die alive.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><b><span style="font-size: medium;">贝壳</span></b></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">自动翻译,如有错误敬请谅解。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">双壳类是一种水生生物,肉质柔软,通常生活在石灰质的外壳内,以免受逆境的影响,它们保持关闭状态,有时张开以吸入海流提供的颗粒。 我认为我们有必要暂时关注它们,像照镜子一样审视自己,因为当我们思考它们时,我们会看到数百万年的生物进化,其设计简单而坚固,能够在陨石、潮汐和海啸中幸存下来。气候变化,也许我们复杂的物种无法实现。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">不知何故,在我们的信息社会中,我们正在变成双壳类,被困在一个刚性泡沫中的生物,尽管能够生活在许多其他人的包围中,但却失去了共享同一空间的能力。 也许我们吸入相同的水和相似的颗粒,尽管每个人都觉得他们的内容菜单是独一无二的。 从逻辑上讲,这是一个谬论,为我们提供信息的公司根据我们的口味来切割它,但有一点距离,很明显,这对每个人来说都是一样的汤。 通过这种方式,每个人每天都在过滤一升又一升的盐水,最终得到一把面包屑,让我们能够继续我们的数字生活。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">今天,我听到一个青少年说他已经退出 Instagram,厌倦了同样清淡的饮食。 我记得我在他这个年纪吃过的东西是基于第一台电脑和游戏机上的第一批视频游戏,这是一种我们都喜欢的可怕食物,我们吃到绝对饱腹感,让我们一点一点回到真实的状态。世界。 我担心今天的情况更加复杂,很少有人真正有能力永久关闭他们的电子设备。 我看到的是,我们周围的气泡最初是塑料的、透明的、有弹性的,现在正在变成模仿贻贝的坚硬外壳。 我们听到的内容越来越不多样化,越来越僵化、严厉和道德化。 社交网络给我们贴上标签,并以这种方式对我们进行分类和划分。 蓝色与红色、黄色与紫色、聪明与愚蠢、道德与非道德,如此循环往复。 因此,数字广场是一场永久的战斗,会产生噪音和无限的战斗,最终粘在我们的外壳外面,增加了一层臭气熏天的薄饼,鼓励我们尽可能保持封闭。 我们忘记了对话,也忘记了向多样性开放。 这种对不同事物的容忍度的丧失是剧毒的,我们失去了独立思考的能力,如果没有不属于我们自己的想法,我们就无法继续提出新的建议。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">那些受到周围家庭或人类社区保护的人,或许还有足够的文化和敏感性,也许能够保护自己免受明显围绕我们的石油泄漏的影响。 文学、音乐、其他美术、历史和哲学的古老叙事从未如此必要。 我们需要求助于所有自古以来为我们留下人类思想和心灵地图的智者。 这些寺庙的石头、壁画或器皿、物品、建筑上的智慧,以及他们所有的尝试,使信息持久有效,因为它继续讲述着人类的困难。 我们想成为神,但我们达不到标准。 我们想要像神一样渴望,像神一样消费,像神一样受到尊重。 最后我们表现得像一群好斗的猴子,露出牙齿或用棍棒互相殴打。 最后,我们把骄傲收进了壳里,关上了门,却没有想到我们会因此而死。</span></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-42821570899939555942024-01-02T08:20:00.000+01:002024-01-02T08:20:26.595+01:00 El gran empacho. The Big Binge. 大吃大喝<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRFygs6C2O0iUDtl0AHUeHFfAuPZJf6doG6b8Fw4EjfVvB80qb9JqCryIgzM3WhbGuJmjl4KizKjCI2O3jQvthf-_i-HUMHTNwkpwdx6acjv_QB5hzIn3vn0voo1Uzze8RyUFI5g5B8j51gQ8EhPj-a3QVLyrMnfmxAI5JPTH8q1GdTRcWYEzZs0yaIDU/s3225/IMG_5371.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="3225" data-original-width="2363" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRFygs6C2O0iUDtl0AHUeHFfAuPZJf6doG6b8Fw4EjfVvB80qb9JqCryIgzM3WhbGuJmjl4KizKjCI2O3jQvthf-_i-HUMHTNwkpwdx6acjv_QB5hzIn3vn0voo1Uzze8RyUFI5g5B8j51gQ8EhPj-a3QVLyrMnfmxAI5JPTH8q1GdTRcWYEzZs0yaIDU/w293-h400/IMG_5371.jpeg" width="293" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Banquetear ha sido siempre un arte, tanto para conseguir invitaciones como para una vez dentro no derrapar en el exceso. Acometiendo la recta de salida de los fastos navideños vemos una gran multitud aquejada de diversos empachos. En esta ocasión no hay problema de que me ponga el primero dado que he sufrido exceso de secreciones en la trompa de Eustaquio, bronquios y demás, así como una turbamulta digestiva y alguna sobrecarga cognitiva. De los polvorones afectivos mejor no hablamos. El resultado es una situación de sorda incomodidad que suspira por una única cosa: el alivio. Según el negociado afectado vendrá antes o después, pero siempre podremos decir: dichosos son los que se alivian.</span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Como sociedad tenemos que reconocer que estamos empachados. Demasiado ruido, demasiada prisa, demasiadas malas noticias, demasiado agobio, demasiada incertidumbre. Este estado puede servir para acelerar hasta un punto la rueda pero si cruzamos la línea roja nos arriesgamos literalmente a reventar. Y aquí cada cual tiene un poquito de responsabilidad a la hora de alimentar esta marabunta colectiva dado que cada queja, insulto, mentira o exabrupto que vertemos alimenta la pira de esa hoguera de las vanidades. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">En la consulta me toca atender cada semana una larga fila de empachos. Gente empachada con su jefe, con los compañeros de trabajo, con la pareja, con la familia, con la suegra, con todos a la vez. Empachos por el perro del vecino, por el novio de la hija, por no cuadrar las cuentas, por no conseguir digerir la soledad. Algunos vienen pidiendo un análisis porque se encuentran cansados sin sospechar aún el empacho que padecen, otros llegan llorando totalmente desesperados, los hay que llegan hiperventilando y sintiéndose a las puertas de la muerte. A todos, sin excepción, los recibo con delicadeza conociendo bien lo que duele un empacho. Los escucho, los acompaño y espero a que se vayan serenado hasta conseguir la disposición de pasar al baño y aliviarse. A veces son horas, a veces días, a veces meses. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Mi nivel personal de empacho influye bastante estos procesos. Cuando voy más ligero suelo tener más paciencia. En cualquier caso dadas mis tablas no suelo cometer graves desatinos. Los temo, eso sí, ante circunstancias de alta presión mantenida no hay tabla que valga, lo sé de buena tinta. Por eso las actuales circunstancias de desastre en la Atención Primaria donde trabajo me preocupan. Hay un gran porcentaje de médicos en riesgo alto de empacho profesional que precisan protección y ayuda. Seguimos sin conseguir tomar medidas que lo hagan. Y ya llegamos tarde. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Estas navidades van a pegar fuerte en los centros de salud al haber venido el pico de la epidemia de gripe antes de las reuniones familiares. Todo volverá a arder, un año más. Pero la paliza ya no le ocurre a un joven residente, le pasa factura a un sistema a punto de la jubilación. Y claro, no es lo mismo. </span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipWVvatg-7kOJvVnlhZ9svigOvekwsx1ISqzi9Q_IgnpDYIx9Ng0FWGbanUyCLMMIZ4P36JAJ5t3LiIhqImtG-upCHonsehp0791TyKkPcTNJ4yCfFq2b7tnaTIB6aNrbZ6M3nqiBcunmIT0S7DWvKbddQukvV7rYcvaYS71eSQu86JEELdy3YbfnHV5A/s1088/IMG_5406.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="974" data-original-width="1088" height="286" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipWVvatg-7kOJvVnlhZ9svigOvekwsx1ISqzi9Q_IgnpDYIx9Ng0FWGbanUyCLMMIZ4P36JAJ5t3LiIhqImtG-upCHonsehp0791TyKkPcTNJ4yCfFq2b7tnaTIB6aNrbZ6M3nqiBcunmIT0S7DWvKbddQukvV7rYcvaYS71eSQu86JEELdy3YbfnHV5A/s320/IMG_5406.jpeg" width="320" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><b>The Big Binge</b> </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Banqueting has always been an art, both to get invitations and, once inside, to avoid slipping into excess. As we head down the home stretch of the Christmas festivities, we see a large crowd suffering from a variety of indulgences. On this occasion it is not a problem for me to be the first, given that I have suffered from excess secretions in the Eustachian tube, bronchi and others, as well as a digestive turmoil and some cognitive overload. It would be better not to talk about the affective dusty stuff. The result is a situation of dull discomfort that yearns for only one thing: relief. Depending on the business concerned, it will come sooner or later, but we can always say: blessed are those who are relieved.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">As a society we have to recognise that we are overloaded. Too much noise, too much haste, too much bad news, too much anxiety, too much uncertainty. This state may serve to speed up the wheel to a certain extent, but if we cross the red line we risk literally bursting. And here everyone has a little responsibility when it comes to fuelling this collective tidal wave, since every complaint, insult, lie or outburst that we pour out feeds the pyre of this bonfire of vanities. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">In the consulting room I have to deal with a long line of empachos every week. People who are fed up with their boss, with their work colleagues, with their partner, with their family, with their mother-in-law, with all of them at the same time. Fevers for the neighbour's dog, for the daughter's boyfriend, for not being able to balance the accounts, for not being able to digest loneliness. Some come asking for an analysis because they are tired without even suspecting that they are suffering from a binge, others arrive crying, totally desperate, some arrive hyperventilating and feeling at death's door. All of them, without exception, I receive them with gentleness, knowing well how much it hurts to be sick. I listen to them, accompany them and wait for them to calm down until they are ready to go to the bathroom and relieve themselves. Sometimes it takes hours, sometimes days, sometimes months. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">My personal level of empacho influences these processes quite a lot. When I am lighter I tend to be more patient. In any case, given my level, I don't usually commit serious blunders. I do fear them, however, in circumstances of sustained high pressure there is no board that is worth it, I know that for a fact. That is why the current circumstances of disaster in primary care where I work worry me. There is a large percentage of doctors at high risk of professional embarrassment who need protection and help. We are still failing to take action to do so. And we are already too late. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">This Christmas is going to hit health centres hard as the peak of the flu epidemic has come before family gatherings. Everything will be on fire again, for another year. But the beating no longer happens to a young resident, it takes its toll on a system on the verge of retirement. And of course, it's not the same.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRPEP9-mCguWyLJvcK38Pcsj-NCr9staKI0tC03WsAfE8Ta4WIe9zqOSli97mDi8vCl4sQ5n15o7UltKBDJCtJwH05-r7PlCaemS1BOpPIJBvwB5l-EXJbbY13AS_T9etYvRkOHYUsMuW46bmbC3GHkse2IMq5DvvXRvFCnWs7nH6NAygZ6ee3l0UV4bY/s719/IMG_5343.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="719" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRPEP9-mCguWyLJvcK38Pcsj-NCr9staKI0tC03WsAfE8Ta4WIe9zqOSli97mDi8vCl4sQ5n15o7UltKBDJCtJwH05-r7PlCaemS1BOpPIJBvwB5l-EXJbbY13AS_T9etYvRkOHYUsMuW46bmbC3GHkse2IMq5DvvXRvFCnWs7nH6NAygZ6ee3l0UV4bY/w400-h300/IMG_5343.jpeg" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><b><span style="font-size: medium;">大吃大喝</span></b></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">机器翻译,抱歉有误。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">宴会一直是一门艺术,既要获得邀请,又要在入席后避免过度狂欢。随着圣诞庆祝活动的开始,我们会看到一大群人因各种放纵而痛苦不堪。在这个场合,对我来说,做第一个人不成问题,因为我的咽鼓管、支气管等分泌物过多,消化系统紊乱,认知能力超负荷。情感方面的尘事还是不说为好。其结果是一种沉闷的不适感,只渴望一种东西:缓解。根据相关业务的不同,缓解或早或晚都会到来,但我们总是可以说:那些得到缓解的人是有福的。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">作为一个社会,我们必须认识到,我们的负担过重。太多的喧嚣、太多的匆忙、太多的坏消息、太多的焦虑、太多的不确定性。这种状态可能会在一定程度上加速车轮的前进,但如果我们越过了红线,就会面临真正爆裂的危险。在这里,每个人都有一点责任为这股集体浪潮推波助澜,因为我们的每一句抱怨、侮辱、谎言或发泄都会为这堆虚荣的篝火提供燃料。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">在咨询室里,我每周都要面对一长串的 "怨妇"。他们对老板、同事、伴侣、家人、婆婆,甚至同时对所有这些人都感到厌烦。因为邻居家的狗,因为女儿的男朋友,因为无法平衡账目,因为无法消化孤独而发烧。有些人因为疲倦而前来要求分析,却根本没有怀疑自己患上了嗜睡症;有些人则是哭着来的,完全绝望了;有些人则是呼吸急促,感觉就快死了。他们无一例外,我都会温柔地接待他们,因为我深知生病的痛苦。我倾听他们的诉说,陪伴他们,等待他们平静下来,直到他们准备好去卫生间解手。有时需要几个小时,有时需要几天,有时需要几个月。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">我个人的体质对这些过程影响很大。当我体重较轻时,我会更有耐心。无论如何,鉴于我的水平,我通常不会犯严重的错误。不过,在持续高压的情况下,我确实害怕犯错误,因为我知道,没有什么板子是值得犯错误的。这就是为什么我工作的基层医疗机构目前的灾难情况让我担心。有很大一部分医生处于职业尴尬的高风险之中,他们需要保护和帮助。我们仍然没有为此采取行动。我们已经为时已晚。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">今年的圣诞节将对保健中心造成沉重打击,因为流感疫情的高峰期已在家庭聚会之前到来。一切又将火上浇油,又是一年。但是,殴打不再发生在年轻的居民身上,它使濒临退休的系统付出代价。当然,这也是不一样的。</span></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-5575957935995832502024-01-01T10:14:00.001+01:002024-01-01T10:14:36.135+01:00It´s a question of time.<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_8z7t6kNwp8IpBGFG2EhDF05ajeUsVrYYmYOfy-7kUg7n5CbGG7Z07XOZ94_ZgutRX_9qVakuHoNzNxkEErxvcj114mr8jw7rKxnuLW0MSsPmtXAz2YGx4Q5e_6kJMla1C6RcnCfVuBc2-4VYaqYz-HSqRevPqVcOh58A8_HaAa0Pdns0U1BYucmZyxQ/s1200/IMG_5298.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="1200" data-original-width="840" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_8z7t6kNwp8IpBGFG2EhDF05ajeUsVrYYmYOfy-7kUg7n5CbGG7Z07XOZ94_ZgutRX_9qVakuHoNzNxkEErxvcj114mr8jw7rKxnuLW0MSsPmtXAz2YGx4Q5e_6kJMla1C6RcnCfVuBc2-4VYaqYz-HSqRevPqVcOh58A8_HaAa0Pdns0U1BYucmZyxQ/w280-h400/IMG_5298.jpeg" width="280" /></span></a></div><span style="font-size: medium;"><br /> </span><p></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Qué mejor manera de empezar el primer día de año que convirtiendo en texto la oscuras intuiciones que el sueño y la pesadilla han vertido en mis arenas en una noche más padeciendo otro episodio COVID cual Sísifo penitente. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Así estamos, con cierto empacho digestivo y respiratorio, pero no les aburriré, vayamos al asunto. Hace unos años hice pública una teoría de la mano de mi amigo Nicolás Fabelo: <a href="https://www.huffingtonpost.es/salvador-casado/la-muerte-como-asintota_b_8553332.html">La muerte como asíntota</a>. Como somos de andar por casa en lugar de publicarla en una revista filosófica o científica lo hicimos en el Huffington post, nos perdonarán. En ella contemplamos el proceso de morir haciendo un símil donde la consciencia sería luz que se acerca al horizonte de sucesos. Esta hipersuperficie delimita dos tipos de espacio tiempo, el del universo conocido y el de la otra parte que aún no conocemos. La teoría nos dice que no hay tiempo allá, es decir que al otro lado todo existe sin esa dimensión. Aunque sí parece existir temperatura, una décimas de grado Kelvin, lo que quizá no dé alguna pista de la posibilidad de un pequeñísimo margen de tiempo que permita algún movimiento, pero no nos engañemos, lo que digamos del otro lado son tan solo hipótesis.</span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Bueno volvamos a nuestra hipótesis, el sujeto al morir se acercaría a su propio horizonte de sucesos y al estar muy cerca su tiempo se curvaría como lo hace la luz al acercarse al agujero negro, eso permitiría que toda la vida pasara ante los ojos, antes de que la luz se apague del todo y el tiempo desaparezca. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Ahí lo dejábamos. Lo que ha pasado esta noche es que mi sueño se ha llenado de aborígenes australianos, tribus perdidas africanas, chamanes del norte y todo tipo de viajeros de tiempo. Incluso si miro bien había algún griego, en Delfos tenían un centro pionero. Aunque les parezca increíble viajar en el tiempo ha sido fundamental para la supervivencia del ser humano. Y al igual que aprendimos el difícil arte de viajar por las tres dimensiones del espacio lo hicimos con la dimensión temporal. Elon Musk es un advenedizo comparado con los valientes polinesios que se enfrentaron al Pacífico, los griegos que salieron en barco del mediterráneo o los vikingos que llegaron a Terranova, entre otros muchos valientes. Pero ¿por qué era tan importante viajar? Sencillamente por que cuando vienen mal dadas no hay más opción. Si estamos hoy sufriendo los excesos navideños es gracias a todos aquellos que se lanzaron a viajes imposibles. También en el tiempo. Con frecuencia era necesario acercarse al mundo de los dioses y espíritus que es como durante mucho tiempo se ha llamado al horizonte de sucesos de la metafísica. El experto inducía un trance, modificaba su conciencia o la de otra persona y se acercaba a esa frontera para buscar respuestas. Se utilizó música, ritmo, danza, drogas y se indujeron sueños. Tenían claro que no se podía uno meter ahí con la consciencia habitual, “nadie puede mirar a dios y seguir vivo”. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Por eso hoy les traigo otro bucle extraño de consciencia y tiempo, el que forma el místico aportando su atención contemplativa por un lado y el que forma el lado metafísico aportando presencia por el otro. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Imaginen a su sabio o místico favorito en actitud meditativa. Su intención es contemplar la luz divina, ser iluminado. Para ello habitualmente aquietará su cuerpo y concentrará su atención el algo que le ayude a abrirse a lo infinito. No hace falta ser un genio es esto, a ustedes quizá les habrá pasado que dando un paseo por algún paraje natural empiezan a experimentar un alivio en el peso de sus preocupaciones y una apertura ante algo que les supera en belleza, armonía, espacio y tiempo. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Es esta la paradoja de los dos tiempos, el humano, flexible, corriente y unido a la vida y al dolor, y el llamémosle divino, inflexible, inmutable y separado de lo vivo y lo sufriente. El ser humano para ser pleno requiere un poco del otro tiempo, la “presencia de Dios”, y probablemente lo metafísico también requiera la atención contemplativa del humano para dar plenitud a su existencia. Aquí ya me estoy arriesgado demasiado, la teología defiende que un Dios pluripotencial no necesita absolutamente nada del ser humano ni de criatura alguna, por eso tan solo apunto que aunque no lo necesite igual no le viene mal del todo: ¿Qué sería de un dios que no pudiera ser contemplado, descubierto, amado?. Y ya tendrían el Inn y el Yang formado, en un bucle infinito que nos abre oportunidades de encontrar sentido y respuestas que de otra forma serían imposibles. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Bueno amigos ahí les dejo. Espero que puedan disfrutar de una feliz jornada en la que quizá quepa alguna sonrisa.</span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWWnB_Y973yWTw6fqIDq_CXOSyiqhcWec5U9dp149bfinyIGjfxqhwOHQUxISn5L3XoSDjoMDnXcQc-WQw6nW0pLCZWN1nVUGqWZC-3BkfGqjjR6udngztgiqC7oIMBipgvjtbmfSqxTVcnCC-nY5HlZp-yKQ8SSbnmXtSIMBQLy8BsH3jPPb9NiY4TRM/s4032/IMG_4001.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="3024" data-original-width="4032" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWWnB_Y973yWTw6fqIDq_CXOSyiqhcWec5U9dp149bfinyIGjfxqhwOHQUxISn5L3XoSDjoMDnXcQc-WQw6nW0pLCZWN1nVUGqWZC-3BkfGqjjR6udngztgiqC7oIMBipgvjtbmfSqxTVcnCC-nY5HlZp-yKQ8SSbnmXtSIMBQLy8BsH3jPPb9NiY4TRM/w400-h300/IMG_4001.jpeg" width="400" /></span></a></div><span style="font-size: medium;"><br /><span style="font-family: Palatino-Roman;"><br /></span></span><p></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><b>It's a question of time</b>.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">What better way to start the first day of the year than turning into text the dark intuitions that dream and nightmare have poured into my sands on yet another night suffering another COVID episode like a penitent Sisyphus. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">So here we are, with a certain digestive and respiratory cramp, but I won't bore you, let's get down to business. A few years ago I published a theory by the hand of my friend Nicolás Fabelo: Death as an asymptote. As we're a homebody, instead of publishing it in a philosophical or scientific journal, we did it in the Huffington post, so you'll forgive us. In it we contemplate the process of dying by making a simile where consciousness would be light approaching the event horizon. This hypersurface delimits two types of spacetime, that of the known universe and that of the other part that we do not yet know. The theory tells us that there is no time there, i.e. everything on the other side exists without that dimension. Although there does seem to be temperature, a tenth of a degree Kelvin, which may not give any clue to the possibility of a tiny margin of time that allows some movement, but let's not fool ourselves, what we say on the other side are only hypotheses.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Well let's go back to our hypothesis, the subject at death would approach its own event horizon and being very close its time would bend as light does when approaching the black hole, that would allow all life to pass before the eyes, before the light is completely extinguished and time disappears. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">That's where we left off. What happened tonight is that my dream was filled with Australian aborigines, lost African tribes, northern shamans and all sorts of time travellers. Even if I look closely there were some Greeks, at Delphi they had a pioneering centre. Incredible as it may seem to you, time travel has been fundamental to human survival. And just as we learned the difficult art of travelling through the three dimensions of space, we did the same with the time dimension. Elon Musk is an upstart compared to the brave Polynesians who braved the Pacific, the Greeks who sailed out of the Mediterranean or the Vikings who reached Newfoundland, among many other brave people. But why was it so important to travel? Simply because when the going gets tough there is no other option. If we are suffering the excesses of Christmas today, it is thanks to all those who embarked on impossible journeys. Also in time. It was often necessary to approach the world of gods and spirits, which is what the event horizon of metaphysics has long been called. The expert induced a trance, modified his or someone else's consciousness and approached that boundary to seek answers. Music, rhythm, dance, drugs and induced dreams were used. It was clear to them that you couldn't go in there with your usual consciousness, "no one can look at god and still be alive". </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">So today I bring you another strange loop of consciousness and time, the one formed by the mystic bringing his contemplative attention on the one hand and the one formed by the metaphysical side bringing presence on the other. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Imagine your favourite sage or mystic in a meditative attitude. His intention is to contemplate the divine light, to be enlightened. To do this he will usually still his body and concentrate his attention on something that will help him to open up to the infinite. You don't need to be a genius to do this, it may have happened to you that while taking a walk in a natural setting you begin to experience a relief from the weight of your worries and an openness to something that surpasses you in beauty, harmony, space and time. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">This is the paradox of the two times, the human, flexible, current and united to life and pain, and the so-called divine, inflexible, immutable and separated from the living and the suffering. The human being requires a little of the other time, the "presence of God", in order to be full, and probably the metaphysical also requires the contemplative attention of the human to give fullness to its existence. Here I am already taking too much of a risk, theology defends that a pluripotential God needs absolutely nothing from human beings or from any creature, so I only point out that even if he doesn't need it, it doesn't hurt him at all: What would become of a God who could not be contemplated, discovered, loved? And they would already have the Inn and the Yang formed, in an infinite loop that opens opportunities for us to find meaning and answers that would otherwise be impossible. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Well friends, that's where I leave you. I hope you can enjoy a happy day in which perhaps there is room for a smile.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAiKDy2eq3yneYBsb9oBqX9MQMebtnqH-GgNYWuprgqNjrOMqhO0ujxw2IEuSdpIWUfjjWYAocq-gxMBEb2oC__HFZQmtRWqkOsIcm-U68thBINtzO8rlZuujc1bicQYQEU-APZdNQcPmPUqUnPFg-yQMdGbQVGWzjRSn1iT7xZzrElvSdVUv6WQx14GQ/s1244/IMG_5378.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1244" data-original-width="1088" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAiKDy2eq3yneYBsb9oBqX9MQMebtnqH-GgNYWuprgqNjrOMqhO0ujxw2IEuSdpIWUfjjWYAocq-gxMBEb2oC__HFZQmtRWqkOsIcm-U68thBINtzO8rlZuujc1bicQYQEU-APZdNQcPmPUqUnPFg-yQMdGbQVGWzjRSn1iT7xZzrElvSdVUv6WQx14GQ/s320/IMG_5378.jpeg" width="280" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><b>这是一个时间问题</b>。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">机器翻译,原谅错误。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">新年伊始的第一天,还有什么比把梦境和噩梦中的黑暗直觉变成文字更好的呢?</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">现在,我的消化系统和呼吸系统都有些痉挛,但我不会让你感到无聊,让我们言归正传吧。几年前,我的朋友尼古拉斯-法贝罗(Nicolás Fabelo)发表了一个理论:死亡是一种渐近线。因为我们都是宅男,所以没有在哲学或科学杂志上发表,而是在《赫芬顿邮报》上发表了,请大家见谅。在这篇文章中,我们通过一个比喻来思考死亡的过程,在这个比喻中,意识就像是接近事件视界的光。这个超曲面划定了两种时空,一种是已知宇宙的时空,另一种是我们尚未知晓的宇宙时空。该理论告诉我们,那里没有时间,也就是说,另一边的一切都不存在时间维度。虽然那里似乎有温度,十分之一开尔文的温度,这可能不会给我们提供任何线索,让我们知道有可能存在微小的时间余量,允许一些运动,但我们不要自欺欺人了,我们所说的另一边只是假设。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">好吧,让我们回到我们的假设,实验对象在死亡时会接近它自己的事件视界,由于非常接近,它的时间会弯曲,就像光在接近黑洞时一样,这将允许所有生命在光完全熄灭和时间消失之前在眼前流逝。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">这就是我们离开的地方。今晚发生的事情是,我的梦里充满了澳大利亚原住民、失落的非洲部落、北方巫师和各种各样的时间旅行者。即使我仔细观察,也能发现一些希腊人,他们在德尔斐有一个开拓中心。你可能会觉得不可思议,但时间旅行是人类生存的根本。就像我们学会了在三维空间中旅行的高难度艺术一样,我们在时间维度上也做到了这一点。与勇闯太平洋的勇敢的波利尼西亚人、驶出地中海的希腊人、到达纽芬兰的维京人以及其他许多勇敢的人相比,埃隆-马斯克不过是个后起之秀。但为什么旅行如此重要?很简单,因为当困难来临时,我们别无选择。如果说今天的圣诞节让我们过足了瘾,那么这要归功于那些踏上不可能完成的旅程的人们。在时间上也是如此。人们常常需要接近神灵的世界,这也是形而上学长期以来所称的 "事件视界"。专家会诱发恍惚,改变自己或他人的意识,并接近那个界限以寻求答案。他们使用音乐、节奏、舞蹈、药物和诱导梦境。他们很清楚,你不可能带着平常的意识进入那里,"没有人可以看着上帝还活着"。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">因此,今天我给大家带来了另一种奇特的意识和时间循环,一方面是神秘主义者带来的沉思注意力,另一方面是形而上学者带来的存在感。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">想象一下你喜爱的圣人或神秘主义者的冥想姿态。他的目的是思考神圣之光,获得启迪。为此,他通常会静止身体,将注意力集中在有助于他向无限敞开的事物上。你不需要是个天才就能做到这一点,也许你曾有过这样的经历,当你在自然环境中散步时,你开始体验到一种从烦恼中解脱出来的感觉,一种向超越你的美丽、和谐、空间和时间的事物敞开的感觉。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">这就是两个时代的悖论,一个是人类,灵活、流动,与生命和痛苦融为一体;另一个是所谓的神圣,缺乏灵活性,一成不变,与生命和痛苦相分离。人需要一点另一个时间,即 "神的存在",才能充实,而形而上学可能也需要人的沉思关注,才能使其存在充实。在这里,我已经冒了太大的风险,神学辩护说,多能的上帝绝对不需要人类或任何生物的任何东西,所以我只想指出,即使他不需要,这对他也没有任何伤害:一个不能被思考、发现和爱的上帝会变成什么样呢?他们已经有了 "客栈 "和 "阳间",在一个无限的循环中,为我们提供了找到意义和答案的机会,而这在其他情况下是不可能的。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">好了,朋友们,我就说到这里。我希望你们能度过一个快乐的一天,在这一天里,也许还有微笑的空间。<span style="font-family: Palatino-Roman;"> </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 13px; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"></span><br /></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-82820614702539594062023-12-23T09:10:00.001+01:002023-12-23T16:17:06.174+01:00Reflexión de fin de año. End-of-year reflection. 年终反思<p></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-eIsBkbMejoOrNSwI0BaBE5B4ZbOyiG9gXrKuCRfoX5tkU79SDkmbNRv2JJ-0lEqu3eHY0dnKZoM-ujEnhvKPTCWG_9qK23QuOtOvbmaTkOrhVWwHc9Tcxm0mBz5vLWRy8dGTdxYRbWXUD7_6TImQ7fVLWX5_8RXoVBSGr0ggtldCgXgKIlRCcyojI3Q/s1170/IMG_5363.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="781" data-original-width="1170" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-eIsBkbMejoOrNSwI0BaBE5B4ZbOyiG9gXrKuCRfoX5tkU79SDkmbNRv2JJ-0lEqu3eHY0dnKZoM-ujEnhvKPTCWG_9qK23QuOtOvbmaTkOrhVWwHc9Tcxm0mBz5vLWRy8dGTdxYRbWXUD7_6TImQ7fVLWX5_8RXoVBSGr0ggtldCgXgKIlRCcyojI3Q/w400-h268/IMG_5363.jpeg" width="400" /></a></div><br /><p></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-align: center; text-indent: 18px;"><span style="font-size: x-small;">Chillida en los trabajos de colocación del Peine del viento</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">Me gustaría aprovechar estas fechas para hacer una última reflexión anual a la par de felicitarles las fiestas. Ha sido un año difícil para muchos, también para este servidor. Las guerras en suelo europeo y al oeste del mediterráneo, la subida de la gasolina y de los precios, los bandazos económicos y la crispación en política interna nos han cocido a todos a fuego lento en un ambiente incómodo, en ocasiones asfixiante. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">Dentro del mundo sanitario, los pediatras y médicos de familia de Madrid hemos protagonizado una de la huelgas más largas de la década, en un conflicto que nos mantuvo cuatro meses alternando paros, manifestaciones semanales y protestas varias. A los facultativos no nos gustan estos exabruptos, no nos suelen salir bien. Si recurrimos a ellos fue por pura desesperación tras la sangría de la pandemia y la negra perspectiva que se nos viene en cima cuando se jubilen el 25% de los compañeros en pocos años. Ha servido de poco, un mínimo ajuste en la nómina y la promesa de trabajar con agendas de 34 pacientes al dia que tras ocho meses de firmarlas siguen siendo el cuento de la lechera para la mayoría. En breve seremos testigos de nuevas llamas. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman">Tanta marejada me ha mantenido a cierta distancia de este blog y de redes sociales, donde de vez en cuando dejo algún haiku. Pido disculpas a aquellos que puedan echar de menos mis pequeñas aportaciones pero no he tenido más remedio. Cuando un temporal destroza el velamen de un barco hay que acometer reparaciones antes de plantearse la más mínima navegación. </span><span style="font-weight: bold;">El silencio tiene una faceta curativa</span><span face="Palatino-Roman">, de máxima utilidad cuando se padecen excesos de ruido como ha sido el caso. Y siendo una medicina que recomiendo en consulta me ha tocado aplicármela a mí mismo para poder seguir tirando. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman">En estos doce meses he profundizado la docencia, acogiendo en mi consulta seis rotaciones rurales de R2 de familia que me han ayudado a revisar y replantear muchas cuestiones. También he desarrollado la ecografía en el punto de atención con más de 600 exploraciones hechas y un esfuerzo en formación que hacia tiempo no me atrevía a asumir. Ambas facetas me han ayudado a recuperar la ilusión y el propósito. </span><span style="font-weight: bold;">Sin sentido una vida profesional vale muy poco. </span><span face="Palatino-Roman">Ahora tengo entre manos el deseo de poder contarlo de alguna forma porque tengo claro que además de las reformas estructurales, económicas y políticas que se puedan hacer con la Atención Primaria es urgente una revolución consciente que nos ayude a rescatar nuestro verdadero propósito sin hundirnos en la desesperación. De momento tengo en prensa un editorial en la revista AMF (</span><span style="font-weight: bold;">Belleza, calma y equilibrio en medicina de familia</span><span face="Palatino-Roman">) y un taller en el congreso de Comunicación de Cuenca de SEMFYC (</span><span style="font-weight: bold;">Fisiopatología, hermenéutica y poesía</span><span face="Palatino-Roman">), pero habrá más propuestas. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman">Les invito a unirse a esta búsqueda de sentido, cada cual de la forma y maneras que estimen oportunas. El solsticio de invierno es tiempo propicio para ello, en la noche más larga quizá nos esa más fácil levantar la mirada a las tenues estrellas o percibir las pequeñas luces que puedan nacer en nuestra vida. </span><span style="font-weight: bold;">En el fondo la Navidad no es más que esto, caminar a oscuras la madrugada y empezar a darnos cuenta de que ya llega la luz</span><span face="Palatino-Roman">. Espero que sus deseos para el año que empieza se puedan cumplir. Reciban un abrazo de quien les escribe. </span></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"></p><div class="separator" style="clear: both; text-align: center;"></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGMk34fyyTC9M9bu6RTC9EdpTwRN_EhdaahiNFGu-GiliiAGAxbTA0yOfCAUStIziq_71CVR3NnpgqkhbdxplBDzYUETan6sMQiDcc1nTISbXFsDWldTwwthpfIXWoreGaYx_ctcqJlrlQEyEwJOHJEsqzqr1gF9vvCbNCq09Ci_bmREqFZJAV34W5Ycs/s1600/IMG_4818.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="953" data-original-width="1600" height="382" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGMk34fyyTC9M9bu6RTC9EdpTwRN_EhdaahiNFGu-GiliiAGAxbTA0yOfCAUStIziq_71CVR3NnpgqkhbdxplBDzYUETan6sMQiDcc1nTISbXFsDWldTwwthpfIXWoreGaYx_ctcqJlrlQEyEwJOHJEsqzqr1gF9vvCbNCq09Ci_bmREqFZJAV34W5Ycs/w640-h382/IMG_4818.jpeg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"></td></tr></tbody></table><br /><div style="text-align: center;"><span style="font-size: small;">Artículo de Manuel Vilas en El Correo</span></div><p></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant-alternates: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><b><span style="font-size: large;">End-of-year reflection</span></b></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">I would like to use this time of year to make a final annual reflection and to congratulate you on the festive season. It has been a difficult year for many, including myself. The wars on European soil and west of the Mediterranean, the rise in petrol and prices, the economic swings and the internal political tension have simmered us all in an uncomfortable, sometimes suffocating atmosphere. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">In the world of healthcare, paediatricians and family doctors in Madrid have been involved in one of the longest strikes of the decade, in a conflict that kept us going for four months, alternating stoppages, weekly demonstrations and various protests. We doctors don't like these outbursts, they don't usually work out well for us. If we resorted to them it was out of sheer desperation after the bloodletting of the pandemic and the black prospect that is looming over us when 25% of our colleagues retire in a few years' time. It has been of little use, a minimal adjustment in the payroll and the promise to work with agendas of 34 patients a day that after eight months of signing them are still the milkmaid's tale for most of them. Soon we will witness new flames. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">So much turmoil has kept me at a certain distance from this blog and social networks, where I occasionally leave a haiku. I apologise to those who may miss my small contributions but I have had no choice. When a storm destroys a ship's sails, repairs must be undertaken before even the slightest sailing is considered. Silence has a curative facet, most useful when suffering from excessive noise, as has been the case here. And being a medicine that I recommend in my consultations, I have had to apply it to myself in order to keep going. </span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">In these twelve months I have deepened my teaching, hosting six rural rotations of family R2s in my practice, which have helped me to review and rethink many issues. I have also developed point-of-care ultrasound with more than 600 examinations performed and an effort in training that I had not dared to undertake for some time. Both facets have helped me to regain my enthusiasm and purpose. Without meaning, a professional life is worth very little. Now I have in my hands the desire to be able to tell the story in some way because it is clear to me that in addition to the structural, economic and political reforms that can be made to Primary Care, a conscious revolution is urgently needed to help us recover our true purpose without sinking into despair. At the moment I have an editorial in the journal AMF (Beauty, calm and balance in family medicine) and a workshop at the SEMFYC Communication Congress in Cuenca (Physiopathology, hermeneutics and poetry), but there will be more proposals to come.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">I invite you to join in this search for meaning, each of you in whatever way and manner you see fit. The winter solstice is a propitious time for this, in the longest night it may be easier to look up at the faint stars or to perceive the little lights that may be born in our lives. This is what Christmas is all about, walking in the dark in the early morning and beginning to realise that the light is coming. I hope that your wishes for the coming year can be fulfilled. I send you a big hug from the one who writes to you.</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAI-uf0rBmzFvJ_sLTzAgjqysmcfjReIk870spWs7oAnouydQWwMGvKsHATs4wPTVVVDySBkD0fzshbdZ17467P0FaRFE7rVipLWT3_7wF2cXfDsl9sT_4XXKTENymQuJiTe8qWVDUV98QspRpjwRxQiN4vv6iLXI31NcPAoa_I5EyRtJyVFS10Xd6Ffw/s1360/IMG_5381.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1360" data-original-width="1088" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAI-uf0rBmzFvJ_sLTzAgjqysmcfjReIk870spWs7oAnouydQWwMGvKsHATs4wPTVVVDySBkD0fzshbdZ17467P0FaRFE7rVipLWT3_7wF2cXfDsl9sT_4XXKTENymQuJiTe8qWVDUV98QspRpjwRxQiN4vv6iLXI31NcPAoa_I5EyRtJyVFS10Xd6Ffw/s320/IMG_5381.jpeg" width="256" /></a></div><br /><span style="font-size: large;"><br /></span><p></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><b><span style="font-size: large;">年终反思</span></b></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">机器翻译,如有错误,敬请原谅。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">我想利用每年的这个时候进行最后一次年度反思,并祝愿大家在节日期间一切顺利。对包括我在内的许多人来说,今年是艰难的一年。欧洲和地中海以西地区的战争、汽油价格和物价上涨、经济动荡和国内政治局势紧张,让我们所有人都沉浸在一种不舒服、有时甚至令人窒息的气氛中。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">在医疗保健领域,马德里的儿科医生和家庭医生参与了本十年中持续时间最长的一次罢工,这场冲突持续了四个月,罢工、每周示威和各种抗议交替进行。我们医生不喜欢这样的罢工,因为罢工通常对我们不利。如果说我们是出于无奈,那也是在经历了大流行病的腥风血雨和几年后我们 25% 的同事退休后的黑暗前景之后的无奈之举。这没有什么用处,工资单上的调整微乎其微,每天 34 个病人的工作议程承诺在签署了 8 个月之后对他们中的大多数人来说仍然是挤奶的故事。很快,我们将看到新的火焰。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">如此多的动荡让我与这个博客和社交网络保持了一定的距离,我偶尔会在那里留下一首俳句。我向那些可能会想念我的微薄贡献的人们道歉,但我别无选择。当暴风雨摧毁了一艘船的风帆时,必须先进行修理,然后才能考虑起航。沉默也有治疗的作用,在遭受过度喧哗时最有用,就像这里的情况一样。作为我在咨询中推荐的一剂良药,我不得不将它应用到自己身上,以便坚持下去。</span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;">在这十二个月里,我深化了教学工作,在我的诊所里接待了六次农村家庭康复医生轮转,这帮助我重新审视和思考了许多问题。我还开展了护理点超声检查,进行了 600 多次检查,并在培训方面做出了一段时间以来不敢做的努力。这两方面都帮助我重新找回了热情和目标。没有意义的职业生活是没有价值的。现在,我希望能够以某种方式讲述这个故事,因为我清楚地认识到,除了可以对初级保健进行结构、经济和政治改革外,还迫切需要一场有意识的革命,以帮助我们恢复真正的目标,而不至于陷入绝望。目前,我在《AMF》杂志上发表了一篇社论(《家庭医疗的美丽、平静与平衡》),并在《AMF》杂志的 "家庭医疗 "栏目中举办了一个研讨会。我邀请你们每个人以你们认为合适的方式和方法,加入这场意义的探索。冬至是一个好时机,在最长的夜里,我们可能更容易仰望微弱的星光,或者感知到生命中可能诞生的微光。这就是圣诞节的意义所在,清晨在黑暗中漫步,开始意识到光明即将到来。我希望你们来年的愿望能够实现。让我这个写信给你的人给你一个大大的拥抱。</span></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-71107884801716332092023-10-23T19:59:00.008+02:002023-10-23T20:14:47.033+02:00La banalización del sufrimiento ajeno. The trivialisation of the suffering of others. 轻视他人的痛苦。<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhXEwwB-g9jA5PUmD6EaRtVXlIY6zNFqIVxsXbEcuxjaqzicZoglfu05kEVAqYyqm7MGs2-EJTFh8245_uQYSibiq6G4XWqvLgiAlmE0-XKSfGZSOnWljtd4nLBEB8jLEsl4KKDozHYhltNttep5z4Ppgr2BDFof4_kCCiQXaH354tb9MbHZjqu78ma3U/s3051/San_Sebastia%CC%81n_(El_Greco,_Museo_del_Prado).jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="3051" data-original-width="2267" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhXEwwB-g9jA5PUmD6EaRtVXlIY6zNFqIVxsXbEcuxjaqzicZoglfu05kEVAqYyqm7MGs2-EJTFh8245_uQYSibiq6G4XWqvLgiAlmE0-XKSfGZSOnWljtd4nLBEB8jLEsl4KKDozHYhltNttep5z4Ppgr2BDFof4_kCCiQXaH354tb9MbHZjqu78ma3U/w298-h400/San_Sebastia%CC%81n_(El_Greco,_Museo_del_Prado).jpeg" width="298" /></span></a></div><span style="font-size: medium;"><br /></span><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">Habitamos una época de luz, tecnología, ciencia y desarrollo. Nunca antes se había visto nada igual, podemos hablar con cualquier persona del mundo usando un reloj, acceder a cantidades ingentes de información en un segundo o sanar enfermedades antes mortales. Por estas razones es fácil que nos creamos más de lo que somos y que trivialicemos cuestiones importantes. Y además <b>es posible que los focos no nos permitan ver bien las sombras que inevitablemente se producen</b>.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">La ley de hierro que ha permitido estos milagros se llama libre mercado y su misión maximizar beneficios. Para ello es necesario dinamizar la economía a cualquier precio. Como consecuencia se anima a la producción y al consumo acelerando tanto la economía como la sociedad y finalmente cada ciudadano. Todo va cada vez más rápido: trabajo, ocio, vida pública y vida privada. Y como telón de fondo estamos sometidos a un enorme flujo de distracción mediado por pantallas y tecnología que nos sumerge en piscinas de estimulación continuada. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">En estas circunstancias <b>la reflexión, la consciencia y la comprensión disminuyen o se inhiben </b>dado que necesitan para surgir de tiempos y procesos lentos que son fagocitados por la prisa incesante que exige el enjambre a nuestro alrededor. En lugar de reflexión propia nos quedamos con titulares ajenos, en lugar de consciencia de vida personal gastamos el tiempo viendo series y en lugar de comprensión asumimos el discurso de nuestros <i>influencers</i> preferidos. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><b><span face="Arial, sans-serif" style="color: #222222;">La aceleración vital y el cortoplacismo inevitablemente asocian miopía social</span></b><span face="Arial, sans-serif" style="color: #222222;">. Al centrarnos en el beneficio terminamos priorizando el propio antes que el común. A este respecto el ejemplo social de políticos, famosos y demás actores públicos actúa de imán que al visibilizarse y ampliarse ejerce un potente atractivo para todos. El problema es que los cuestionables códigos éticos de estos personajes les son disculpados mediante su innegable simpatía o atractivo y así en lugar de criticar que evadan impuestos o nos engañen, la reacción general tiende a disculparlos y promover su imitación.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">De esta forma <b>se banaliza el mal</b> como Ana Arendt describió en los oficiales del ejército nazi que cometieron barbaridades acatando órdenes que no se permitieron cuestionar. A otro nivel lo vemos también en altos ejecutivos o altos políticos cuando por seguir consignas corporativas toman cursos de acción con efectos deletéreos para la sociedad. Y a menor escala en todos aquellos que defraudan impuestos, rapiñan recursos públicos o cometen engaños y fraudes con los privados. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">En este contexto de descremado ético generalizado y de lucha social por recursos limitados, en el que pareciera que todo es posible si con ello gano algo, se da otro interesante fenómeno que <b>banaliza el sufrimiento ajeno</b>. Por un lado <b>la fatalidad ajena nos interesa cada vez menos dado que no nos ayuda a conseguir ningún beneficio personal</b>. Dedicamos tan solo un instante a la noticia y como mucho asociamos un pequeño sentimiento de lástima que enseguida nos quitamos de encima pulsando en el siguiente contenido. Bastante pesadez tiene nuestra vida para que la llenemos de tantas malas noticias. Y como los medios y plataformas de comunicación nos atacan con inagotables propuestas de catástrofes, guerras, muertos y sinsentido terminamos defendiéndonos con distracciones más benévolas que actúan de cortina sobre la desagradable realidad del sufrimiento ajeno. Por otro lado <b>los propios canales de información tienden a aislarnos en burbujas sociales cada vez más pequeñas en las que se sitúan los afines, amigos y colegas</b>. De este modo segmentamos el mundo trazando una línea roja entre los nuestros y los demás, a los que muchas veces veremos como enemigos o amenazas. El mal o el sufrimiento de lo que queda más allá de esa línea no nos afecta, que cada palo aguante su vela y que a mí no me lo cuenten. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><b><span face="Arial, sans-serif" style="color: #222222;">Al eliminar de mi realidad la contemplación, consciencia, reflexión y comprensión del sufrimiento ajeno, inevitablemente me quedo con menos recursos para hacer lo mismo con el propio</span></b><span face="Arial, sans-serif" style="color: #222222;">. El sufrimiento ajeno lo puedo negar o distraer, el propio no. Y cuando es moderado e intenso menos todavía. Por esta razón <b>cada vez los médicos sufren más sobrecarga dado que los problemas personales que anteriormente la sociedad era capaz de auto gestionar terminan llegando en tromba a las consultas de medicina de familia y de salud mental</b>. En ellas nos piden que les quitemos ese pensamiento rumiante, esa emoción terrible, ese estado de nervios, esa desesperación, ese sinsentido, esa soledad no deseada. En los cinco minutos de consulta poco puede hacer el galeno más que ofrecer alguna pastilla o aconsejar psicoterapia. Y el sufriente comprende que deberá acudir a otras puertas o seguir buscando a alguien que le quite el problema. Al haber banalizado el sufrimiento ajeno el propio ha aumentado de tamaño y se ha hecho ingobernable. Nuestra tolerancia a la frustración y al malestar ha disminuido comparada con la de nuestro predecesores, en un sistema laboral y social que no tolera las bajadas de rendimiento. Nos hemos convertido en líderes en consumo de psicofármacos y en drogas ilegales que aunque temporalmente parcheen algo tampoco consiguen arreglar el fondo del problema.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><b><span face="Arial, sans-serif" style="color: #222222;">La única forma de empezar a enmendar un problema es tomando consciencia de él</span></b><span face="Arial, sans-serif" style="color: #222222;">. Ante el sufrimiento ajeno solemos opinar. Esto ha sido siempre así y en los mentideros de cada pueblo o barrio se han comentado sin pausa las desgracias ajenas. Ahora pasa lo mismo pero en foros virtuales. Las redes sociales están llenas de bronca entre los que opinan blanco y lo que lo ven negro ante cualquier cuestión. Tras posicionarnos, opinar, apoyar a los nuestros y criticar al contrario terminamos como mucho mandando un donativo y con eso cerramos el asunto. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">Tal vez debamos recordar lo que hacían nuestras abuelas cuando rezaban por lo atribulados. A su modo contemplaban ese sufrimiento y lo presentaban ante el misterio que sus creencias acogían. El sufrimiento no era negado ni maquillado, se sostenía y se dejaba entrar en la zona de intimidad personal. Solo los que terminan comprendiendo que el sufrimiento ajeno es el mismo que el propio y que lo que les pasa a los demás nos pasa a nosotros, podrán entender que cuando nos toque a nosotros sufrir es el mundo el que sufre y tal vez así hacer más llevadero el mismo. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><b><span face="Arial, sans-serif" style="color: #222222;">La dimensión contemplativa permite sostener la mirada del malestar desde un pequeño instante a un tiempo mayor en lugar de salir huyendo</span></b><span face="Arial, sans-serif" style="color: #222222;"> que es con diferencia nuestra reacción más instintiva. Abrir nuestra consciencia al malestar es la puerta que nos permitirá avanzar hacia nuevas posibilidades. Podemos fijarnos en aquellos que han conseguido contemplar en profundidad el sufrimiento de un grupo o colectivo y obrar en consecuencia o en los artistas y personas con gran sensibilidad que han conseguido transformarlo en obras de arte. También comprobaremos que lo han conseguido con el propio, <b>la sublimación es uno de los mecanismos psicológicos más elegantes para transformar el plomo del sufrmimiento en oro, que además sirve para alumbrar y compartir con los demás. <o:p></o:p></b></span></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><b><br /></b></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">Algunos propugnan que hacen falta más pastillas y psicoterapeutas, pero si lo pensamos bien su incremento no solucionaría por sí solo el problema. Lo que precisamos ante todo es darnos cuenta como sociedad y como personas de lo que está pasando. De como <b>el cambio social está condicionando por un lado mayores niveles de sufrimiento personal autopercibido y por otro aumentado nuestras dificultades para manejarlo y, en muchos casos, asumirlo como inherente a la condición de estar vivos</b>. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">Y tal vez los profesionales sanitarios podamos ir un poco más allá y analizar qué podemos hacer al respecto y qué no. Sin una visión clara, y si me permiten una perspectiva mayor, no será posible discernir la cuestión de hasta donde llegar con las propuestas de diagnóstico y tratamiento que hagamos a nuestros pacientes. Como primera sugerencia <b>aporto la importancia de hacer una aproximación hermenéutica del malestar que nos presenten</b>, explicando a quien lo sufra las posibles conexiones entre sus circunstancias vitales y las reacciones físicas, psicológicas, sociales y existenciales derivadas. Con frecuencia quien está atravesando una crisis vital no consigue entender lo que pasa dado que las respuestas suelen estar en un punto ciego para él que no le es posible mirar. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">Por otra parte <b>tal vez tenga valor aprovechar los tiempos de malestar emocional propios para conectarlos de alguna forma con los ajenos y favorecer la comprensión de que nuestra condición de criaturas vivas nos une a todas las demás tanto en la dimensión más luminosa como en la más oscura</b>. Aunque el que sufre se suele percibir solo y aislado no es posible estar más unido al resto de la humanidad que en estas circunstancias. Esta aproximación filosófica no precisa de estudios superiores ni de títulos universitarios, cualquier persona que haya sufrido puede ofrecer su comprensión vital, su empatía y su respeto a la que esté sufriendo en este momento. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;">Recordar que <b>la aproximación al sufrimiento humano puede hacerse desde los cuatro ángulos que lo constituyen (biológico, psicológico, social y existencial) y no quedarse meramente en lo superficial es quizá la prioridad tanto para los profesionales de la salud como para el resto de la sociedad</b>. Hace falta reflexión y comprensión, pero necesitamos ayudas en un mundo que marcha a gran velocidad y no las favorece. Retomar el arte de la conversación tranquila, la contemplación pausada, el estar en silencio con nosotros mismos o el atrevernos a crear pequeñas obras de arte pueden ser cursos de acción a rescatar. En justicia el sufrimiento ajeno es tan respetable como el nuestro, si lo frivolizamos terminaremos burlándonos de nosotros mismos. Por eso <b>humanizarnos seguramente tenga que ver con nuestra forma de relacionarnos con las sombras humanas. Según nos relacionemos con las dificultades, enfermedades y catástrofes de los demás así haremos con las nuestras.<o:p></o:p></b></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span face="Arial, sans-serif" style="color: #222222; font-size: medium;"><b><br /></b></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: medium;"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi26vbace9cYepoeGYYBNh1QbYN2YfmE4rVImMYHBjL5Nq8SA6Z7rSD3QoN1nJn9x3XjAx8cUSu_EdUIhJ3zzqYtHozSdrtXLeEE0IN0cVPEVekMGPhKECAzkMU7yNAvBhQmhOvzdbTXTdyV1YlB3ay880zvdNjJHWt0xv-dRVH6LUacL5PoQXW2XkLexY/s720/hicMQqe_N_720x0__1.jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="480" data-original-width="720" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi26vbace9cYepoeGYYBNh1QbYN2YfmE4rVImMYHBjL5Nq8SA6Z7rSD3QoN1nJn9x3XjAx8cUSu_EdUIhJ3zzqYtHozSdrtXLeEE0IN0cVPEVekMGPhKECAzkMU7yNAvBhQmhOvzdbTXTdyV1YlB3ay880zvdNjJHWt0xv-dRVH6LUacL5PoQXW2XkLexY/w400-h266/hicMQqe_N_720x0__1.jpg" width="400" /></span></a></div><div style="text-align: center;"><span style="font-size: medium;">Ruinas de Gaza</span></div><span style="font-family: "Times New Roman", serif; font-size: medium;"><br /></span><p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><o:p><span style="font-size: medium;"> </span></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><b><span style="font-size: medium;">The trivialisation of the suffering of others.</span></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">We live in an age of light, technology, science and development. Nothing like it has ever been seen before, we can talk to anyone in the world using a watch, access vast amounts of information in a second, or cure previously fatal diseases. For these reasons it is easy for us to think we are more than we are and to trivialise important issues. And the spotlight may not allow us to see the shadows that inevitably follow.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">The iron law that has enabled these miracles is called the free market and its mission is to maximise profits. For this it is necessary to dynamise the economy at any price. As a consequence, production and consumption are encouraged, accelerating both the economy and society and finally every citizen. Everything is going faster and faster: work, leisure, public life and private life. And as a backdrop we are subjected to an enormous flow of distraction mediated by screens and technology that immerses us in pools of continuous stimulation. </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">In these circumstances reflection, awareness and understanding are diminished or inhibited as they need to emerge from slow times and processes that are swallowed up by the relentless haste demanded by the swarm around us. Instead of self-reflection, we are left with other people's headlines, instead of awareness of our personal lives, we spend our time watching TV series and instead of understanding, we take on the discourse of our influencers.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">The acceleration of life and short-termism inevitably lead to social myopia. By focusing on profit, we end up prioritising our own rather than the common good. In this respect, the social example of politicians, celebrities and other public actors acts as a magnet that, when made visible and amplified, exerts a powerful attraction for all. The problem is that the questionable ethical codes of these figures are excused by their undeniable likeability or attractiveness, and so instead of criticising their tax evasion or cheating, the general reaction tends to excuse them and promote their imitation.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">In this way evil is trivialised, as Anne Arendt described in the Nazi army officers who committed barbarities by obeying orders they did not allow themselves to question. On another level we also see it in top executives and politicians when they follow corporate slogans and take courses of action with deleterious effects on society. And on a lesser scale in all those who defraud taxes, plunder public resources or commit deceit and fraud with the private sector.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">In this context of generalised ethical skimming and social struggle for limited resources, in which it seems that everything is possible if I gain something from it, there is another interesting phenomenon that trivialises the suffering of others. On the one hand, we are less and less interested in the fate of others because it does not help us to achieve any personal benefit. We dedicate only a moment to the news and at most we associate a small feeling of pity that we immediately get rid of by clicking on the following content. Our lives are heavy enough for us to fill them with so much bad news. And as the media and communication platforms attack us with endless proposals of catastrophes, wars, deaths and nonsense, we end up defending ourselves with more benevolent distractions that act as a curtain over the unpleasant reality of the suffering of others. On the other hand, the information channels themselves tend to isolate us in smaller and smaller social bubbles in which we are placed in the company of like-minded people, friends and colleagues. In this way we segment the world by drawing a red line between our own and others, whom we often see as enemies or threats. The evil or suffering of what lies beyond that line does not affect us; let every man hold his own and don't tell me about it.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">By eliminating from my reality the contemplation, awareness, reflection and understanding of the suffering of others, I am inevitably left with fewer resources to do the same with my own. I can deny or distract from the suffering of others, but not from my own. And when it is moderate and intense, even less so. For this reason, doctors are increasingly overburdened as personal problems that society was previously capable of managing itself end up arriving in a flood at family medicine and mental health practices. They ask us to take away that ruminative thought, that terrible emotion, that state of nerves, that desperation, that meaninglessness, that unwanted loneliness. In the five minutes of the consultation, the doctor can do little more than offer a pill or advise psychotherapy. And the sufferer understands that he or she will have to go to other doors or keep looking for someone to take away the problem. Having trivialised the suffering of others, our own suffering has grown in size and has become unmanageable. Our tolerance for frustration and discomfort has diminished compared to that of our predecessors, in an employment and social system that does not tolerate underachievement. We have become leaders in the consumption of psychotropic drugs and illegal drugs which, although temporarily patching something up, also fail to fix the root of the problem.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">The only way to begin to correct a problem is to become aware of it. In the face of the suffering of others, we tend to give our opinion. This has always been the case, and in the "mentideros" of each town or neighbourhood, the misfortunes of others have been commented on without pause. Now the same thing is happening in virtual forums. The social networks are full of arguments between those who have a white opinion and those who see it as black on any issue. After taking a stand, giving our opinions, supporting our own and criticising our opponents, we end up at best sending a donation and that is the end of the matter. </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">Perhaps we should remember what our grandmothers did when they prayed for the beleaguered. In their own way they contemplated that suffering and presented it to the mystery that their beliefs embraced. Suffering was not denied or made up, it was sustained and allowed to enter the zone of personal intimacy. Only those who end up understanding that the suffering of others is the same as their own, and that what happens to others happens to us, will be able to understand that when it is our turn to suffer, it is the world that suffers, and perhaps in this way make it more bearable.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">The contemplative dimension allows us to hold the gaze of discomfort from a small moment to a longer time instead of running away, which is by far our most instinctive reaction. Opening our awareness to discomfort is the door that will allow us to move towards new possibilities. We can look at those who have managed to contemplate in depth the suffering of a group or collective and act accordingly, or at artists and people with great sensitivity who have managed to transform it into works of art. Sublimation is one of the most elegant psychological mechanisms for transforming the lead of suffering into gold, which also serves to enlighten and share with others. </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">Some argue that we need more pills and psychotherapists, but if we think about it, increasing the number of pills and psychotherapists alone will not solve the problem. What we need first and foremost is to realise as a society and as individuals what is happening. How social change is on the one hand conditioning higher levels of self-perceived personal suffering and on the other hand increasing our difficulties in dealing with it and, in many cases, assuming it as inherent to the condition of being alive.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">And perhaps we health professionals can go a little further and look at what we can do about it and what we cannot do about it. Without a clear vision, and if you will allow me a broader perspective, it will not be possible to discern the question of how far we can go with the diagnostic and treatment proposals we make to our patients. As a first suggestion, I would suggest the importance of taking a hermeneutic approach to the malaise presented to us, explaining to the sufferer the possible connections between their life circumstances and the resulting physical, psychological, social and existential reactions. Often those who are going through a life crisis are unable to understand what is happening because the answers are often in a blind spot that they are unable to see. </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">On the other hand, it may be worthwhile to take advantage of one's own times of emotional distress to connect them in some way with those of others and to promote the understanding that our condition as living creatures unites us with all others in both the brightest and darkest dimensions. Although the sufferer often feels alone and isolated, it is not possible to be more united with the rest of humanity than in these circumstances. This philosophical approach does not require higher education or university degrees; anyone who has suffered can offer their vital understanding, empathy and respect to those who are suffering at this moment.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;">Remembering that human suffering can be approached from all four angles (biological, psychological, social and existential) and not just superficially is perhaps the priority for both health professionals and the rest of society. Reflection and understanding are needed, but we need help in a fast-moving world that does not favour it. Resuming the art of quiet conversation, slow contemplation, being in silence with ourselves or daring to create small works of art may be courses of action to be rescued. In fairness, the suffering of others is as respectable as our own; if we frivolise it, we will end up making fun of ourselves. That is why humanising ourselves probably has to do with the way we relate to human shadows. As we relate to the difficulties, illnesses and catastrophes of others, so will we relate to our own.</p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEingBukKeXd4mmD1JuErlaKsIWTY1kkEB2GZGRcxaELGZsZlTMN1tXN9syYHe58Kg2Dr8SZDjPumwldQKpLya2QefkzLVRV2J3xcphvnLku9cWxOWRH6J8DzhKv1n_NeOtnTwqhqB4Ath-ns3JNKAeGYuuwwzbvvUJMiT4_DNPc5JVKy14vWxfrSpTOlkU/s980/4PAYN73CJVMNFEFPWEE6PDD2IY.jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="629" data-original-width="980" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEingBukKeXd4mmD1JuErlaKsIWTY1kkEB2GZGRcxaELGZsZlTMN1tXN9syYHe58Kg2Dr8SZDjPumwldQKpLya2QefkzLVRV2J3xcphvnLku9cWxOWRH6J8DzhKv1n_NeOtnTwqhqB4Ath-ns3JNKAeGYuuwwzbvvUJMiT4_DNPc5JVKy14vWxfrSpTOlkU/w400-h256/4PAYN73CJVMNFEFPWEE6PDD2IY.jpg" width="400" /></span></a></div><div style="text-align: center;"><span style="font-size: medium;">Ruinas de Alepo</span></div><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><o:p><span style="font-size: medium;"><br /></span></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><o:p><span style="font-size: medium;"><br /></span></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><b><span style="font-size: medium;">轻视他人的痛苦。</span></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">自动翻译,如有错误敬请谅解。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">我们生活在一个光、技术、科学和发展的时代。 以前从未见过这样的情况,我们可以使用手表与世界上的任何人交谈,在一秒钟内访问大量信息或治愈以前致命的疾病。 由于这些原因,我们很容易相信自己比实际情况更重要,并轻视重要的问题。 也有可能聚光灯无法让我们看清不可避免出现的阴影。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">创造这些奇迹的铁律被称为自由市场,其使命是利润最大化。 为此,必须不惜一切代价提振经济。 结果,生产和消费受到鼓励,从而加速了经济和社会的发展,最终加速了每个公民的发展。 一切都变得越来越快:工作、休闲、公共生活和私人生活。 作为背景,我们受到屏幕和技术介导的大量干扰,让我们沉浸在持续的刺激之中。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">在这种情况下,反思、意识和理解会被削弱或抑制,因为它们需要从缓慢的时间和过程中出现,而这些时间和过程又被我们周围的人群所要求的不断的匆忙所吞噬。 我们没有进行自我反思,而是看到了其他人的头条新闻,我们花时间观看连续剧,而不是了解个人生活,我们没有理解,而是假设了我们最喜欢的影响者的话语。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">生命力的加速和短期主义不可避免地与社会短视联系在一起。 通过关注利润,我们最终会优先考虑自己的利益,而不是共同的利益。 在这方面,政客、名人和其他公众人物的社会榜样就像一块磁铁,当它变得可见和扩大时,就会对每个人产生强大的吸引力。 问题在于,这些人物的可疑道德准则是通过他们不可否认的同情心或吸引力而得到原谅的,因此,普遍的反应不是批评他们逃税或欺骗我们,而是倾向于原谅他们并促进他们的模仿。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">这样,邪恶就被轻视了,正如安娜·阿伦特在纳粹军官中所描述的那样,他们通过执行不允许自己质疑的命令而犯下暴行。 在另一个层面上,我们还可以在高级管理人员或高级政治家身上看到这种情况,他们为了遵循公司口号而采取对社会产生有害影响的行动方针。 在较小的范围内,包括所有骗税、掠夺公共资源或对私人进行欺骗和欺诈的人。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">在普遍存在的道德掠夺和社会对有限资源的争夺的背景下,似乎只要我这样做就能有所收获,一切皆有可能,另一个有趣的现象出现了,它淡化了他人的痛苦。 一方面,我们对他人的命运越来越不感兴趣,因为它无助于我们获得任何个人利益。 我们在新闻上只花一会儿时间,最多会联想到一种小小的怜悯之情,点击以下内容后,我们会立即摆脱这种感觉。 我们的生活已经足够沉重,足以让我们充满这么多坏消息。 当媒体和通讯平台用无休无止的灾难、战争、死亡和愚蠢的建议攻击我们时,我们最终用更仁慈的消遣来保护自己,这些消遣充当了掩盖他人痛苦的不愉快现实的帷幕。 另一方面,信息渠道本身往往将我们孤立在越来越小的社会泡沫中,而志同道合的人、朋友和同事都位于其中。 通过这种方式,我们通过在自己和他人之间划出一条红线来划分世界,我们经常将他们视为敌人或威胁。 在那条线之外留下的邪恶或痛苦不会影响我们,让每根棍子举起蜡烛,不要告诉我。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">通过从我的现实中消除对他人痛苦的沉思、意识、反思和理解,我不可避免地会剩下更少的资源来对自己做同样的事情。 我可以否认或转移别人的痛苦,但不能否认或转移我自己的痛苦。 当它是中等和强烈时,则更是如此。 出于这个原因,医生越来越多地承受着更多的负担,因为社会以前能够自我管理的个人问题最终涌入家庭医学和心理健康咨询。 他们要求我们消除那种沉思的想法、那种可怕的情绪、那种紧张状态、那种绝望、那种无意义、那种不想要的孤独。 在五分钟的咨询中,医生除了提供药物或建议心理治疗外,几乎无能为力。 患者明白他们将不得不去其他门或继续寻找某人来解决问题。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">由于轻视了他人的痛苦,我们自己的痛苦就扩大了,变得难以控制。 在一个不能容忍绩效下降的工作和社会体系中,与我们的前辈相比,我们对挫折和不适的容忍度有所下降。 我们已经成为精神药物和非法药物消费的领导者,尽管它们暂时修补了一些东西,但无法解决问题的根源。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">开始纠正问题的唯一方法就是意识到它。 当面对别人的痛苦时,我们通常会发表自己的意见。 情况一直如此,在每个城镇或街区的八卦工厂里,人们都在不停地讨论别人的不幸。 现在同样的事情也发生在虚拟论坛上。 社交网络在任何问题上都充满了白人观点和黑人观点之间的愤怒。 在表明立场、发表意见、支持我们的人民并批评相反的人之后,我们最多只能捐出一笔捐款,然后我们就结束了这件事。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">也许我们应该记住我们的祖母在为陷入困境的人祈祷时所做的事情。 他们以自己的方式思考这种痛苦,并将其呈现给他们信仰所拥抱的神秘。 痛苦没有被否认或掩饰,它被维持并被允许进入个人亲密的区域。 只有那些最终明白别人的痛苦与自己的痛苦是一样的,以及发生在别人身上的事情也发生在我们身上的人,才能明白,当轮到我们受苦时,受苦的是世界,也许因此多做点,自己能承受。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">沉思的维度让我们能够将不舒服的目光从一小片刻持续到更长的时间,而不是逃避,这是迄今为止我们最本能的反应。 向不适敞开我们的意识是让我们走向新可能性的大门。 我们可以看看那些成功地深入思考一个群体或集体的痛苦并采取相应行动的人,或者那些具有高度敏感性的艺术家和人们,他们成功地将其转化为艺术作品。 我们也会验证他们是否已经通过自己的努力实现了,升华是最优雅的心理机制之一,将苦难的铅变成金,这也有助于照亮和与他人分享。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">有些人主张需要更多的药物和心理治疗,但如果我们仔细想想,增加这些药物本身并不能解决问题。 我们首先需要的是作为一个社会和人民认识到正在发生的事情。 社会变革如何一方面调节更高水平的自我感知的个人痛苦,另一方面增加我们管理痛苦的难度,并且在许多情况下,将其视为生存条件所固有的。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">也许我们卫生专业人员可以更进一步分析我们能做什么和不能做什么。 如果没有清晰的愿景,如果你允许我有更广阔的视野,就不可能辨别我们向患者提出的诊断和治疗建议能走多远的问题。 作为第一个建议,我提出了对呈现在我们面前的不适采取解释学方法的重要性,向那些遭受这种不适的人解释他们的生活环境与由此产生的身体、心理、社会和存在反应之间可能存在的联系。 通常,那些正在经历人生危机的人无法理解正在发生的事情,因为答案通常是他们看不到的盲点。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">另一方面,利用情绪不适的时间以某种方式与他人联系并促进人们理解我们作为生物的状况将我们与所有其他人团结在一起,无论是在最光明的还是最黑暗的维度,也许是有价值的。 。 尽管患者通常认为自己是孤独和孤立的,但在这种情况下,与其他人的团结是不可能的。 这种哲学方法不需要高等教育或大学学位;任何遭受过苦难的人都可以向此刻正在遭受苦难的任何人提供重要的理解、同情和尊重。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;"><o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">记住,可以从构成人类痛苦的四个角度(生物、心理、社会和存在)来解决人类痛苦,而不仅仅是停留在表面上,这也许是卫生专业人员和社会其他人的首要任务。 反思和理解是需要的,但在一个高速发展且不利于它的世界中,我们需要帮助。 回归安静交谈的艺术、缓慢的沉思、对自己保持沉默或敢于创作小型艺术作品都可以成为拯救的行动方针。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><span style="font-size: medium;">公平地说,别人的痛苦和我们自己的痛苦一样值得尊敬,如果我们轻视它,最终就会取笑自己。 这就是为什么我们自己的人性化肯定与我们与人类阴影的联系方式有关。 正如我们关心他人的困难、疾病和灾难一样,我们也会处理自己的困难、疾病和灾难。</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><o:p><span style="font-size: medium;"><br /></span></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><o:p><span style="font-size: medium;"><br /></span></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGAm9y-MMKJvRkCrUVs0o63JuO8yl7ipK_XegFOkXmuMRJW3ZRta1JCkim-99tTzUXWnDkT_AZeKjcvxDS-HVNRCW3IlLhXIaBP-ekKtKN6Hz8NC9wEQyDOPX1TC6KPPAYcBS1zGswvjcpVaRfgTE7NRTwfB71u2EJS7fWIxwldft3uRNnmIhdbAyCbD8/s591/l-grimas-de-sangre.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="591" data-original-width="304" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGAm9y-MMKJvRkCrUVs0o63JuO8yl7ipK_XegFOkXmuMRJW3ZRta1JCkim-99tTzUXWnDkT_AZeKjcvxDS-HVNRCW3IlLhXIaBP-ekKtKN6Hz8NC9wEQyDOPX1TC6KPPAYcBS1zGswvjcpVaRfgTE7NRTwfB71u2EJS7fWIxwldft3uRNnmIhdbAyCbD8/w206-h400/l-grimas-de-sangre.jpeg" width="206" /></span></a></div><span style="font-size: medium;"><br /></span><div style="text-align: center;"><span style="font-size: medium;">Oswado Guayasamin, Lágrimas de sangre. </span></div><p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm;"><o:p><br /></o:p></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-31523180983223032922023-10-21T08:18:00.000+02:002023-10-21T08:18:03.277+02:00El mensaje de la princesa. The Princess's message. 公主的消息。<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKNYbOwdoEUL3AuMYDACro28hvKtRg9tamDRYHmLnt_bxfL3Q2Bq9ZV9mEJypRN26UgXY8OOvIWiZ9-0y8Ci3EmRJp7uldvB0SomFjsO7APCsnuhuaYmml0KBnbeIdN_8vvW8U-wbBY9C6L0fkos1rs9fiExNXCSD-JPJ8r9M0_0FO80-HxWukj3dZ99Y/s1200/13F18B01-4C10-4840-B62A-F0D4F365A56D.webp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="800" data-original-width="1200" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKNYbOwdoEUL3AuMYDACro28hvKtRg9tamDRYHmLnt_bxfL3Q2Bq9ZV9mEJypRN26UgXY8OOvIWiZ9-0y8Ci3EmRJp7uldvB0SomFjsO7APCsnuhuaYmml0KBnbeIdN_8vvW8U-wbBY9C6L0fkos1rs9fiExNXCSD-JPJ8r9M0_0FO80-HxWukj3dZ99Y/w400-h266/13F18B01-4C10-4840-B62A-F0D4F365A56D.webp" width="400" /></span></a></div><span style="font-size: medium;"><br /></span><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="background-color: white; font-kerning: none;"><span style="font-size: medium;">“Después de haber prestado juramento de servicio a España ante nuestra bandera hace apenas dos semanas y tras haber iniciado mi formación militar, que me está permitiendo <b>compartir el aprendizaje continuo con personas que han elegido una vida de servicio con grandes exigencias y renuncias personales</b>…"</span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;">"Lo que puedo decirles es que entiendo muy bien y <b>soy consciente de cuál es mi deber y de lo que implican mis responsabilidades"</b></span></span></p>
<p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;"><br /></span></span></p><p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;">Leonor de Borbón tuvo el privilegio de presentar la edición de este año de los premios que llevan su nombre con un discurso del que me permito extraer dos ideas de valor para los que ejercemos la medicina. No son tiempos fáciles para nosotros, en especial desde la pandemia que puso ante los ojos de todos de relieve la verdadera situación de sobrecarga e indefensión que muchas veces padecemos. Es cierto que nuestra época está trayendo tensiones múltiples para la entera sociedad, pero me permitirán que hoy me centre en la realidad que más conozco para tratar de proponer algún curso de acción constructivo. </span></span></p>
<p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;">La crisis de los sistemas sanitarios es global. Es de causa múltiple y compleja aquejando a países y profesionales del orbe entero. Si preguntamos a los interesados cómo se sienten nos hablarán de su sobrecarga física y psicológica, su malestar ante los cambios sociales que producen intolerancia al malestar y disminución de la capacidad de auto gestionarse en los pacientes, así como de su profunda sed existencial al ver como los valores médicos tradicionales y el sentido de lo que hacen se difumina en muchos casos. </span></span></p>
<p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;">Y en esto viene una chiquilla de 17 años que está haciendo la mili a hablarnos de las “grandes exigencias y sacrificios personales del mundo militar”. Muchos no habrán comprendido la frase dado que desde que España tiene un ejército profesionalizado el mundo militar se ha alejado de la sociedad civil. Antes los varones pasábamos obligatoriamente por él y aprendíamos de primera mano de que iban esas exigencias y sacrificios. Baste decir que entregabas un año de tu vida al servicio de los demás sin cobrar sueldo, alejándote de tus rutinas y familia y en compañía de gente diversa que otras circunstancias no te cruzarías en la vida. </span></span></p>
<p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;">El mundo sanitario también tiene grandes exigencias y sacrificios. Durante la carrera te pasabas la vida en clase y estudiando mientras veías que el resto del campus tomaba el sol en el césped. Luego enn el MIR te plantaban de cuatro a seis guardias al mes de 24 horas, que es como condensar la mitad de la semana laboral en apenas un día en un ambiente de trabajo a máxima presión. Y cuando empezabas a trabajar de especialista lo habitual era encontrar suplencias, destinos y turnos poco apetecibles. No les daré más detalles, el camino no era ni es fácil. </span></span></p>
<p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;">El problema que tenemos es que cada vez más profesionales no asumen tanta “exigencia y renuncias personales” y se van. Al irse crean problemas para los que se quedan: el resto de los compañeros y los pacientes en general. </span></span></p>
<p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;">No es nada fácil tomar conciencia de que ya no se puede más. Sobre todo si se llevan muchos años de sacrificio a la espalda. Esto lo saben todos los que han tenido que atravesar crisis personales de larga duración. En el caso que nos ocupa creo que somos muy conscientes de “cuál es nuestro deber y lo que implica nuestra responsabilidad”, de hecho solemos caer en la sobreimplicación de la que solo salimos tras sufrir largos y penosos procesos de burnout. Lo cierto es que es básico para preservar la salud mental conocer las propias lineas rojas y tratar por todos los medios de no cruzarlas. </span></span></p>
<p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;">Al ver durante los últimos meses el desempeño de la Princesa de Asturias entre militares me han venido recuerdos de mi propia adolescencia. Por eso recomiendo a todos los residentes que rotan conmigo tener experiencias laborales, de voluntariado o de cualquier tipo en otros países o con personas y proyectos alejados de su rutina habitual. La atomización social que sufrimos nos aleja de los demás y de la realidad. Es necesario recordar que las circunstancias de vida de grandes mayorías son realmente duras y complejas, y que cuando protestamos por la nuestra tal vez necesitemos perspectiva. </span></span></p>
<p style="background-color: white; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px 0px 22px;"><span style="font-kerning: none;"><span style="font-size: medium;">La historia nos enseña que para entrar en el mundo de los adultos, los jovenes tenían que atravesar su correspondiente proceso de iniciación. Eso implica aprender a bregar con el propio dolor y la propia sombra. Nadie lo pasa bien ahí, pero los que atraviesan esos lances se manejarán mejor después. </span></span></p>
<p><span style="font-size: medium;"><span style="background-color: white; font-family: Helvetica;">Me han gustado los reconocimientos que este año se han hecho en Oviedo. Creo que es de justicia agradecer y honrar a los que trabajan para el bien común y personalizarlo de alguna forma para hacerlo visible. Aunque bien sabemos que tras esas caras famosas hay muchas anónimas que desde la limpieza, la docencia, la cultura, la seguridad, o demás servicios nos sostienen a todos.</span><span style="background-color: white; font-family: Helvetica;"> </span> </span></p><p><span style="font-size: medium;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-B0O6bLMWOr168rxEJTH8mcYxc1fgXc5D-35raQklXp50mCpyNxsJg9GgQ3YJAbkCzioiMhfFCFcHA7iXIS69DYCgGS2-ZmeXvIK9s5xlXb9OgyOi10Qxvgp8R_U3lrwUjGfkBNvuC4jYaNRtFqZJLMBcgt9JiUautfEG-yxa1GUcC9CXOTB1TDeiggU/s2000/E3A342C0-9AF4-4C74-A20B-DF50383BB453.webp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="1338" data-original-width="2000" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-B0O6bLMWOr168rxEJTH8mcYxc1fgXc5D-35raQklXp50mCpyNxsJg9GgQ3YJAbkCzioiMhfFCFcHA7iXIS69DYCgGS2-ZmeXvIK9s5xlXb9OgyOi10Qxvgp8R_U3lrwUjGfkBNvuC4jYaNRtFqZJLMBcgt9JiUautfEG-yxa1GUcC9CXOTB1TDeiggU/s320/E3A342C0-9AF4-4C74-A20B-DF50383BB453.webp" width="320" /></span></a></div><span style="font-size: medium;"><br /></span><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><b><span style="font-size: medium;">The Princess's message.</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">"After having taken the oath of service to Spain before our flag just a fortnight ago and after having begun my military training, which is allowing me to share continuous <b>learning with people who have chosen a life of service with great demands and personal renunciations</b>..."</span></p><p><span style="font-size: medium;">"What I can tell you is that I understand very well and <b>I am aware of what my duty is and what my responsibilities entail"</b></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Leonor de Borbón had the privilege of presenting this year's edition of the awards that bear her name with a speech from which I would like to extract two valuable ideas for those of us who practise medicine. These are not easy times for us, especially since the pandemic that brought home to all of us the real situation of overload and helplessness that we often suffer. It is true that our times are bringing multiple tensions for society as a whole, but allow me to focus today on the reality with which I am most familiar in order to try to propose some constructive course of action. </span></p><p><span style="font-size: medium;">The crisis in health systems is global. It has multiple and complex causes, affecting countries and professionals across the globe. If we ask those concerned how they feel, they will tell us of their physical and psychological overload, their unease at the social changes that are producing intolerance of discomfort and diminishing patients' capacity for self-management, as well as their deep existential thirst as they see their health systems deteriorate.</span></p><p><span style="font-size: medium;">And here comes a 17-year-old girl who is doing her military service to talk to us about the "great demands and personal sacrifices of the military world". Many will not have understood the phrase, given that since Spain has had a professionalised army, the military world has distanced itself from civilian society. In the past, men were obliged to go through it and learn first-hand what the demands and sacrifices were all about. Suffice it to say that you gave a year of your life to the service of others without pay, away from your routines and family and in the company of people you would otherwise never come across in your life. </span></p><p><span style="font-size: medium;">The healthcare world also has great demands and sacrifices. During your degree you spent your life in class and studying while watching the rest of the campus sunbathing on the lawn. Then in the MIR you had four to six 24-hour shifts per month, which is like condensing half of the working week into just one day in a high-pressure work environment. And when you started working as a specialist, it was common to find substitutions, assignments and shifts that were not very appetising. I will not give you more details, the path was not and is not easy. </span></p><p><span style="font-size: medium;">The problem we have is that more and more professionals do not take on so many "demands and personal sacrifices" and leave. When they leave, they create problems for those who remain: the rest of their colleagues and patients in general. </span></p><p><span style="font-size: medium;">And here comes a 17-year-old girl who is doing her military service to talk to us about the "great demands and personal sacrifices of the military world". Many will not have understood the phrase, given that since Spain has had a professionalised army, the military world has distanced itself from civilian society. In the past, men were obliged to go through it and learn first-hand what the demands and sacrifices were all about. Suffice it to say that you gave a year of your life to the service of others without pay, away from your routines and family and in the company of people you would otherwise never come across in your life. </span></p><p><span style="font-size: medium;">The healthcare world also has great demands and sacrifices. During your degree you spent your life in class and studying while watching the rest of the campus sunbathing on the lawn. Then in the MIR you had four to six 24-hour shifts per month, which is like condensing half of the working week into just one day in a high-pressure work environment. And when you started working as a specialist, it was common to find substitutions, assignments and shifts that were not very appetising. I will not give you more details, the path was not and is not easy. </span></p><p><span style="font-size: medium;">The problem we have is that more and more professionals do not take on so many "demands and personal sacrifices" and leave. When they leave, they create problems for those who remain: the rest of their colleagues and patients in general.</span></p><p><span style="font-size: medium;">It is not easy to realise that you can't do it any more. Especially if you have had many years of sacrifice behind you. Anyone who has had to go through a long-term personal crisis knows this. In this case, I think we are all too aware of "what our duty is and what our responsibility entails", in fact we tend to fall into over-involvement from which we only emerge after suffering long and painful burnout processes. The truth is that in order to preserve mental health it is essential to know one's own red lines and to try by all means not to cross them. </span></p><p><span style="font-size: medium;">Watching the performance of the Princess of Asturias in the military over the last few months has brought back memories of my own adolescence. That is why I recommend to all residents who rotate with me to have work, volunteering or any other kind of experience in other countries or with people and projects far from their usual routine. The social atomisation we suffer from distances us from others and from reality. We need to remember that the life circumstances of large majorities are really hard and complex, and that when we protest for our own we may need perspective. </span></p><p><span style="font-size: medium;">History teaches us that in order to enter the adult world, young people had to go through a process of initiation. This involves learning to deal with one's own pain and one's own shadow. No one has a good time there, but those who go through those throws will handle it better afterwards.</span></p><p><span style="font-size: medium;">I liked the awards that were made in Oviedo this year. I think it is only fair to thank and honour those who work for the common good and to personalise it in some way to make it visible. Although we are well aware that behind these famous faces there are many anonymous people who, through cleaning, teaching, culture, security and other services, support us all.</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><b><span style="font-size: medium;">公主的消息。</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">自动翻译如有错误敬请谅解。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">“两周前,我在国旗前宣誓为西班牙服役,并开始了军事训练,这让我能够与那些选择了高要求和个人牺牲的服役生活的人们分享不断的学习。 ”。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">“我可以告诉你的是,我非常了解并意识到我的职责是什么以及我的责任意味着什么”</span></p><p><span style="font-size: medium;">莱昂诺·德·波旁 (Leonor de Borbón) 有幸在颁奖典礼上以她的名字命名了今年的奖项,并发表了演讲,我从演讲中提炼出两个对我们这些行医者有价值的想法。 对于我们来说,这并不是一个轻松的时期,特别是自从这场大流行病让每个人都看到了我们经常遭受的超负荷和无助的真实状况。 确实,我们的时代给整个社会带来了多重紧张,但今天你会让我专注于我最了解的现实,试图提出一些建设性的行动方案。</span></p><p><span style="font-size: medium;">卫生系统的危机是全球性的。 它有多重复杂的原因,影响着世界各地的国家和专业人士。 如果我们询问那些感兴趣的人的感受,他们会告诉我们他们的身体和心理超负荷,他们面对社会变化的不适,这些变化导致患者无法忍受不适和自我管理能力下降,以及他们的在许多情况下,传统医学价值观及其所做的事情的意义是如何模糊的,对此存在深刻的渴求。</span></p><p><span style="font-size: medium;">一位正在服兵役的17岁女孩来和我们谈论“军事世界的伟大要求和个人牺牲”。 许多人不会理解这句话,因为西班牙拥有一支专业化的军队,军事界已经与民间社会保持距离。 以前,我们男人必须经历它并亲身了解这些要求和牺牲的含义。 可以说,您将生命中的一年奉献给了他人,没有领取薪水,远离了日常生活和家庭,并与您在生活中不会遇到的形形色色的人在一起。</span></p><p><span style="font-size: medium;">医疗保健领域也有巨大的需求和牺牲。 在攻读学位期间,您的一生都在课堂和学习中度过,而您则看着校园其他人在草地上享受日光浴。 然后在 MIR,他们每个月安排四到六名 24 小时警卫,这就像在压力最大的工作环境中将一周工作时间的一半压缩为一天。 当你开始作为一名专家工作时,通常的事情就是寻找没有吸引力的替代、任务和轮班。 我不会向您提供更多细节,这条路过去并不容易,现在也不容易。</span></p><p><span style="font-size: medium;">我们面临的问题是,越来越多的专业人士不承担那么多“个人要求和辞职”并离开。 他们的离开会给那些留下来的人带来问题:其他同事和一般患者。</span></p><p><span style="font-size: medium;">意识到你不能再这样做并不容易。 尤其是如果他们背后有多年的牺牲。 每个经历过长期个人危机的人都知道这一点。 就目前的情况而言,我相信我们非常清楚“我们的职责是什么,我们的责任意味着什么”,事实上我们很容易陷入过度卷入的境地,只有在经历了漫长而痛苦的倦怠过程后才能摆脱困境。 事实是,了解自己的红线并尽力不跨越它们对于保持心理健康至关重要。</span></p><p><span style="font-size: medium;">近几个月来,看着阿斯图里亚斯公主在军队中的表现,我想起了自己的青春期。 这就是为什么我建议所有与我一起轮换的住院医生都有在其他国家工作、志愿者或任何类型的经验,或者与远离他们平常生活的人和项目一起工作的经历。 我们所遭受的社会原子化使我们与他人和现实变得疏远。 有必要记住,绝大多数人的生活环境确实艰难而复杂,当我们抗议我们的生活时,我们可能需要有远见。</span></p><p><span style="font-size: medium;">历史告诉我们,年轻人要进入成年人的世界,必须经历相应的启蒙过程。 这意味着学会处理自己的痛苦和自己的阴影。 没有人在那里过得愉快,但那些经历过这些挣扎的人以后会处理得更好。</span></p><p><span style="font-size: medium;">我喜欢今年在奥维多获得的认可。 我认为感谢和表彰那些为共同利益而努力的人并以某种方式将其个性化以使其可见是公平的。 尽管我们深知,在这些名人面孔的背后,还有许多默默无闻的人,他们从清洁、教学、文化、安全或其他服务领域支持着我们所有人。</span></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-19245144412958202842023-10-04T09:39:00.005+02:002023-10-04T09:39:43.314+02:00Reconstruyendo los pilares. Rebuilding the pillars. 重建支柱<p><span style="font-size: medium;"> </span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK5luqfrn2sgQU3bnkfgFrOE9sdl9S8JJxlCeUwhxS9AenDI3HqddnS1ZgqjA2T6g89BA2gYB8wKTNJ3ZwrJHRaskKoMXQKvC7CXMtne9UZak9SScymKgYd73HkBXfO99uXLht_JrDOeGrby2_2PG9J0F24UnfsaDl5oyOQDl46ZugN26A3nCLXR4Snl0/s680/F7gBn9RW8AA6E5h%20(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="510" data-original-width="680" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK5luqfrn2sgQU3bnkfgFrOE9sdl9S8JJxlCeUwhxS9AenDI3HqddnS1ZgqjA2T6g89BA2gYB8wKTNJ3ZwrJHRaskKoMXQKvC7CXMtne9UZak9SScymKgYd73HkBXfO99uXLht_JrDOeGrby2_2PG9J0F24UnfsaDl5oyOQDl46ZugN26A3nCLXR4Snl0/w400-h300/F7gBn9RW8AA6E5h%20(1).jpg" width="400" /></a></span></div><span style="font-size: medium;"><br /></span><p></p><p class="MsoNormal"><span style="font-size: medium;">Ayer asistí a la <a href="https://www.somamfyc.com/congresos/congreso-2023/">jornada anual</a> que organiza la Sociedad
Madrileña de Medicina Familiar y Comunitaria. Me he animado a compartir <a href="https://twitter.com/hashtag/xxxcongresosomamfyc?src=hashtag_click">algunas impresiones</a> por ser la ocasión proclive para tomar el pulso a la especialidad en
particular y a la Atención Primaria en general. Lo mejor de este tipo de
jornadas es el valor que aportan tanto dentro de las salas como en los
pasillos. En las primeras mucho nivel, invitados ilustres que aportaron
formación y participación de representantes de los grupos de trabajo que dieron
jugosas pistas. Estos últimos en un formato breve de 6 minutos que nos permitió
confirmar que pese a todo sigue habiendo profesionales motivados. Hubo un toque
de humor a cargo de <a href="https://twitter.com/1cada8h">@1cada8horas</a>, otro institucional (en los últimos años no
vino nadie de la gerencia), y guiños variados en las mesas. Complementaban la
jornada algunos talleres prácticos y el espacio científico de presentaciones y
poster que reconozco disfruté. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: medium;">No puede hablar con los 300 asistentes pero sí que abracé y
saludé a muchos amigos tanto en activo como jubilados. Me agradó especialmente
que estos últimos se animaran a acudir. Agradecí a José Manuel Freire su
intermediación para que la jornada tuviera lugar en el Ateneo de Madrid, un
lugar ilustre y magnético. Después de hablar con Alberto Cutillas y algunos
miembros de la actual junta, con compañeros seniors y algún residente creo
poder certificar un nivel de perfusión distal aceptable. No es poca cosa tras
las asistolias de la pandemia y la postpandemias, tras las huelgas y desencuentros
con la administración. Sentí también mucho cansancio de fondo y flotaba en el
ambiente ese olor a desesperación que no nos terminamos de quitar de encima. Salí
contento. Produce un alivio en el alma tomar consciencia de la tenacidad de
tanta gente buena que pese al viento en contra sigue navegando. <o:p></o:p></span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSrv6px_G5mqLhhxzviQoteFDFvuA4tsb5jK_L3w90l5IjeJ6CMg71te86-lswpJROgc2jB14SVE4vEBG0tg2nZ79VjnhLLbWIlT012m40lAMcZjGbunT7gwWgP-cGiAyTBResDlzt5AT9rc6i7Ug7jQiGVwJv1AIR97U3gjVG3mSGwZeCAL2vNGfaslc/s680/F7glysVXUAA6vvd%20(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="680" data-original-width="510" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSrv6px_G5mqLhhxzviQoteFDFvuA4tsb5jK_L3w90l5IjeJ6CMg71te86-lswpJROgc2jB14SVE4vEBG0tg2nZ79VjnhLLbWIlT012m40lAMcZjGbunT7gwWgP-cGiAyTBResDlzt5AT9rc6i7Ug7jQiGVwJv1AIR97U3gjVG3mSGwZeCAL2vNGfaslc/w300-h400/F7glysVXUAA6vvd%20(1).jpg" width="300" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><b><span style="font-size: medium;">Rebuilding the pillars</span></b></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;">Yesterday I attended the annual conference organised by the Madrid Society of Family and Community Medicine. I have decided to share some of my impressions as it is the perfect opportunity to take the pulse of the speciality in particular and of Primary Care in general. The best thing about this type of conference is the value it provides both inside the rooms and in the corridors. In the first ones, there was a high level, illustrious guests who provided training and participation of representatives of the working groups who gave juicy clues. The latter in a short 6-minute format that allowed us to confirm that despite everything there are still motivated professionals. There was a touch of humour by @1cada8horas, another institutional one (in recent years no one from the management came), and a variety of winks at the tables. </span></p><p class="MsoNormal"><span style="font-size: medium;">The day was complemented by some practical workshops and the scientific area of presentations and posters, which I must admit I enjoyed. I cannot speak to the 300 attendees but I did hug and greet many friends, both active and retired. I was especially pleased that the latter were encouraged to attend. I thanked José Manuel Freire for brokering the event to take place at the Ateneo de Madrid, an illustrious and magnetic venue. </span></p><p class="MsoNormal"><span style="font-size: medium;">After speaking with Alberto Cutillas and some members of the current board, with senior colleagues and some residents, I believe I can certify an acceptable level of distal perfusion. This is no mean feat after the pandemic and post-pandemic asystole, after the strikes and disagreements with the administration. I also felt a lot of fatigue in the background, and there was a whiff of desperation in the air that we still can't shake off. I left happy. It is a relief for the soul to be aware of the tenacity of so many good people who, despite the headwinds, continue to sail.</span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1xrSREmN7VfiTP5Gxya6efMJGDOiYfG4AAdcBxGr4mIEyT_e2wRswKwdv-a_Ly1NFgDbUD-wrUCtdLeG2zMxEd_16NI63MFG9FFtZSSWvyzsl81wLvBfQasPY5lNNplZbllOADucIhKQp81P78Bd2tZfkpTqiaK63U0jQajYN2sEZ5dRTOK34DfN3AX4/s680/F7hHJwBWcAABm1w.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="680" data-original-width="510" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1xrSREmN7VfiTP5Gxya6efMJGDOiYfG4AAdcBxGr4mIEyT_e2wRswKwdv-a_Ly1NFgDbUD-wrUCtdLeG2zMxEd_16NI63MFG9FFtZSSWvyzsl81wLvBfQasPY5lNNplZbllOADucIhKQp81P78Bd2tZfkpTqiaK63U0jQajYN2sEZ5dRTOK34DfN3AX4/w300-h400/F7hHJwBWcAABm1w.jpg" width="300" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p class="MsoNormal"><b><span style="font-size: medium;">重建支柱</span></b></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;">昨天,我参加了马德里家庭与社区医学学会举办的年会。我决定与大家分享我的一些感想,因为这是一次把握本专业乃至整个初级医疗脉搏的绝佳机会。这类会议的最大特点是,无论是在会场内还是在走廊上,都能体现出它的价值。在前者,有高水平、杰出的嘉宾提供培训,也有工作组代表的参与,他们提供了多汁的线索。后者以短短 6 分钟的形式让我们确认,尽管发生了一切,但仍有积极进取的专业人士。@1cada8horas(另一位体制内人士,近年来管理层没有人来过)的幽默,以及餐桌上的各种眨眼。当天还举办了一些实用的研讨会,以及演讲和海报科学区,我必须承认,我很喜欢这些活动。</span></p><p class="MsoNormal"><span style="font-size: medium;">我不能对 300 名与会者说什么,但我确实拥抱和问候了许多朋友,有在职的,也有退休的。我尤其高兴的是,大会鼓励退休人员参加会议。我感谢何塞-曼努埃尔-弗莱雷(José Manuel Freire)促成这次活动在马德里雅典耀大学(Ateneo de Madrid)举行,这是一个辉煌而富有磁性的场所。</span></p><p class="MsoNormal"><span style="font-size: medium;">在与阿尔贝托-库蒂亚斯(Alberto Cutillas)和现任董事会的一些成员、资深同事和一些住院医生交谈之后,我相信我可以证明远端灌注达到了可接受的水平。在经历了大流行和大流行后的窒息,在经历了罢工和与行政部门的分歧之后,这绝非易事。我还感觉到了许多疲惫,空气中弥漫着一股我们仍然无法摆脱的绝望气息。我高兴地离开了。能够意识到有这么多善良的人们在逆风中依然坚韧不拔,继续扬帆起航,我的心灵得到了慰藉。</span></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-25115400937229848492023-06-18T08:08:00.004+02:002023-06-18T08:08:18.261+02:00 La pandemia no acabó. The pandemic is not over. 大流行病还没有结束<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnci2CdDu4NJ5L3aZrAm3buW1QuWng_5Uc4hb_4nhVYsxoAwMkRSgHYrf5-0RzI_m6Lmx_tyWpGomhK8698Q_eg-8lvHFHhI3CI9Gokh8ZGNNNam9jpx9MbsUw85YuYWFF5wyTsBr9XCij8l0LokQl0A1oMswKDgI8kGBKlW3L_lwLBfiYAOZCwrsG/s2341/4FAEB6FC-70A0-435A-9D00-19B466FCE720.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1369" data-original-width="2341" height="374" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnci2CdDu4NJ5L3aZrAm3buW1QuWng_5Uc4hb_4nhVYsxoAwMkRSgHYrf5-0RzI_m6Lmx_tyWpGomhK8698Q_eg-8lvHFHhI3CI9Gokh8ZGNNNam9jpx9MbsUw85YuYWFF5wyTsBr9XCij8l0LokQl0A1oMswKDgI8kGBKlW3L_lwLBfiYAOZCwrsG/w640-h374/4FAEB6FC-70A0-435A-9D00-19B466FCE720.jpeg" width="640" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Al hipercapitalismo no le gustan los duelos. Hace valer hasta el extremo el antiguo dicho “el muerto al hoyo y el vivo al bollo”. Y para ello no duda en usar todas las armas de distracción masiva que posee. Pero la realidad es tozuda y los hechos son los hechos, la pandemia por Covid ha matado a millones de personas de forma directa e indirecta. Hay registros públicos de 5 millones de muertos, la OMS calcula que tres veces más, y un servidor se atreve a pronosticar una cifra muchísimo más alta. Lo cierto es que todas las familias han sufrido los efectos de la pandemia y han tenido que lamentar víctimas entre sus miembros o en su círculo de vecinos o amigos. A lo que se añade los casos superados tanto de covid agudo como de covid prolongado, muchos millones de afectados. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">A nivel social no hemos conseguido hacer un proceso de duelo en condiciones. Hemos sido testigos del manejo político de la pandemia, primero con puño de hierro, luego con mano de seda. Basta mirar a los países occidentales primero y a China después y como se pasó de una situación de emergencia a otra de normalidad total de un día para otro a conveniencia del poder ejecutivo de turno. Y es que la economía sigue siendo quien maneja los hilos, las paradas como decíamos al inicio no son bien toleradas por una industria y un comercio que toleran mal los descensos de beneficios. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">De este modo, como si de un pase de magia se tratara, nos han cambiado la situación mundial de una terrible apocalipsis a un mundo de color y fantasía en el que lo pasado pasado y vivamos el presente. El problema es que tenemos encima un buen montón de muertos, y aunque se muchos se empeñen, a los muertos propios es difícil taparles la boca. Están demasiado presentes. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Como médico de familia he vivido la pandemia en primera línea, y además de sufrir los casos familiares y personales cercanos he tenido muchos más por causa de mi trabajo. Mucho más sufrimiento, muchos más muertos. Sin embargo el duelo que hemos podido hacer los sanitarios no dista mucho del que ha hecho el resto de la sociedad. En lugar de llorar en condiciones o procesar la pérdida, hemos seguido trabajando a destajo y mirando hacia delante. Quién ha podido, claro está, los casos de burnout, enfermedades físicas y mentales se han incrementado como nunca. Pese a la falta de transparencia basta darse una vuelta por los centros de salud de Madrid y preguntar cuántos facultativos faltan…</span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Ser testigos del colapso del sistema sanitario durante las sucesivas olas pandémicas ha sido algo muy duro para muchos profesionales que creíamos en la estabilidad y solidez de la organización. La mala gestión inicial, la insuficiente reserva funcional de la Atención Primaria, los sistemas de urgencia o de las Unidades de Cuidados Intensivos, han elevado la presión al límite sobre los que sostenían dichos servicios. Y no ha sido agradable, muchos profesionales hemos tocado fondo y quién más y quién menos se ha llevado la correspondiente herida o quemadura. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">En Madrid tuvimos además que padecer la gestión sanitaria marca de la casa. A poco de salir de la última ola a los responsables les da por desmantelar las urgencias de Atención Primaria, y efectivamente consiguen cargarse por completo el servicio. Cómo sería la indignación que esto provocó una huelga de pediatras y médicos de familia de cuatro meses, en lo que ha sido quizá una torpe manera de hacer el duelo pandémico para los facultativos capitalinos que vimos como el sueldo de varias nóminas se reducía con fruición. No lo damos por malo, a base de gritar, manifestarnos por la Gran Vía, corear consignas y verbalizar lo que pensábamos de tirios y troyanos nos ha salido caro pero nos ha ayudado a manifestar el profundo malestar y dolor de los que vimos qué fácil es pasar de los aplausos de balcón a la incomprensión pública y a la desidia del político. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">En otros lugares no ha sido así, cada cual ha hecho lo que ha podido. Lo cierto es que seguimos adelante sin haber aprendido todas las lecciones. Seguimos sin tener información epidemiológica de calidad. Seguimos sin saber que utilidad real tienen las medidas de aislamiento social, mascarillas y demás. Seguimos sin saber cómo evitar otras pandemias. Seguimos sin saber cómo mejorar los sistemas sanitarios. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Y por supuesto seguimos sin saber cómo mejorar los duelos sociales. <a href="https://twitter.com/jcamilovazquez/status/1669610792579223552?s=61&t=i-aqOCWtRO2zssEdvpTdCA">Un compañero</a> preguntaba estos días cómo podría ser un símbolo público que expresara el luto por el Covid, al modo del pañuelo blanco de las madres de la plaza de mayo, y me parecía una cuestión interesante. Porque ha habido un luto que quizá no hemos sabido hacer de la mejor manera pese al dolor. Y hay lágrimas que hay que dejar salir, como todos sabemos. </span></span></p>
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<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><a href="https://www.bbc.com/mundo/noticias-61333739">https://www.bbc.com/mundo/noticias-61333739</a></span></span></p>
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<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><a href="https://digital.csic.es/handle/10261/266325">https://digital.csic.es/handle/10261/266325</a></span></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6p5tSVpUK0WfvL2GHq9KkFmDs3T_xgrN_UCjTvLdeIHR2d3uk1FCmj5xdA_aDAV5TUOPT8PvU2r8aKjUXd0oWhV0X4wMnpmuXiXYQytiFJIttCQ1tI6RKGqWlIpMxDapyrDVFy2omF_mT5gYRAHdp0Hmg7v6tbHCjTbCwneARuBfvysvawzY4DO8y/s1967/9F0F9AD0-D7E1-4647-8079-CA45FC733BEF.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1471" data-original-width="1967" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6p5tSVpUK0WfvL2GHq9KkFmDs3T_xgrN_UCjTvLdeIHR2d3uk1FCmj5xdA_aDAV5TUOPT8PvU2r8aKjUXd0oWhV0X4wMnpmuXiXYQytiFJIttCQ1tI6RKGqWlIpMxDapyrDVFy2omF_mT5gYRAHdp0Hmg7v6tbHCjTbCwneARuBfvysvawzY4DO8y/w640-h478/9F0F9AD0-D7E1-4647-8079-CA45FC733BEF.jpeg" width="640" /></a></div><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><br /></span></p><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgcW1vlxTvt3hrvbVHaG8OUaCS9HmY3HSUvLrz2hVF-XCbrOUGgOJ1eertBl-Q7zAANpDv6NqcbZHAZBEY_1cE8L28vxBx2v-AJ25ffu7jd12FLE6Au3_dNbyCy9D_IMjvkXIYblN2iuGxoGVqX21XJsrdZk-K4GJQZCv5-T-JvknJ8cyigxhdjZHg/s1136/465C960B-488B-4CC5-99C4-8C111D368B6B.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="824" data-original-width="1136" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgcW1vlxTvt3hrvbVHaG8OUaCS9HmY3HSUvLrz2hVF-XCbrOUGgOJ1eertBl-Q7zAANpDv6NqcbZHAZBEY_1cE8L28vxBx2v-AJ25ffu7jd12FLE6Au3_dNbyCy9D_IMjvkXIYblN2iuGxoGVqX21XJsrdZk-K4GJQZCv5-T-JvknJ8cyigxhdjZHg/w400-h290/465C960B-488B-4CC5-99C4-8C111D368B6B.png" width="400" /></a></div><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><br /></span></p><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxeKeeW4yDImNMeBIq5ZzMA5casjr-fu_Jo4nkoumJT4pPEb1GOZofFVk5FcaS6dkehkjhHk-IwjGUkEdlv4oQOEh8myqSAtS3SrbU611I8gtEyqKoXLxTRNpde0FiMmxwvoLqqznU2n8tm3OWuUZtKsZZ9-S0ZEPgGkm5YA58HJBYf2AAL3CyUSOX/s1200/A08CC20E-8B6D-4175-9020-6E0D7E1E9BCF.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1200" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxeKeeW4yDImNMeBIq5ZzMA5casjr-fu_Jo4nkoumJT4pPEb1GOZofFVk5FcaS6dkehkjhHk-IwjGUkEdlv4oQOEh8myqSAtS3SrbU611I8gtEyqKoXLxTRNpde0FiMmxwvoLqqznU2n8tm3OWuUZtKsZZ9-S0ZEPgGkm5YA58HJBYf2AAL3CyUSOX/w400-h400/A08CC20E-8B6D-4175-9020-6E0D7E1E9BCF.png" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><b>The pandemic is not over</b></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Hypercapitalism does not like duels. It makes the old saying "the dead to the hole and the living to the bun" apply to the extreme. And to this end it does not hesitate to use all the weapons of mass distraction it possesses. But reality is stubborn and the facts are the facts, the Covid pandemic has killed millions of people directly and indirectly. There are public records of 5 million deaths, the WHO estimates three times that number, and I would venture to predict a much higher figure. What is certain is that every family has suffered the effects of the pandemic and has had to mourn victims among its members or in their circle of neighbours or friends. On top of this, there are many millions of people affected by both acute and prolonged covid. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">On a social level, we have not managed to carry out a proper mourning process. We have witnessed the political handling of the pandemic, first with an iron fist, then with a silk hand. Just look at the Western countries first and China later and see how they went from an emergency situation to a situation of total normality from one day to the next at the convenience of the executive power of the day. And it is the economy that continues to pull the strings, and as we said at the beginning, stoppages are not well tolerated by an industry and commerce that do not tolerate drops in profits very well. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">In this way, as if by magic, the world situation has changed from a terrible apocalypse to a world of colour and fantasy in which the past is the past and we live in the present. The problem is that we have a lot of dead people on top of us, and even if many of them insist, it is difficult to keep their mouths shut from their own dead. They are too present. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">As a family doctor, I have lived through the pandemic on the front line, and in addition to suffering from close family and personal cases, I have had many more because of my work. Much more suffering, many more deaths. However, the mourning that we health workers have been able to do is not very different from that of the rest of society. Instead of grieving properly or processing the loss, we have continued to work hard and look forward. Who has been able to, of course, cases of burnout, physical and mental illness have increased as never before. Despite the lack of transparency it is enough to take a walk around the health centres of Madrid and ask how many doctors are missing...</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">Witnessing the collapse of the health system during the successive pandemic waves has been very hard for many professionals who believed in the stability and solidity of the organisation. The initial mismanagement, the insufficient functional reserve of primary care, emergency systems or intensive care units, have pushed the pressure to the limit on those who supported these services. And it has not been pleasant, many of us professionals have hit rock bottom and some of us have been hit by the corresponding pressure.</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">In Madrid we have also had to suffer from the house's trademark health management. Shortly after coming out of the last wave, those in charge decided to dismantle the primary care emergency services, and effectively succeeded in completely destroying the service. How outraged they were that this provoked a four-month strike by paediatricians and family doctors, in what was perhaps a clumsy way of pandemic mourning for the capital's doctors, who saw their salaries reduced with fruition. We don't take it for bad, by shouting, demonstrating along the Gran Vía, chanting slogans and verbalising what we thought of Tyrians and Trojans has cost us dearly, but it has helped us to express the deep unease and pain of those of us who saw how easy it is to go from applause on the balcony to public incomprehension and political neglect. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">In other places this has not been the case, everyone has done what they could. The truth is that we are still going ahead without having learnt all the lessons. We still do not have quality epidemiological information. We still don't know how useful social isolation measures, masks and so on really are. We still do not know how to prevent other pandemics. We still do not know how to improve health systems. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">And of course we still don't know how to improve social grief. A colleague asked recently what a public symbol could be to express the mourning for Covid, like the white scarf of the mothers of the Plaza de Mayo, and I thought it was an interesting question. Because there has been a mourning that perhaps we have not known how to mourn in the best way despite the pain. And there are tears that must be let out, as we all know. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><br /></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">https://www.bbc.com/mundo/noticias-61333739</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">https://digital.csic.es/handle/10261/266325</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7nNF9fbV5XKB71kGzRnJ9o6HF_6-Cip4k7UpIQ64XmU50CqBAxyv2jMTg7S4i-mgW6CsyG5pOrT4J3hsZ8FoX0mEvW8Zl77KSVkzxvVkosWgzwApxpq48WFzKA1s5X2tUv_ZP4mCyFiSConcHXNJ5G5PQQJVJsuPZ599ILL9FMsSp0kqzXEuXXiLP/s2732/A6DE641E-84CD-47C6-93F0-EEB8626AFE74.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="2732" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7nNF9fbV5XKB71kGzRnJ9o6HF_6-Cip4k7UpIQ64XmU50CqBAxyv2jMTg7S4i-mgW6CsyG5pOrT4J3hsZ8FoX0mEvW8Zl77KSVkzxvVkosWgzwApxpq48WFzKA1s5X2tUv_ZP4mCyFiSConcHXNJ5G5PQQJVJsuPZ599ILL9FMsSp0kqzXEuXXiLP/w400-h300/A6DE641E-84CD-47C6-93F0-EEB8626AFE74.png" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><b>大流行病还没有结束</b></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">机器翻译,抱歉有错误。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">超资本主义不喜欢决斗。它让 "死人进洞,活人进包 "这句老话发挥到了极致。为此,它毫不犹豫地使用它所拥有的所有大规模分散注意力的武器。但现实是顽固的,事实就是事实,科维德大流行病已经直接和间接地杀死了数百万人。公开记录显示有500万人死亡,世卫组织估计是这个数字的三倍,我大胆预测会有更高的数字。可以肯定的是,每个家庭都受到了这一流行病的影响,不得不在其成员中或在其邻居或朋友圈中悼念受害者。除此之外,还有数以百万计的人受到急性和长期病毒的影响。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">在社会层面上,我们还没有设法进行适当的哀悼过程。我们目睹了对这一流行病的政治处理,先是用铁拳,然后是用绢手。只要看看西方国家先是,后来是中国,看看它们是如何在当时的行政权力的便利下,从一个紧急状况变成一个完全正常的状况的。而继续拉动经济的是经济,正如我们在开始时所说的,停工对于不善于容忍利润下降的工业和商业来说是不能容忍的。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">这样一来,就像变魔术一样,世界局势从可怕的启示录变成了一个充满色彩和幻想的世界,在这个世界里,过去是过去,我们生活在现在。问题是,我们上面有很多死人,即使他们中的很多人坚持,也很难对自己的死人守口如瓶。他们的存在感太强了。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">作为一名家庭医生,我在前线经历了这场大流行病,除了遭受近亲和个人的病例之外,我还因为我的工作而多了很多。更多的痛苦,更多的死亡。然而,我们卫生工作者所能做的哀悼,与社会上其他的人没有什么不同。我们没有适当地悲痛或处理损失,而是继续努力工作,向前看。当然,谁能做到这一点,倦怠、身体和精神疾病的案例前所未有地增加。尽管缺乏透明度,但只要在马德里的保健中心走一圈,问问有多少医生失踪就够了......</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">目睹卫生系统在连续的大流行病浪潮中的崩溃,对许多相信该组织的稳定性和稳固性的专业人士来说是非常艰难的。最初的管理不善,初级保健、急救系统或重症监护室的功能储备不足,已经把支持这些服务的人的压力推到了极限。这并不令人愉快,我们中的许多专业人员已经跌到了谷底,还有谁?</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">在马德里,我们也不得不遭受这所房子的标志性健康管理。在走出上一波浪潮后不久,那些负责人决定解散初级保健急救服务,并有效地成功地完全摧毁了该服务。他们是多么的愤怒,这激起了儿科医生和家庭医生为期四个月的罢工,这也许是对首都医生大流行的一种笨拙的哀悼方式,他们看到他们的工资随着成果而减少。我们不以为然,通过大喊大叫,沿着Gran Vía游行示威,高呼口号,用语言表达我们对提利尔人和特洛伊人的看法,让我们付出了沉重的代价,但它帮助我们表达了我们这些人深深的不安和痛苦,因为我们看到从阳台上的掌声到公众的不理解和政治忽视是多么容易。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">在其他地方,情况并非如此,每个人都做了他们所能做的。事实是,我们仍然在没有吸取所有教训的情况下继续前进。我们仍然没有高质量的流行病学信息。我们仍然不知道社会隔离措施、口罩等到底有多大作用。我们仍然不知道如何预防其他大流行病。我们仍然不知道如何改善卫生系统。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">当然,我们也仍然不知道如何改善社会的悲痛。一位同事最近问,可以用什么公共标志来表达对科维德的哀悼,就像五月广场的母亲们的白围巾一样,我认为这是一个有趣的问题。因为一直有一种哀悼,也许我们不知道如何以最好的方式哀悼,尽管有痛苦。而有些眼泪是必须要流出来的,这一点我们都知道。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">https://www.bbc.com/mundo/noticias-61333739</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;">https://digital.csic.es/handle/10261/266325</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: medium;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmTCvwzHas-AsckwtWGTCKI3xqrbhLPiMY6mj6J3YEIHFsa2HDp7eBFPUV9hKUbIHHFpisbOIqnwLBUvwPC2nMYxibtVlIixtiRxohlBbFPWnlYfpiG9SKdsxboCi1Fs1DIgdWrBPJwDRd5XP0FOC4WJliFj4z6xZvsk0__5Rw8DtNq1_k2y9GI4n3/s4032/2BE9E023-A04D-4F64-BF05-3C26BB7D2363.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="3024" data-original-width="4032" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmTCvwzHas-AsckwtWGTCKI3xqrbhLPiMY6mj6J3YEIHFsa2HDp7eBFPUV9hKUbIHHFpisbOIqnwLBUvwPC2nMYxibtVlIixtiRxohlBbFPWnlYfpiG9SKdsxboCi1Fs1DIgdWrBPJwDRd5XP0FOC4WJliFj4z6xZvsk0__5Rw8DtNq1_k2y9GI4n3/w400-h300/2BE9E023-A04D-4F64-BF05-3C26BB7D2363.jpeg" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><div><span style="font-family: Palatino-Roman;"><br /></span></div>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-31238535253603659892023-06-08T19:36:00.003+02:002023-06-08T19:36:54.382+02:00El arte de contar. The art of storytelling. 计数的艺术 <div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;"><iframe allowfullscreen="" class="BLOG_video_class" height="331" src="https://www.youtube.com/embed/GYkq9Rgoj8E" width="398" youtube-src-id="GYkq9Rgoj8E"></iframe></span></div><span style="font-size: medium;"><br /></span><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">El lunes pasado atendí dos presentaciones. La primera fue una reunión por Zoom que impartía la gerencia de Atención Primaria en nuestro centro cabecera. Alguien de algún despacho recorría los centros de salud del área hablando de cuestiones corporativas con un power point. Aguanté media hora. Las diapositivas densas, la exposición también. </span></p><p><span style="font-size: medium;">Por la tarde me animé a ver la keynote de Apple, la primera que he visto. Dos horas y pico en formato cinematográfico viendo a ingenieros de la compañía vender todo tipo de productos. No sé lo que les habrá costado en dinero y en horas pero he de reconocer que fue una obra maestra del marketing. El actual presidente de la compañía no tiene el carisma ni el ego de Steve Jobs, gran amante del directo, y optó por una gran producción audiovisual de primera calidad. Consiguieron que no fuera aburrido pese a la gran cantidad de aspectos promocionados y probablemente elevar el precio de las acciones y las perspectivas de ventas. </span></p><p><span style="font-size: medium;">Como médico de Atención Primaria me fije en las técnicas de comunicación, tanto verbal como no verbal y en la ambientación, juego de imágenes y demás efectos facilitadores de la venta de productos e ideas. Siempre he defendido que el marketing debería ser asignatura obligatoria en toda carrera de ciencias de la salud donde una de las habilidades del clínico ha de ser “vender” y explicar ideas a compañeros y pacientes. </span></p><p><span style="font-size: medium;">Mi reflexión tras sopesar las dos presentaciones es constatar el bajo nivel de comunicación corporativa de las organizaciones sanitarias grandes, donde se presta muy poca atención y cuidado a la gestión de información y la mejora y potenciación de la comunicación interprofesional, y el altísimo valor de los mensajes de las grandes empresas privadas cuyo poder no deja de crecer gracias a ello. </span></p><p><span style="font-size: medium;">Al intercambiar puntos de vista con la médico residente que rota este mes en nuestro centro parece que el estilo comunicativo de la docencia pre y postgrado sigue siendo del nivel de la generación anterior: larguísimas presentaciones PowerPoint infumables impartidas por clínicos sin mucha preparación docente. Y así seguimos porque los cursos que reciben siguen esa línea y las presentaciones de sesiones clínicas o casos que ella y sus compañeros hacen no distan mucho de las de sus maestros. </span></p><p><span style="font-size: medium;">La sugerí que echara un vistazo a los de la manzana. Me parece que no lo hará. </span></p><p><span style="font-size: medium;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4gl6WbJCrB-85ED20QXL67ib4NDxdGHhM-XTHVe-UeF-5ddT8aaVBr2COQ6arBR9zeKGkamORGVYdO2oQCfP18Ucdh4FzjLF6r3WMwuYYZOLhDP81x4l2XQNUHoDWowlFGZ824yHxZCVAoQlGkCshiGMvetGcKuiPA0j0wESXdzFBCFGPqLm5UrT3/s724/1E08F560-F92C-4385-BED3-4CCB82F40993.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="724" data-original-width="551" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4gl6WbJCrB-85ED20QXL67ib4NDxdGHhM-XTHVe-UeF-5ddT8aaVBr2COQ6arBR9zeKGkamORGVYdO2oQCfP18Ucdh4FzjLF6r3WMwuYYZOLhDP81x4l2XQNUHoDWowlFGZ824yHxZCVAoQlGkCshiGMvetGcKuiPA0j0wESXdzFBCFGPqLm5UrT3/w305-h400/1E08F560-F92C-4385-BED3-4CCB82F40993.jpeg" width="305" /></span></a></div><span style="font-size: medium;"><br /></span><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><b><span style="font-size: medium;"> The art of storytelling</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Last Monday I attended two presentations. The first was a Zoom meeting given by the Primary Care management in our primary care centre. Someone from some office was going around the health centres in the area talking about corporate issues with a power point. I endured half an hour. The slides were dense, and so was the presentation. </span></p><p><span style="font-size: medium;">In the afternoon I was encouraged to watch the Apple keynote, the first I had ever seen. Two hours and a bit in cinematic format watching the company's engineers selling all kinds of products. I don't know what it must have cost them in money and hours, but I have to admit that it was a masterpiece of marketing. The current CEO of the company doesn't have the charisma or ego of Steve Jobs, a great lover of live shows, and opted for a great audiovisual production of the highest quality. They managed to keep it from being boring despite the many aspects promoted and probably boost the share price and sales prospects. </span></p><p><span style="font-size: medium;">As a primary care physician, I paid special attention to communication techniques, both verbal and non-verbal, and to the ambience, the play of images and other effects that facilitate the sale of products and ideas. I have always advocated that marketing should be a compulsory subject in every health sciences degree where one of the skills of the clinician has to be "selling" and explaining ideas to colleagues and patients. </span></p><p><span style="font-size: medium;">My reflection after weighing up the two presentations is to note the low level of corporate communication in large healthcare organisations, where very little attention and care is paid to information management and the improvement and enhancement of interprofessional communication, and the very high value of the messages of large private companies whose power is constantly growing thanks to this. </span></p><p><span style="font-size: medium;">When exchanging points of view with the resident doctor who is rotating at our centre this month, it seems that the communicative style of undergraduate and postgraduate teaching is still at the level of the previous generation: very long, unbearable PowerPoint presentations given by clinicians without much teaching preparation. And that's still the case because the courses they receive follow that line and the presentations of clinical sessions or cases that she and her classmates give are not very different from those of their teachers. </span></p><p><span style="font-size: medium;">I suggested that she take a look at the ones on the block. I don't think she will.</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLJtpvMUCjWlLgzXkAFYT-wp4mngpuUJaK25fwDWm0a4VkiD8emPuqM0eGKy1sUHyh7a8mtxKL36YQ2J73ZzHsvpbvHz5SIjQMbsZPI0-Uih0pvO3YcErN21COFZ3lz1VXhcm-CgIdAnz88TYYl21aOrjJBIoC6aQNhEN7y0qVqfjt1YLF1M0PEJnu/s2048/798E5022-14DC-460D-80EE-41478C9C5524.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="2048" data-original-width="1704" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLJtpvMUCjWlLgzXkAFYT-wp4mngpuUJaK25fwDWm0a4VkiD8emPuqM0eGKy1sUHyh7a8mtxKL36YQ2J73ZzHsvpbvHz5SIjQMbsZPI0-Uih0pvO3YcErN21COFZ3lz1VXhcm-CgIdAnz88TYYl21aOrjJBIoC6aQNhEN7y0qVqfjt1YLF1M0PEJnu/w333-h400/798E5022-14DC-460D-80EE-41478C9C5524.jpeg" width="333" /></span></a></div><span style="font-size: medium;"><br /></span><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><b><span style="font-size: medium;">计数的艺术</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">机器翻译,抱歉有错误。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">上周一我参加了两个演讲。第一场是由我们初级保健中心的初级保健管理层举行的放大会议。某个办公室的人拿着power point在该地区的卫生中心转了一圈,谈论企业问题。我忍受了半个小时。幻灯片很密集,演讲内容也很密集。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">下午,我被鼓励去看苹果公司的主题演讲,这是我第一次看到。两个小时,以电影的形式观看了该公司的工程师推销各种产品。我不知道这一定花了他们多少钱和时间,但我不得不承认,这是一个营销的杰作。该公司现任首席执行官没有史蒂夫-乔布斯的魅力和自负,他是一个非常热爱现场表演的人,他选择了一个最高质量的伟大视听制作。尽管宣传了很多方面,他们还是设法使其不至于无聊,并可能提升了股价和销售前景。 </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">作为一名初级保健医生,我注意沟通技巧,包括语言和非语言,以及氛围、图像的发挥和其他促进产品和想法销售的效果。我一直主张,市场营销应该是每个卫生科学专业的必修课,临床医生的技能之一必须是向同事和病人 "销售 "和解释想法。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">在权衡了这两场演讲之后,我的思考是注意到大型医疗机构的企业沟通水平很低,很少关注和关心信息管理以及改善和提高专业间的沟通,而大型私人公司的信息价值非常高,他们的权力也因此不断增长。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">当与本月在我们中心轮换的住院医生交流观点时,似乎本科生和研究生教学的交流方式仍然停留在上一代的水平上:由临床医生在没有太多教学准备的情况下进行非常长的、令人难以忍受的PowerPoint演示。 而且情况依然如此,因为他们接受的课程也是按照这个思路进行的,她和她的同学们对临床环节或病例的介绍与老师的介绍没有什么不同。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">我建议她看一看这块的。我想她不会的。</span></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-13707461417518016972023-06-05T18:49:00.001+02:002023-06-05T18:49:04.761+02:00Construir esperanza en Atención Primaria. Building hope in Primary Care. 在初级保健中建立希望<p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"> </span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj40f8V3rrIK2JJHioaLlMDfmLBIR-EkOVmN3JuHXkd_dg4CbqXc2TEocrCT7G-9h1JQag4HoiNjyQNmgR4X8mZfaUmpUQN0KSmzfP_XOWwzKXTeqFvHWZrB6pZlU9U0Jd2q5eif-AubWqwxb6zfKtwCEcWnDf9mBNmWX0h0bSmDHvCnDpHzwcBB99A/s1399/1D01AE62-5965-499A-91A1-284C58F9E2C2.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1399" data-original-width="1088" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj40f8V3rrIK2JJHioaLlMDfmLBIR-EkOVmN3JuHXkd_dg4CbqXc2TEocrCT7G-9h1JQag4HoiNjyQNmgR4X8mZfaUmpUQN0KSmzfP_XOWwzKXTeqFvHWZrB6pZlU9U0Jd2q5eif-AubWqwxb6zfKtwCEcWnDf9mBNmWX0h0bSmDHvCnDpHzwcBB99A/w311-h400/1D01AE62-5965-499A-91A1-284C58F9E2C2.jpeg" width="311" /></a></div><br /><p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"><br /></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"><br /></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;">Para los que llevamos tiempo trabajando en centros de salud de Madrid los últimos años han sido muy duros. La pandemia ha sido cruel en todas partes pero en las grandes ciudades ha estrangulado con más crueldad a todo el servicio sanitario. En los centros de salud madrileños sufrimos un colapso por ola y en muchos padecimos la crudeza de tener que trabajar de forma prolongada aunando presiones asistenciales desbordadas con plantillas de médicos y pediatras diezmadas.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"> </span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;">Ver que tras la pandemia no pasaba nada y que en lugar de reforzar los servicios de urgencia de Atención Primaria se desmantelaban lanzó a pediatras y médicos de familia a la calle durante cuatro meses. Tristemente he de admitir que todo sigue igual después de aquello. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"> </span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;">Nadie sabe aún que intenciones tiene la Consejería de Sanidad de Madrid pero no creo que tengamos que esperar mucho para averiguarlo. Las propuestas irán en la línea de incrementar la colaboración público-privada de la forma que consideren más apropiada. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"> </span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;">Pero no es mi intención entrar en el jardín de las propuestas. Hoy no. Tan solo compartir una humilde declaración de intenciones, dado que la crisis de la sanidad pública y de la Atención Primaria es una realidad globalizada y compleja que no vamos a solucionar esta noche. La idea que quiero expresar tiene que ver con el resurgimiento de la medicina de familia, con su potencia y su salud que no va en paralelo a la línea decreciente de la organización si no al contrario. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"> </span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;">No nos damos cuenta de que la sociedad nunca ha necesitado con más intensidad generalistas como ahora. En tiempos de confusión y policrisis la visión y el servicio que pueden dar los generalistas dentro de cualquier sistema sanitario, público o privado, es vital. Si empresas como Amazon están invirtiendo mucho dinero en servicios de Atención Primaria no es por que sean hermanitas de la caridad precisamente. El gasto sanitario se hace exponencial si el ciudadano accede directamente al nivel especializado y crece logarítmicamente mientras más dañada esté la primaria. En Europa estamos viendo como el gasto sanitario aumenta pese al mecanismo de contención clásico de las listas de espera que seguirán aumentando inevitablemente. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"> </span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;">¿Cómo conjugar pues el hundimiento de los centros de salud con la importancia no reconocida de los médicos generales? <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"> </span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;">Me temo que seremos testigos de cómo el propio mercado pone orden. Con la marcha de muchos generalistas desde Atención Primaria a otros servicios y la jubilación de otros tantos, será inevitable ver colapsar cada vez más equipos. Revertir esta realidad precisará de mejorar las condiciones laborales y hacer cambios estructurales para que se optimice el trabajo de administrativos, enfermeras y demás personal que por distintas razones en el momento actual no desarrollan con plenitud todas las competencias y capacidades de las que disponen. Potenciar modelos de gestión que disminuyan la burocracia y mejoren el ejercicio de las competencias de los profesionales deficitarios sin sobrecargarlos será también un reto necesario. Y contar con el apoyo de sistemas de información y herramientas de historia clínica electrónica que ayuden al profesional con interfaz de audio, asistentes en protocolos, interacciones, prescripción… así como otras medidas.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"> </span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;">Por otra parte los médicos de familia tendremos que reconstruirnos y aumentar tanto nuestras capacidades diagnósticas como terapéuticas. Incorporar la ecografía en consulta como herramienta básica diaria, la técnicas de comunicación clínica más actuales, la reflexión clínica como garantía de calidad y seguridad del paciente... Aprender a trabajar en equipos virtuales conectados tanto con profesionales de centros de salud cercanos y hospitales de referencia como de otros grupos en otras Comunidades o países. Incorporar herramientas de inteligencia artificial aplicadas tanto a la historia clínica como a nuestro pacientes con chatbots personalizados por el clínico que podrán ser prescritos a pacientes según patología o necesidades. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"> </span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;">Vamos a ver grandes cambios en los próximos años, por eso es fundamental no desesperar. La esperanza es una potente medicina. Para poder prescribirla es necesario tenerla en las venas. Si los profesionales sanitarios se desesperan vamos mal. Por ello no quiero ser tan simple como para hacer un brindis al sol y proponer humanizar la medicina sin más. Se trata de que cada cual piense cómo puede reconstruir su práctica y la forma de lidiar con la dificultad. Podemos hacerlo, tenemos herramientas y gente muy valiosa más cerca de lo que pensamos.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"><br /></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"><br /></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"><br /></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirfxapX-OejAxV54ZmdA4XzpA2DFAwP8Ssn9jIFCs1RnpVL4xWtDC2ezpTFsYXPbVK_6aZU3x5kx6aeLHWCcHBQY9nviDkfnG70hHlFtSYTmF_1DYB5qlPf6Nksl1wGFGWrbGJDJABb1KQELoaXHwkgSFdi5lvz4itI_reZRxc95QQ0Iu-R3hXtckM/s2048/3ACD4FC4-2E00-4D16-BFCB-CA1A93A96AB7.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1536" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirfxapX-OejAxV54ZmdA4XzpA2DFAwP8Ssn9jIFCs1RnpVL4xWtDC2ezpTFsYXPbVK_6aZU3x5kx6aeLHWCcHBQY9nviDkfnG70hHlFtSYTmF_1DYB5qlPf6Nksl1wGFGWrbGJDJABb1KQELoaXHwkgSFdi5lvz4itI_reZRxc95QQ0Iu-R3hXtckM/w300-h400/3ACD4FC4-2E00-4D16-BFCB-CA1A93A96AB7.jpeg" width="300" /></a></div><br /><span lang="ES" style="font-size: 18pt;"><br /></span><p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"><br /></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"><b><br /></b></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><b>Building hope in Primary Care</b></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">For those of us who have been working in health centres in Madrid for some time, the last few years have been very hard. The pandemic has been cruel everywhere, but in the big cities it has strangled the entire health service even more cruelly. In Madrid's health centres we suffered a wave of collapse and in many of them we suffered the harshness of having to work for long periods of time, combining overburdened care pressures with decimated medical and paediatric staff. </p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">Seeing that nothing happened after the pandemic and that instead of reinforcing primary care emergency services, they were dismantled, put paediatricians and family doctors out on the streets for four months. Sadly, I have to admit that everything has remained the same since then. </p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">Nobody knows yet what the Madrid Regional Ministry of Health's intentions are but I don't think we will have to wait long to find out. The proposals will be along the lines of increasing public-private collaboration in whatever way they deem most appropriate. </p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">But it is not my intention to enter the garden of proposals. Not today. Just to share a humble statement of intent, given that the crisis in public health and Primary Care is a globalised and complex reality that we are not going to solve tonight. The idea I want to express has to do with the resurgence of family medicine, with its power and its health that is not parallel to the declining line of organisation, but the opposite. </p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">We do not realise that society has never needed generalists more intensely than it does now. In times of turmoil and polycrisis the vision and service that generalists can provide within any healthcare system, public or private, is vital. If companies like Amazon are investing a lot of money in primary care services, it is not because they are little sisters of charity. Health spending becomes exponential if the citizen directly accesses the specialised level and it grows logarithmically the more damaged the primary care system is. In Europe we are seeing how health spending is increasing despite the classic containment mechanism of waiting lists, which will inevitably continue to grow. </p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">So how do we combine the collapse of health centres with the unrecognised importance of general practitioners? </p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><span lang="ES" style="font-size: 18pt;"></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">I am afraid that we will witness the market itself bringing order. With the departure of many generalists from primary care to other services and the retirement of many others, it will be inevitable to see more and more teams collapse. Reversing this reality will require improving working conditions and making structural changes to optimise the work of administrative staff, nurses and other personnel who, for various reasons, are currently not fully developing all the competencies and skills they have available to them. To promote management models that reduce bureaucracy and improve the exercise of the right to health care.</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">I fear that we will witness the market itself bringing order. With the departure of many generalists from primary care to other services and the retirement of many others, it will be inevitable to see more and more teams collapse. Reversing this reality will require improving working conditions and making structural changes to optimise the work of administrative staff, nurses and other personnel who, for various reasons, are currently not fully developing all the competencies and skills they have available to them. It will also be a necessary challenge to promote management models that reduce bureaucracy and improve the exercise of the competencies of professionals without overburdening them. And to have the support of information systems and electronic medical record tools that help professionals with audio interfaces, assistants in protocols, interactions, prescriptions, etc., as well as other measures.</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">On the other hand, we family doctors will have to rebuild ourselves and increase both our diagnostic and therapeutic capabilities. Incorporate ultrasound in the consultation room as a basic daily tool, the most up-to-date clinical communication techniques, clinical reflection as a guarantee of quality and patient safety... Learning to work in virtual teams connected with professionals from nearby health centres and reference hospitals as well as other groups in other regions or countries. Incorporate artificial intelligence tools applied both to the clinical history and to our patients with chatbots personalised by the clinician that can be prescribed to patients according to their pathology or needs. </p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">We are going to see great changes in the coming years, so it is essential not to despair. Hope is a powerful medicine. To be able to prescribe it, you need to have it in your veins. If health professionals despair we are in a bad way. That is why I do not want to be so simple as to make a toast to the sun and propose to humanise medicine without further ado. It is a matter of everyone thinking about how they can rebuild their practice and how to deal with the difficulty. We can do it, we have tools and very valuable people closer than we think.</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><b>在初级保健中建立希望</b></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">机器翻译,抱歉有错误。</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">对于我们这些在马德里的卫生中心工作了一段时间的人来说,过去几年是非常艰难的。这场大流行病在各地都很残酷,但在大城市,它更残酷地扼杀了整个卫生服务。在马德里的保健中心,我们遭受了一波崩溃,在许多保健中心,我们遭受了不得不长期工作的严酷待遇,将负担过重的护理压力与减员的医疗和儿科工作人员结合起来。</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">看到大流行病后没有任何事情发生,初级保健急救服务非但没有得到加强,反而被拆除,让儿科医生和家庭医生在街头流浪了四个月。可悲的是,我不得不承认,从那时起一切都没有变化。</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">现在还没有人知道马德里地区卫生部的意图是什么,但我认为我们不用等太久就能知道。这些建议将沿着以他们认为最合适的方式增加公私合作的思路进行。</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">但我不打算进入提案的花园。鉴于公共卫生和初级保健的危机是一个全球化的复杂现实,我们今晚不可能解决这个问题,我只想与大家分享一个谦虚的意向声明。我想表达的想法与家庭医学的复兴有关,它的力量和健康与组织的衰落路线不平行,而是相反。</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">我们没有意识到,社会从来没有像现在这样强烈地需要全科医生。在动荡和多危机时期,全科医生在任何医疗系统中,无论是公共还是私人,所能提供的视野和服务是至关重要的。如果像亚马逊这样的公司在初级保健服务方面投入大量资金,这并不是因为他们是慈善的小姐妹。如果公民直接进入专业层面,医疗支出就会变成指数级,而初级保健系统越是受损,医疗支出就会呈对数增长。在欧洲,我们看到尽管有典型的等待名单的遏制机制,但医疗支出仍在增加,这将不可避免地继续增长。</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">那么,我们如何将保健中心的崩溃与全科医生未被认识到的重要性结合起来?</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">我担心我们将见证市场本身带来的秩序。随着许多全科医生离开基层医疗机构到其他服务机构,以及其他许多人的退休,看到越来越多的团队崩溃将是不可避免的。要扭转这一现实,需要改善工作条件,进行结构性改革,以优化行政人员、护士和其他工作人员的工作,由于各种原因,他们目前没有充分发展所有可用的能力和技能。加强管理模式 </p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">我担心,我们将见证市场本身带来的秩序。随着许多全科医生离开基层医疗机构到其他服务机构,以及许多其他人的退休,看到越来越多的团队崩溃将是不可避免的。要扭转这一现实,需要改善工作条件,进行结构性改革,以优化行政人员、护士和其他人员的工作,由于各种原因,他们目前没有充分发展他们所拥有的所有能力和技能。促进管理模式,减少官僚主义,改善专业人员能力的发挥,同时又不使他们负担过重,这也将是一个必要的挑战。并且要有信息系统和电子医疗记录工具的支持,通过音频界面、协议的助手、互动、处方等帮助专业人员,以及其他措施。</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">另一方面,我们家庭医生将不得不重建自己,提高我们的诊断和治疗能力。将超声作为基本的日常工具纳入诊室,采用最新的临床交流技术,将临床反思作为质量和病人安全的保证...。学习在虚拟团队中工作,与附近的卫生中心和参考医院的专业人员以及其他地区或国家的其他团体联系。纳入人工智能工具,既适用于临床病史,也适用于我们的病人,由临床医生个性化的聊天机器人,可以根据病人的病理或需求开出处方。</p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; margin: 0cm;">在未来几年,我们将看到巨大的变化,所以必须不要绝望。希望是一种强大的药物。为了能够开出它,你需要在你的血管里有它。如果卫生专业人员感到绝望,我们就会陷入糟糕的境地。这就是为什么我不想如此简单地向太阳敬酒,并提议不加思索地使医学人性化。这是一个每个人都要思考如何重建他们的实践和如何处理困难的问题。我们可以做到这一点,我们有工具和非常有价值的人,比我们想象的更接近。</p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-40408180318996886822023-04-17T13:23:00.000+02:002023-04-17T13:23:17.554+02:00 Escatología Sanitaria. Health Scatology. 卫生末世论<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL_A78SNfzXIu5vcf1ZP-iH96Q5S8CHg2wBUNkpvj6IpydQJs8LNFijzbyoONthjZfiJYB6Pc7spW1yQMqLhmvBcaEHw0vX2JWFMBZwf4G8DFlSHb3cYfqVDBIPE8CuF1_HEfUJgxGBnylzAelmiRM8iu9uqO9HuWEh-E1-cPrTVXdtZOv3TdUm-X7/s500/1089fb893d5053e11d487f06573f02fe.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="500" data-original-width="400" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL_A78SNfzXIu5vcf1ZP-iH96Q5S8CHg2wBUNkpvj6IpydQJs8LNFijzbyoONthjZfiJYB6Pc7spW1yQMqLhmvBcaEHw0vX2JWFMBZwf4G8DFlSHb3cYfqVDBIPE8CuF1_HEfUJgxGBnylzAelmiRM8iu9uqO9HuWEh-E1-cPrTVXdtZOv3TdUm-X7/w320-h400/1089fb893d5053e11d487f06573f02fe.jpg" width="320" /></a></div><p><br /></p><div style="text-align: center;">Ilustración Paula Alvear, libro <a href="https://www.amazon.es/Arconte-enfurecido-Salvador-Casado-Buend%C3%ADa/dp/1660432146/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=">Arconte Enfurecido</a></div><span style="font-size: medium;"><br /></span><p></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Recientemente la <a href="https://twitter.com/draisabelnunyez?lang=es">dra. Isabel Núñez Lozano</a> y un servidor hemos usado el termino <b>Escatología Sanitaria</b> para ilustrar un nuevo punto de vista sobre la situación en Atención Primaria. Aplicamos la primera acepción del diccionario de la Real Academia que define el concepto como conjunto de creencias que hacen referencia a lo que hay más allá de la muerte. En nuestro ámbito cultural tendríamos cuatro estados: juicio, purgatorio, infierno y gloria. </span></p><p><span style="font-size: medium;">Al aplicarlo a la Atención Primaria hacemos el experimento mental de asumir su muerte institucional. No es una hipótesis, tan solo es un punto de vista. Tras esta suposición miramos los diferentes centros de salud y efectivamente encontramos muchos en situación de purgatorio, otros con condiciones de trabajo infernales y algunos en estado de gloria, los menos. </span></p><p><span style="font-size: medium;">Aunque haya voces que defiendan la pertinencia de la Atención Primaria y la Medicina de Familia, nos parece justo reconocer que pese a que ambas son muy valiosas y defendibles, la actual institución tiene un gran número de equipos en situación de desbordamiento y un gran número de pediatras y médicos de familia saturados. Tras la larga huelga de cuatro meses de Madrid de este año, reactiva a la falta de refuerzo tras el colapso pandémico, los datos son demoledores: un millón de madrileños sin pediatra ni médico de familia asignado, huida de médicos jóvenes, jubilaciones del 25% de los médicos de familia en 5 años, abandono del 25% de los pediatras este año y cifras altísima de consumo de psicofármacos/psicoterapia en facultativos de primaria. En nuestra experiencia madrileña creemos verosímil certificar la muerte técnica de la Atención Primaria tal y como se diseñó en su día. </span></p><p><span style="font-size: medium;">En consecuencia creemos que hay razones para priorizar el refuerzo de los centros de salud en peor situación y el cuidado de los profesionales más sobrecargados. Esto no puede esperar ni depender de la mesa sectorial. </span></p><p><span style="font-size: medium;">Por otro lado animamos a que se tomen en serio las propuestas de reforma que hay encima de la mesa (<a href="http://equipocesca.org/reforma-de-la-atencion-primaria-a-la-europea-y-renacentista-de-nadar-en-una- piscina-a-nadar-en-alta-mar-juan-gervas-mercedes-perez-fernandez-madrid-abril-2023/">Juan Gérvas et al</a>, Ángel Ruíz Tellez...) y otras que se puedan consensuar. Dado que de los acuerdos actuales con la Consejería de Sanidad se puede esperar bastante poco. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Compartimos la presentación que hicimos en un taller práctico presentado en el <a href="https://comunicacionysalud.semfyc.es/presentation-info/?presentation_id=912605&amp;DayTab=2">Congreso de Comunicación</a> de Semfyc en Zaragoza el mes pasado. Próximamente añadiremos un artículo complementario que está en prensa. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">http://equipocesca.org/reforma-de-la-atencion-primaria-a-la-europea-y-renacentista-de-nadar-en-una-</span><span style="font-size: large;">piscina-a-nadar-en-alta-mar-juan-gervas-mercedes-perez-fernandez-madrid-abril-2023/</span></p><p><span style="font-size: medium;">Ruíz A. La Sanidad Eludida. 2019 ed Círculo Rojo. <a href="https://editorialcirculorojo.com/la-sanidad-eludida/">https://editorialcirculorojo.com/la-sanidad-eludida/</a></span></p><p><span style="font-size: medium;">Ruiz A. A este lado del espejo. 2022 Amazon. https://www.amazon.es/este-lado-del-espejo-Mundo-Visita-</span><span style="font-size: medium;">ebook/dp/B0BTJT69K5/ref=sr_1_1qid=1681632447&amp;refinements=p_27%3AAngel+Ruiz+++T%C3%A9llez&amp;s=b</span><span style="font-size: large;">ooks&amp;sr=1-1</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><b><span style="font-size: medium;">Health Scatology</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Recently, Dr. Isabel Núñez Lozano and myself have used the term Health Scatology to illustrate a new point of view on the situation in Primary Care. We apply the first meaning of the dictionary of the Royal Academy which defines the concept as a set of beliefs that refer to what lies beyond death. In our cultural sphere we would have four states: judgement, purgatory, hell and glory. </span></p><p><span style="font-size: medium;">By applying it to Primary Care we make the mental experiment of assuming its institutional death. It is not a hypothesis, it is just a point of view. Following this assumption, we looked at the different health centres and indeed we found many in purgatory, others with hellish working conditions and some in a state of glory, the fewest. </span></p><p><span style="font-size: medium;">Although there are voices defending the relevance of Primary Care and Family Medicine, we think it is fair to recognise that although both are very valuable and defensible, the current institution has a large number of teams in a situation of overflow and a large number of paediatricians and family doctors saturated. After the four-month long strike in Madrid this year, reactive to the lack of reinforcements after the pandemic collapse, the data are devastating: one million Madrid citizens without a paediatrician or family doctor assigned, young doctors fleeing, 25% of family doctors retiring in 5 years, 25% of paediatricians leaving this year and extremely high figures for the consumption of psychotropic drugs/psychotherapy in primary care doctors. In our experience in Madrid, we believe it is plausible to certify the technical death of Primary Care as it was designed in its day. </span></p><p><span style="font-size: medium;">Consequently, we believe that there are reasons to prioritise the reinforcement of the health centres in the worst situation and the care of the most overburdened professionals. This cannot wait or depend on the sectoral roundtable. </span></p><p><span style="font-size: medium;">On the other hand, we encourage the reform proposals on the table (Juan Gérvas et al, Ángel Ruíz Tellez...) and others that can be agreed upon to be taken seriously. Given that little can be expected from the current agreements with the Regional Ministry of Health. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">We share the presentation we gave at a practical workshop presented at the Semfyc <a href="https://comunicacionysalud.semfyc.es/wp-content/uploads/2023/03/Taller-37_Escatologia-sanitaria-y-Catastrofes-vitales.pdf">Communication Congress</a> in Zaragoza last month. We will soon add a complementary article that is in press.</span></p><p><span style="font-size: medium;"><br /></span></p><p><b><span style="font-size: medium;">卫生末世论</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">机器翻译,请原谅错误。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">最近,伊莎贝尔-努涅斯-洛萨诺博士和我本人使用了 "卫生末世学 "一词来说明关于初级保健状况的一个新观点。我们采用了皇家学院词典中的第一种含义,该词典将这一概念定义为一套提及死亡之后的信仰。在我们的文化领域,我们会有四种状态:审判、炼狱、地狱和光荣。</span></p><p><span style="font-size: medium;">通过将其应用于初级保健,我们做了一个假设其机构死亡的心理实验。这不是一个假设,它只是一个观点。根据这个假设,我们观察了不同的健康中心,确实发现很多处于炼狱中,其他的工作条件是地狱式的,还有一些处于光荣的状态,这是最少的。</span></p><p><span style="font-size: medium;">虽然有声音为初级保健和家庭医学的相关性辩护,但我们认为应该承认,虽然这两者都非常有价值,可以辩护,但目前的机构有大量的团队处于泛滥的状态,大量的儿科医生和家庭医生已经饱和。在今年马德里长达四个月的罢工后,由于大流行病崩溃后缺乏增援,数据是毁灭性的:一百万马德里市民没有被分配到儿科医生或家庭医生,年轻医生逃离,25%的家庭医生在5年内退休,25%的儿科医生今年离开,初级保健医生的精神药物/心理治疗的消费数字极高。根据我们在马德里的经验,我们认为可以证明初级保健在技术上的死亡,因为它是在当时设计的。</span></p><p><span style="font-size: medium;">因此,我们认为有理由优先考虑加强情况最差的医疗中心和照顾负担最重的专业人士。这不能等待或依赖部门圆桌会议。</span></p><p><span style="font-size: medium;">另一方面,我们鼓励认真对待桌面上的改革建议(Juan Gérvas等人,Ángel Ruíz Tellez......)和其他可以达成一致的建议。鉴于目前与地区卫生部达成的协议几乎不能指望。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">我们分享我们在上个月在萨拉戈萨<a href="https://comunicacionysalud.semfyc.es/wp-content/uploads/2023/03/Taller-37_Escatologia-sanitaria-y-Catastrofes-vitales.pdf">Semfyc</a>交流大会上提出的实践研讨会上的发言。我们将很快补充一篇正在印刷的补充文章。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><br /></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-13172891514313608762023-04-05T09:44:00.002+02:002023-04-05T09:44:25.013+02:00 Asumir el desastre. Facing up to disaster. 承担灾难。<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIf3lJCa56WqCpuzFTUzScp6amra0JXf7mwelgQgo7VAYzLu_97rZhxzGi5tzF82EguKuinr-58RDgC2xMOrLtRpVwl77NuFQr-byj4NC_NG-QtJFEpP__TV4d40a8N3fUmG9Ayc0Mo1D-wC4HkT-Jq4SnjnRQFD6kBhiHJ30avvAtXF_P54qX0ODI/s500/68634ab38d55629205d5533b5964bcbb.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="500" data-original-width="384" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIf3lJCa56WqCpuzFTUzScp6amra0JXf7mwelgQgo7VAYzLu_97rZhxzGi5tzF82EguKuinr-58RDgC2xMOrLtRpVwl77NuFQr-byj4NC_NG-QtJFEpP__TV4d40a8N3fUmG9Ayc0Mo1D-wC4HkT-Jq4SnjnRQFD6kBhiHJ30avvAtXF_P54qX0ODI/w308-h400/68634ab38d55629205d5533b5964bcbb.jpg" width="308" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Esta semana <a href="https://twitter.com/BertaHerranz/status/1643153603115220992?s=20">otra médica de familia</a> de Madrid anuncia que abandona la Atención Primaria. Reconozco que hasta hace muy poco estas noticias me causaban una terrible desazón máxime cuando, como es el caso, conocía a la persona. Ahora sigo notando una punzada pero asumo la noticia con naturalidad, es lo que hay. Acabamos de terminar una huelga que ha sido como la carga de la brigada ligera, un último intento desesperado de pedir auxilio. Si no nos llegó con la pandemia menos ahora. La realidad es que los residentes de familia están más interesados en buscar opciones fuera de los centros de salud, los médicos a punto de jubilarse deseándolo (y sin posibilidad de quedarse con un plan ajustado a sus necesidades) y los que están entre medias huyendo los que pueden y rezando los que quedan. </span></p><p><span style="font-size: medium;">El futuro de la Atención Primaria tendrá enfermeras, auxiliares, paramédicos, inteligencia artificial, aplicaciones, teleconsultas y todo lo que quieran. Lo que seguro que no tiene son médicos de familia ni pediatras suficientes. Habrá alguno, pero dudo mucho que pueda hacer una labor más allá de lo que exige la mera supervivencia. El contrato social entre pacientes y médicos se ha roto. Reformularlo implica algo más que lucha sindical. </span></p><p><span style="font-size: medium;">En pocas semanas los madrileños votarán qué gestión sanitaria quieren. Las encuestas indican que permanecerá la línea actual. Que tengan un buen día. </span></p><p><span style="font-size: medium;"><br /></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2nT6WzC5wcaUtTEcBlzgBhLwljmZRaP_1kBjN4qZT57vAwdpoVoUVWTGQ4thKtUdB3KFxRcDKMvd5Qv1GnggLLZ2qxlcpzfyL5xGEj1ztuldjRk6zPC54hneCayrCgh2P6k2XDGy1IYVkAJRCJmc06shUj3AVcq8c97X3KmvINYbIU18dDqUebTEz/s2048/Fj9KdLEWAAEfGLE%20(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1532" data-original-width="2048" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2nT6WzC5wcaUtTEcBlzgBhLwljmZRaP_1kBjN4qZT57vAwdpoVoUVWTGQ4thKtUdB3KFxRcDKMvd5Qv1GnggLLZ2qxlcpzfyL5xGEj1ztuldjRk6zPC54hneCayrCgh2P6k2XDGy1IYVkAJRCJmc06shUj3AVcq8c97X3KmvINYbIU18dDqUebTEz/s320/Fj9KdLEWAAEfGLE%20(1).jpg" width="320" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p><span style="font-size: medium;"><br /></span></p><p><b><span style="font-size: medium;">Facing up to disaster.</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">This week another family doctor in Madrid announces that she is leaving primary care. I must admit that until very recently this news caused me terrible dismay, especially when, as in this case, I knew the person. Now I still feel a pang but I accept the news naturally, it is what it is. We have just finished a strike that has been like the charge of the light brigade, a last desperate attempt to call for help. If it didn't reach us with the pandemic, even less so now. The reality is that family residents are more interested in looking for options outside the primary health centres, doctors on the verge of retirement wishing for it (and with no chance of being left with a plan adjusted to their needs) and those in between fleeing those who can and those who are left praying. </span></p><p><span style="font-size: medium;">The future of Primary Care will have nurses, assistants, paramedics, artificial intelligence, applications, teleconsultations and everything else they want. What it certainly won't have are enough family doctors and paediatricians. There will be some, but I doubt very much that they will be able to do a job beyond what is required for mere survival. The social contract between patients and doctors has been broken. Reformulating it involves more than union struggle. </span></p><p><span style="font-size: medium;">In a few weeks the people of Madrid will vote on what health management they want. Polls indicate that the current line will remain. Have a nice day.</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXS3NqzFA8r7oJ2o65YnQ8XL5rlG_CBteUPtmdwWuFQQI-iMNAun2BweBKaWRR0ghv88XJlA9lVLXqZRBUW18a2jjTfRCUUs9vodt-fvI1hXPCCgdSFK-dq52_0S4GCoCVXriAb9qAG7BrMvxvsw50ajX41jNPU7my3UaZBPZ5mAYzKg5Rl-HF-YpT/s600/FkTwl8lWQAAq5h5%20(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="499" data-original-width="600" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXS3NqzFA8r7oJ2o65YnQ8XL5rlG_CBteUPtmdwWuFQQI-iMNAun2BweBKaWRR0ghv88XJlA9lVLXqZRBUW18a2jjTfRCUUs9vodt-fvI1hXPCCgdSFK-dq52_0S4GCoCVXriAb9qAG7BrMvxvsw50ajX41jNPU7my3UaZBPZ5mAYzKg5Rl-HF-YpT/s320/FkTwl8lWQAAq5h5%20(1).jpg" width="320" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><b>承担灾难。</b></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">机器翻译,请原谅错误。</span></p><p><span style="font-size: medium;">本周,马德里的另一位家庭医生宣布,她将离开初级保健。我必须承认,直到最近,这个消息还让我感到非常沮丧,尤其是在这个案例中,我认识这个人。现在我仍然感到震惊,但我很自然地接受了这个消息,它就是这样。我们刚刚结束了一次罢工,这次罢工就像轻骑兵的冲锋,是最后一次绝望的求救尝试。如果说大流行病时没有传到我们这里,现在就更不用说了。现实情况是,家庭居民更愿意在保健中心之外寻找选择,濒临退休的医生希望如此(而且没有机会留下一个根据他们的需要调整的计划),而那些介于两者之间的人则是逃离那些可以逃离的人,而那些人则是在祈祷。</span></p><p><span style="font-size: medium;">未来的初级保健将有护士、助理、护理人员、人工智能、应用程序、远程会诊和他们想要的其他一切。但它肯定不会有足够的家庭医生和儿科医生。会有一些,但我非常怀疑他们是否能够做超出单纯生存所需的工作。病人和医生之间的社会契约已经被打破。重新制定合同涉及的不仅仅是工会的斗争。</span></p><p><span style="font-size: medium;">几周后,马德里人民将投票决定他们想要什么样的卫生管理。民意调查显示,目前的路线将保持不变。祝您有愉快的一天。</span></p><p><span style="font-size: medium;"><br /></span></p><p><br /></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-76046582348664629062023-03-17T09:57:00.002+01:002023-03-18T10:32:56.025+01:00 Fumata blanca. White smoke. 白烟<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvvApWiH63oFT-efl5y-2pURWnFNgn11rbR9K-NkI7xvGodjrfR94uHN2Quhv8T4tWOaFcPYyHWTp-um1im-V12Mj0QSaIAaQKs2MrFfxjRt328s1lEncTBo3SHuqHPcnagi1DBgTzKxzLOkqxmG6zBSf99-DeHcObpkeV768YQyGdprw-KI0arxn1/s1600/FipSbYVXkAAU_kr.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1196" data-original-width="1600" height="299" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvvApWiH63oFT-efl5y-2pURWnFNgn11rbR9K-NkI7xvGodjrfR94uHN2Quhv8T4tWOaFcPYyHWTp-um1im-V12Mj0QSaIAaQKs2MrFfxjRt328s1lEncTBo3SHuqHPcnagi1DBgTzKxzLOkqxmG6zBSf99-DeHcObpkeV768YQyGdprw-KI0arxn1/w400-h299/FipSbYVXkAAU_kr.jpg" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p><span style="font-size: medium;">La elección del Papa de Roma no suele ser sencilla. Los cardenales se recluyen días o semanas hasta que logran ponerse de acuerdo y lo anuncian con una humareda blanca por una chimenea. Ayer se logró por fin firmar un acuerdo entre el sindicado Amyts que reperesenta a pediatras y médicos de familia de Madrid y la Consejería de Sanidad. </span></p><p><span style="font-size: medium;">Es un avance parcial que por un lado consigue alguna mejora económica (convierte un complemento previo (TSA) en otro lineal, e incentiva el turno de tarde) y establece unos límites a las agendas que habrá que ver cómo se implementan. </span></p><p><span style="font-size: medium;">En resumen, poco presupuesto más (unos 15 millones) y el refuerzo lo harán voluntarios (los mismos pediatras y médicos de familia). No es difícil averiguar que los centros quemados seguirán como están. </span></p><p><span style="font-size: medium;">Por otra parte es innegable que Amyts ha conseguido un hito: </span></p><p><span style="font-size: medium;">1.Unir a todos los médicos de la primaria madrileña haciéndoles tomar conciencia de la verdadera situación de debacle que atravesamos.</span></p><p><span style="font-size: medium;">2. Contarlo en lenguaje comprensible a la población y lograr su apoyo con manifestaciones multitudinarias que han sido históricas. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Una negociación entre un pequeño sindicato (que representa a unos 5000 pediatras y médicos de familia) y la administración de Madrid no arreglará los profundos problemas estructurales que atraviesa la Atención Primaria madrileña, pero se ha conseguido algo importante, reconocer que en las próximas elecciones la población se juega la sanidad pública. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ1nKF552gTXeB3humiGPWgEUCF7cD17Ey22_iim6txSkaEnvWfIzAqqd_3qqBB0270r686Yc5h8ajMxdj8jfCWBXaBDN52ddlVehyfVg_CSleS5hmqA_GJGDMk0VmnEaKTvBA5538YqjOl_fmzSWgKYil0XqBomuzKl8SvNDnlf89DYD8RQKq8P9B/s620/3500.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="372" data-original-width="620" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ1nKF552gTXeB3humiGPWgEUCF7cD17Ey22_iim6txSkaEnvWfIzAqqd_3qqBB0270r686Yc5h8ajMxdj8jfCWBXaBDN52ddlVehyfVg_CSleS5hmqA_GJGDMk0VmnEaKTvBA5538YqjOl_fmzSWgKYil0XqBomuzKl8SvNDnlf89DYD8RQKq8P9B/s320/3500.jpg" width="320" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p><b><span style="font-size: medium;">White smoke</span></b></p><p><span style="font-size: medium;">The election of the Pope of Rome is not usually easy. The cardinals withdraw for days or weeks until they manage to reach an agreement and announce it with a white smoke from a chimney. Yesterday an agreement was finally signed between the union Amyts, which represents paediatricians and family doctors in Madrid, and the Regional Ministry of Health. </span></p><p><span style="font-size: medium;">It is a partial advance that on the one hand achieves some economic improvement (it converts a previous complement (TSA) into another linear one, in incentivises the afternoon shift) and establishes some limits to the agendas that we will have to see how they are implemented. </span></p><p><span style="font-size: medium;">In short, little more budget (about 15 million) and the reinforcement will be done by volunteers (the same paediatricians and family doctors). It is not difficult to see that the burnt-out centres will remain as they are. </span></p><p><span style="font-size: medium;">On the other hand, it is undeniable that Amyts has achieved a milestone: </span></p><p><span style="font-size: medium;">1.Unite all primary care doctors in Madrid making them aware of the real situation of debacle we are going through.</span></p><p><span style="font-size: medium;">2. Telling the public about it in understandable language and gaining their support with mass demonstrations that have been historical. </span></p><p><span style="font-size: medium;">A negotiation between a small union (representing some 5000 paediatricians and family doctors) and the Madrid administration will not solve the deep structural problems that Madrid's primary care system is going through, but something important has been achieved: recognition that in the next elections the population is putting public health care at stake.</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeaLFYeQlfjORCNCh5haMSw00YDcrVUa8pXiLO81mMqq19poP5XZklP7r3OQ6ONlKL3K9wufBDR1TcMyKKZKDpUyfNC_R3hZsOJWamQpR72qg18Vr42PBwR4FPhcGccPpaNAUKzV2X2njU_G1Y6pgOR0aRH-GSyLMCW2dZ-8PbUESB25zU4rUf_wkD/s680/E3WyeArWQAMXi8d.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="680" data-original-width="510" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeaLFYeQlfjORCNCh5haMSw00YDcrVUa8pXiLO81mMqq19poP5XZklP7r3OQ6ONlKL3K9wufBDR1TcMyKKZKDpUyfNC_R3hZsOJWamQpR72qg18Vr42PBwR4FPhcGccPpaNAUKzV2X2njU_G1Y6pgOR0aRH-GSyLMCW2dZ-8PbUESB25zU4rUf_wkD/s320/E3WyeArWQAMXi8d.jpg" width="240" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p><b><span style="font-size: medium;">白烟</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">机器翻译,抱歉有错误。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">罗马教皇的选举通常并不容易。枢机主教们隐居数日或数周,直到他们设法达成协议,并通过烟囱冒出白烟宣布。昨天,代表马德里的儿科医生和家庭医生的Amyts工会与地区卫生部终于签署了一项协议。</span></p><p><span style="font-size: medium;">这是一个部分进展,一方面实现了一些经济上的改善(它将以前的补充(TSA)转换成另一个线性补充,以激励下午的班次),并对议程建立了一些限制,我们将不得不看他们如何实施。</span></p><p><span style="font-size: medium;">简而言之,增加了一点预算(大约1500万),而且强化工作将由志愿者完成(同样是儿科医生和家庭医生)。不难看出,那些被烧毁的中心将保持现状。</span></p><p><span style="font-size: medium;">另一方面,不可否认的是,Amyts已经取得了一个里程碑。</span></p><p><span style="font-size: medium;">1.团结马德里所有的初级保健医生,使他们认识到我们正在经历的溃败的真实情况。</span></p><p><span style="font-size: medium;">2. 2.用可理解的语言告诉公众,并通过历史性的大规模示威活动获得他们的支持。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">一个小工会(代表大约5000名儿科医生和家庭医生)和马德里政府之间的谈判不会解决马德里初级保健系统正在经历的深层结构问题,但已经取得了一些重要的成果:承认在下一次选举中,民众将公共卫生保健置于危险之中。</span></p><p><span style="font-size: medium;"><br /></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgrNRXByBPmwdnm5WyhPOrpc_wxlLUaqEWm8g4bLbBULaZAmt47ous8JXC6OyFNjAnnxITx5nBoR0Hy0E19_DK13-BMcyRBxo6ldLfLqZniqtqBpBBvdKIKH0wB92IWUVZZjoUaCEgXt35ZPB6VGDKEvNc2z8AC4wX6js62dS0Ho7kxHmaTIyIfoY3N" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="1622" data-original-width="1170" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEgrNRXByBPmwdnm5WyhPOrpc_wxlLUaqEWm8g4bLbBULaZAmt47ous8JXC6OyFNjAnnxITx5nBoR0Hy0E19_DK13-BMcyRBxo6ldLfLqZniqtqBpBBvdKIKH0wB92IWUVZZjoUaCEgXt35ZPB6VGDKEvNc2z8AC4wX6js62dS0Ho7kxHmaTIyIfoY3N" width="173" /></a></div><br /><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhlRpcfdEztaHg3ZfJpE9RrUGGBS7vO0c3ucwCU74SBwFblICNJvIFtGFkBjSta882wY8axskftc8vlJmojFf2lKDdun1wtX3dCcZZeNECFQvE7xOh_BQzCqpRUT1TXc9NMS2ZDFp-kvV7dyLWiWxFZuUp2eQBhmh8WO3xACD1L-0VLDsoCRIxDy6Uj" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="1576" data-original-width="1170" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEhlRpcfdEztaHg3ZfJpE9RrUGGBS7vO0c3ucwCU74SBwFblICNJvIFtGFkBjSta882wY8axskftc8vlJmojFf2lKDdun1wtX3dCcZZeNECFQvE7xOh_BQzCqpRUT1TXc9NMS2ZDFp-kvV7dyLWiWxFZuUp2eQBhmh8WO3xACD1L-0VLDsoCRIxDy6Uj" width="178" /></a></div><br /><br /></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjR8JrYBIGenTZL41DtRLnwG9-B55azGNt6rgJvHuhFvcOwauNvVyhIKJEbtjdZXK9rVsUbnEI1fELm6Iq3GftZjeC3G37zRUWUIZ0nFOvxziF7WcPlxEhLULzTNVE3WjQjaT0vTMRW6gXdAyDcyJKc5lHP9T8_tu9YoJfsfrrjivYdotb5WlTIvOqM" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="1582" data-original-width="1170" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEjR8JrYBIGenTZL41DtRLnwG9-B55azGNt6rgJvHuhFvcOwauNvVyhIKJEbtjdZXK9rVsUbnEI1fELm6Iq3GftZjeC3G37zRUWUIZ0nFOvxziF7WcPlxEhLULzTNVE3WjQjaT0vTMRW6gXdAyDcyJKc5lHP9T8_tu9YoJfsfrrjivYdotb5WlTIvOqM" width="177" /></a></div><br /><br /></div><br /><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEg3ZG8Xs1QjVg9SCtq-Qht6czZM3Nyevd2QWJsuDJuyrQ-MpsXkJncpKUbvUx8uYrUx1yrxNPTUh4gVMDBPXBr526LTu2HVRYviX5dclS2YImorju1tFesjd9v-IUhbjRXoKb38fQioAobTd16g0ZzENW2_fSjjpWhHQAWI8a6Ur9WwGSRsiMqGTVNB" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="1602" data-original-width="1170" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEg3ZG8Xs1QjVg9SCtq-Qht6czZM3Nyevd2QWJsuDJuyrQ-MpsXkJncpKUbvUx8uYrUx1yrxNPTUh4gVMDBPXBr526LTu2HVRYviX5dclS2YImorju1tFesjd9v-IUhbjRXoKb38fQioAobTd16g0ZzENW2_fSjjpWhHQAWI8a6Ur9WwGSRsiMqGTVNB" width="175" /></a></div><br /><p><br /></p><br /><br /><p></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-21784355927421407562023-02-25T08:17:00.007+01:002023-02-25T08:28:58.905+01:00Confusión. Confusion. 混乱。<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhedgI38PY-G6leyX3Z0699jtGgfUDeEwSeUQwA3DzTTLJurOZE8OD7grVoxnmgDI6XONbpxMseTn31LjCoKJcXpBbV62MYsRTg7CoOi56WQg-QceLjCrH7-hQlDweg1AafMpyTBlPRTBusDynyKatj9tJkSNOc2tAzlppmE554kGD3G3TeB917DlMB/s1975/8F1A5C35-145F-4B3F-8959-C3917C6E017F.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1975" data-original-width="1170" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhedgI38PY-G6leyX3Z0699jtGgfUDeEwSeUQwA3DzTTLJurOZE8OD7grVoxnmgDI6XONbpxMseTn31LjCoKJcXpBbV62MYsRTg7CoOi56WQg-QceLjCrH7-hQlDweg1AafMpyTBlPRTBusDynyKatj9tJkSNOc2tAzlppmE554kGD3G3TeB917DlMB/w238-h400/8F1A5C35-145F-4B3F-8959-C3917C6E017F.jpeg" width="238" /></a></div><br /><p><br /></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">Dentro del alma</span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">En mitad de la niebla</span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">Prados de flores.</span></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;"><br /></span></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;"><a href="https://twitter.com/doctorcasado/status/1629370966517207043?s=61&t=h4er85JZm7Dq5dRSZXkEZQ">#haiku</a></span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">Cuando la niebla matinal impide ver lo cercano no hay más remedio que ir despacio. En el mundo sanitario madrileño vivimos tiempos confusos. Nos damos cuenta de que todo cambia a gran velocidad pero no nos resulta fácil comprender. Es todo demasiado duro. Pero no hay niebla que no termine de levantar y cuando lo haga veremos lo que hay. No nos va a gustar. De hecho ya vamos atando cabos, Andalucía da luz verde para <a href="https://www.elsaltodiario.com/sanidad-publica/puerta-se-abre-privatizar-atencion-primaria-andalucia-madrid">“externalizar”</a> la Atención Primaria, el Consejero Escudero defiende un cambio de modelo basado en enfermeras, se cumplen tres meses de huelga de pediatras y médicos de familia en Madrid sin que haya acuerdo, se pagan<a href="https://elpais.com/espana/madrid/2023-02-22/ayuso-salda-en-seis-meses-1390-millones-de-la-deuda-con-los-hospitales-publicos-de-gestion-privada-entre-grandes-tensiones-en-el-gobierno.html"> 1390 millones</a> de deudas por sobrecostes a hospitales madrileños públicos de gestión privada…</span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">Vivir un cambio de modelo puede considerarse una catástrofe vital profesional. Mete más presión a los profesionales, aumenta la incertidumbre y empeora las condiciones de trabajo. Venimos notando pródromos en nuestras carnes desde hace años y desde la pandemia las contracciones son cada vez más frecuentes y dolorosas. El parto es inminente, bastará una legislatura más. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">De momento muchos facultativos aguantan como pueden tomando psicofármacos o yendo al psicólogo. Otros decidieron marcharse, algunos consiguen reconocer que ya no pueden más y piden la baja. Añadan los 1000 que se jubilan en cinco años y resten los MIR que no se quedarán. Las matemáticas pueden ser crueles pero no engañan. Evidentemente nos dirigimos a un sistema basado en enfermería. Y evidentemente será necesario un refuerzo privado. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">El problema de la Atención Primaria es nacional, pero será Madrid quien rompa la baraja e imponga el nuevo modelo que será exportado progresivamente a las demás Comunidades. Para evitarlo sería necesario un consenso a nivel nacional que implicara leyes y medidas centrales de protección del actual modelo. Como es fácil de entender ese consenso nunca ha existido y nunca existirá, lavándose las manos el gobierno central y la respectiva oposición sean del signo que sean. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">Madrid lleva infrafinanciando la Atención Primaria con el presupuesto más exiguo del estado durante décadas. El resultado está a la vista, los médicos están en llamas. Pero sus gritos de dolor son tan solo una pequeña molestia que toleran por cortesía sabiendo que al final cesarán. Seguirá habiendo protestas, mareas blancas, gestos y manifestaciones pero en esta ocasión el nuevo plan ya está atado y bien atado. A falta de desplegarlo en pocos meses. Porque una sanidad publica ahogada solo se salva, según dicen, con la colaboración público privada, aunque se guarden de decir lo que costará eso, que será mucho más sin ningún tipo de duda. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">No soy capaz de aventurar si un cambio en las urnas conseguirá modificar las cosas, hemos cruzado muchas líneas rojas y hay cosas que no podrán repararse. Pero si no sucede esto es lo que hay, lentejas. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;">Yo seguiré pasando consulta mientras el cuerpo aguante. Seguiré estudiando y escribiendo poesía. Pero no será fácil, eso lo tengo claro. </span></span></p>
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<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: large;"><span face="Palatino-Roman"></span><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqYeaUfs_NyPzYp-YUWr1E8-5MXocDPqBru9ah8pXmyqkT_OqlqGJ1_ok7Psr1XN3_QtBxmQXmNoLdd5d4a9kNbofH51BPqApigqXxoLHAtVSgrssHAs7cwFtFnutusNWBqWw-L_qKub0viIayX6JGC8oWhOPsgHyMqJZth9yLjuyWI-Lv7gfGhBnT/s1749/B9A8CB55-2916-45F0-87CA-7551E27177B3.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1380" data-original-width="1749" height="315" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqYeaUfs_NyPzYp-YUWr1E8-5MXocDPqBru9ah8pXmyqkT_OqlqGJ1_ok7Psr1XN3_QtBxmQXmNoLdd5d4a9kNbofH51BPqApigqXxoLHAtVSgrssHAs7cwFtFnutusNWBqWw-L_qKub0viIayX6JGC8oWhOPsgHyMqJZth9yLjuyWI-Lv7gfGhBnT/w400-h315/B9A8CB55-2916-45F0-87CA-7551E27177B3.jpeg" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiwRLr0WH-EdEZcrqmJzi3KhNxq0knd8vEKMsatehOrGffeSTiTr0sEeWFmIzu6oIJTF7-pQ4vAp1g5N9XxD4DbFRiirkfsNKcwcXrwQ0wRBvHhMK5VRTS3tqr62ko11ObPvh9GwPscZdhIj8nZ7NgFHRaIFX1YBdD60gtVFxWXf06D2aVGHbGcnIL/s2022/1A25D23D-7C2E-4FE4-9B59-64F48AB1DFED.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1854" data-original-width="2022" height="366" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiwRLr0WH-EdEZcrqmJzi3KhNxq0knd8vEKMsatehOrGffeSTiTr0sEeWFmIzu6oIJTF7-pQ4vAp1g5N9XxD4DbFRiirkfsNKcwcXrwQ0wRBvHhMK5VRTS3tqr62ko11ObPvh9GwPscZdhIj8nZ7NgFHRaIFX1YBdD60gtVFxWXf06D2aVGHbGcnIL/w400-h366/1A25D23D-7C2E-4FE4-9B59-64F48AB1DFED.jpeg" width="400" /></a></div><br /><p></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><br /></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span face="Palatino-Roman"><span style="font-size: large;"><br /></span></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><b>Confusion</b>.</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">Inside the soul</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">In the middle of the fog</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">Meadows of flowers.</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">When the morning fog prevents us from seeing what is near, there is no choice but to go slowly. In Madrid's healthcare world we live in confusing times. We realise that everything is changing at great speed but it is not easy to understand. It is all too hard. But there is no fog that will not lift and when it does we will see what is there. We are not going to like it. In fact, we are already tying up loose ends, Andalusia gives the green light to "outsource" primary care, Minister Escudero defends a change of model based on nurses, three months of strike by paediatricians and family doctors in Madrid have passed without an agreement, 1.39 billion in debts are being paid for cost overruns to privately managed public hospitals in Madrid...</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">To experience a change of model can be considered a vital professional catastrophe. It puts more pressure on professionals, increases uncertainty and worsens working conditions. We have been feeling the prodromes in our flesh for years and since the pandemic the contractions have become more frequent and painful. The birth is imminent, it will only take one more term of office. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">For the time being, many doctors are coping as best they can by taking psychotropic drugs or seeing a psychologist. Others have decided to leave, some manage to recognise that they can't take it any more and ask for sick leave. Add the 1000 who are retiring in five years and subtract the MIRs who will not stay. Mathematics may be cruel but it is not deceiving. Clearly we are heading for a nursing-based system. And obviously private reinforcement will be necessary. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">The problem of primary care is a national one, but it will be Madrid that will break the deck and impose the new model that will be progressively exported to the other regions. To avoid this, a national consensus would be necessary, involving laws and central measures to protect the current model. As is easy to understand, such a consensus has never existed and will never exist, with the central government and the respective opposition washing their hands of the matter, regardless of which party they belong to. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">Madrid has been underfunding primary care with the most meagre budget in the state for decades. The result is plain to see, the doctors are on fire. But their cries of pain are just a minor nuisance that they tolerate out of politeness, knowing that they will eventually cease. There will continue to be protests, white tides, gestures and demonstrations but this time the new plan is already tied up and well tied up. It has yet to be deployed in a few months' time. Because the only way to save a strangled public health system is through public-private collaboration, although they are careful not to say how much it will cost, which will undoubtedly be much more. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">I am not able to say whether a change at the ballot box will change things. But if it doesn't, this is what it is. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">I will continue to consult for as long as my body holds out. I will continue studying and writing poetry. But it won't be easy, that's for sure. </span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo6hL5yo-Nk8Bp5bRlFqSgJhJJrRl5ej1ZvQvFBDtHzGTKTBnT41nUc7V_pbtwC0MyMRCRGeUmD52OOBb1YTOiD8G7KQx4ZcBgQYC2HVG82PNH5KYsetTaa34wmMMlZc84kRxYEOD_xTTkpDUrXQeX-qV-suJ5tdI1-jYcbx_3yEWLy8F03LLkwxTC/s1360/79C86D13-21CE-4B5B-BA93-7BE16001F077.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1360" data-original-width="1088" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo6hL5yo-Nk8Bp5bRlFqSgJhJJrRl5ej1ZvQvFBDtHzGTKTBnT41nUc7V_pbtwC0MyMRCRGeUmD52OOBb1YTOiD8G7KQx4ZcBgQYC2HVG82PNH5KYsetTaa34wmMMlZc84kRxYEOD_xTTkpDUrXQeX-qV-suJ5tdI1-jYcbx_3yEWLy8F03LLkwxTC/s320/79C86D13-21CE-4B5B-BA93-7BE16001F077.jpeg" width="256" /></a></div><br /><span style="font-size: large;"><br /></span><p></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><b>混乱。</b></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">机器翻译,抱歉有错误。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">灵魂的内部</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">在雾的中间</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">鲜花的草地。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">当晨雾使我们无法看清附近的事物时,我们别无选择,只能慢慢走。在马德里的医疗保健世界里,我们生活在混乱的时代。我们意识到,一切都在飞速变化,但这并不容易理解。这一切都太难了。但是,没有什么迷雾是不会散去的,当它散去时,我们会看到那里有什么。我们不会喜欢它。事实上,我们已经在收拾残局了,安达卢西亚为 "外包 "初级保健开了绿灯,埃斯库德罗部长为基于护士的模式变革辩护,马德里的儿科医生和家庭医生的三个月罢工已经过去,没有达成协议,13.9亿的债务正在为马德里的私人管理的公立医院的成本超支而支付。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">经历模式的改变可以说是一场重要的职业灾难。它给专业人员带来了更大的压力,增加了不确定性,恶化了工作条件。我们多年来一直感觉到肉体上的前驱症状,自从大流行以来,收缩变得更加频繁和痛苦。分娩迫在眉睫,只需再来一任就可以了。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">就目前而言,许多医生正在通过服用精神药物或看心理医生来尽力应对。其他人已经决定离开,有些人设法认识到他们不能再忍受了,于是要求请病假。加上5年后退休的1000人,再减去不会留下的MIRs。数学可能是残酷的,但它不会欺骗人。很明显,我们正在走向一个以护理为基础的系统。显然,私人的强化是必要的。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">初级保健的问题是一个全国性的问题,但将会是马德里打破牌局,将新的模式强加给其他地区,并逐步输出。为了避免这种情况,有必要达成一个全国性的共识,涉及法律和中央措施来保护目前的模式。不难理解,这样的共识从未存在过,也不会存在,中央政府和各自的反对派都对此事洗耳恭听,无论他们属于哪个党派。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">几十年来,马德里一直以该州最微薄的预算为基础医疗提供资金不足。结果是显而易见的,医生们都火了。但他们的痛苦呼喊只是一个小麻烦,他们出于礼貌而容忍,知道他们最终会停止。将继续有抗议、白潮、手势和示威,但这一次,新计划已经被束之高阁,而且束之高阁。它还有待在几个月后部署。因为拯救被扼杀的公共卫生系统的唯一方法是通过公私合作,尽管他们小心翼翼地不说这将花费多少钱,而这无疑将是更多的。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">我不能说投票箱上的改变是否会改变事情。但如果没有,这就是事实。</span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;"><br /></span></p><p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-size: large;">只要我的身体坚持得住,我就会继续做咨询。我将继续学习和写诗。但我不会 </span></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-71536323853612752632023-02-22T11:48:00.000+01:002023-02-22T11:48:59.428+01:00El difícil dilema de la Atención Primaria. The difficult dilemma of Primary Care. 初级保健的艰难困境<p><span style="font-size: medium;"> </span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKSeU2Rgs5PYJvawa3SvC1_mBfLBnbXgoB0Kq-qRrgL_L3s_8mwpqH3-TjcM6Ms9XC6V28lWLLsL2orCGc-JU7HvEuktWBKI3N_uAgjZY9UIcKKzrMXQMVcDiHnan6yiDBFXra5CxwaFkbaaiJQm6-w1rMXY0sxwgFszX5WfTmZQf3PDOaJ1XNVl7O/s551/Fj97o2GXgAM8R6C%20(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="380" data-original-width="551" height="221" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKSeU2Rgs5PYJvawa3SvC1_mBfLBnbXgoB0Kq-qRrgL_L3s_8mwpqH3-TjcM6Ms9XC6V28lWLLsL2orCGc-JU7HvEuktWBKI3N_uAgjZY9UIcKKzrMXQMVcDiHnan6yiDBFXra5CxwaFkbaaiJQm6-w1rMXY0sxwgFszX5WfTmZQf3PDOaJ1XNVl7O/s320/Fj97o2GXgAM8R6C%20(1).jpg" width="320" /></span></a></div><span style="font-size: medium;"><br /></span><p></p><p class="MsoNormal"><o:p><span style="font-size: medium;"> </span></o:p></p>
<p class="MsoNormal"><span style="font-size: medium;">Trabajar como médico de familia en Madrid nunca es aburrido.
En los tiempos que corren menos bajo el intenso bombardeo mediático que enmarca
la crisis de la Atención Primaria y el conflicto entre pediatras y médicos con
la Consejería de Sanidad. Muchos argumentan que de esta guerra depende la
supervivencia del modelo, y tienen argumentos dado que el Consejero parece
apostar por una “<a href="https://twitter.com/DoctorCasado/status/1627692921305632768?s=20">sanidad líquida</a>” basada en enfermería y telemedicina que se
aleje del actual modelo comunitario “de inspiración cubana”.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: medium;">Recuerdo cuando hace años tuve que elegir especialidad tras
aprobar el MIR, yo quería ser médico, en el más amplio significado de la
palabra. Las posibilidades que más se ajustaban eran medicina interna y medicina
de familia y me decanté por la que sin duda es la más cercana al paciente, su
familia y su comunidad. Hoy el paradigma se ha erosionado tras muchos años de
gestión ineficiente, falta de liderazgo, presupuestos menguantes y nulas
reformas. Ningún político a nivel nacional se ha atrevido a implementar los
cambios de calado que los expertos llevan tiempo pidiendo. Y con la pandemia
todo explotó. Muchos médicos de primaria no han aguantado la presión y su marcha
o ausencia ha recargado a los restantes hasta niveles nunca vistos. En Madrid
se estima que 200.000 niños y 800.000 adultos no tienen pediatra ni médico
asignado, por lo que han de ser atendidos por el resto de sus compañeros. Desde
hace meses hay muchos centros de salud en situación crítica sin que ningún
gestor haga nada por reforzarlos o defenderlos. Esta situación hace huir de la
comunidad a los residentes que terminan su formación, lo que, junto al hecho de
que un tercio de la plantilla se jubila en los próximos años, desmoraliza a los
demás. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: medium;">La madrileña huelga de tres meses ha puesto de manifiesto el
mensaje de socorro de los facultativos a la ciudadanía, que a tenor de las
masivas manifestaciones parece que ha captado el mensaje. Los que no han entendido
gran cosa son los altos responsables de la política madrileña que siguen sin
sentarse a negociar en serio y mantienen una posición inflexible. Quieren una
sanidad líquida que permita colaboración público-privada y saben que el camino
es seguir estrangulando la parte más vulnerable del sistema: sus médicos. Es
verdad que la presión la sufren todos los profesionales de la sanidad pero si
miramos bien las cargas de trabajo son los pediatras y médicos de familia
quienes llevan mucho tiempo soportando de lejos mayor sobrecarga. <o:p></o:p></span></p>
<p class="MsoNormal"><br /></p>
<p class="MsoNormal"><span style="font-size: medium;">Lo que quizá no sean capaces de calcular con precisión es el
número de votantes que no están de acuerdo en que no haya pediatra para sus
hijos o médicos para sus mayores o para ellos mismos. Tendremos que esperar a mayo
para comprobarlo.</span></p>
<p class="MsoNormal"><span style="font-size: medium;">Por mi parte he de reconocer que la actual situación genera
un nivel de ruido de fondo altamente tóxico. Me resulta difícil concentrarme,
estudiar, reflexionar los casos clínicos, aprender cosas nuevas e investigar. Al
terminar la consulta me quedan pocas fuerzas para las necesarias labores de
formación continuada y de mantenimiento profesional. Reconozco que siento miedo
de que la estructura se hunda y siga dañando a más compañeros e incluso a mí
mismo. No es fácil trabajar en estas condiciones. En el consultorio rural donde
trabajo afortunadamente está la plantilla completa y hay muy buen ambiente. Lo
valoro mucho por su importancia y excepcionalidad. Pero sigo experimentando un
abismo de vulnerabilidad que los actuales responsables de gestión parecen
empeorar. La sociedad se merece que quien la cuide lo haga en las mejores
condiciones, mantener a los médicos agobiados, sobrecargados y agotados no es
muy inteligente. Si se siguen cruzando líneas rojas muchos seguiremos
marchándonos, eso lo tengo claro. También que quienes más lo sufrirán serán los
de siempre. Y aquellos que tienen un seguro médico privado y deciden creer que
es mejor bajar impuestos y desmontar la sanidad pública terminarán comprobando,
cuando les toque, que no es oro todo lo que reluce. <o:p></o:p></span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdz4voYFB354jSi3zuZ5bemqh1rrW7OS0fbXN3Pl0g6ohjvaetRAtfrPu_YY4Dwy4YLNexiXFHBAHpc44lVUxFnYmAO4w-JUX-hSD7HGGSx3FpoQ1aDCLK2CzFQhW2MRwUXGutX3gEzebolsZgBvdb8Fa8R_0wuf80KBWRJv8mGjcYhsix4mbGV_lG/s680/E3WyeArWQAMXi8d.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="680" data-original-width="510" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdz4voYFB354jSi3zuZ5bemqh1rrW7OS0fbXN3Pl0g6ohjvaetRAtfrPu_YY4Dwy4YLNexiXFHBAHpc44lVUxFnYmAO4w-JUX-hSD7HGGSx3FpoQ1aDCLK2CzFQhW2MRwUXGutX3gEzebolsZgBvdb8Fa8R_0wuf80KBWRJv8mGjcYhsix4mbGV_lG/w300-h400/E3WyeArWQAMXi8d.jpg" width="300" /></span></a></div><span style="font-size: medium;"><br /></span><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><b><span style="font-size: medium;">The difficult dilemma of Primary Care</span></b></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;">Working as a family doctor in Madrid is never boring. In this day and age, even less so under the intense media bombardment surrounding the crisis in primary care and the conflict between paediatricians and doctors with the Regional Ministry of Health. Many argue that the survival of the model depends on this war, and they have a point, given that the Regional Minister seems to be committed to a "liquid healthcare" based on nursing and telemedicine that moves away from the current "Cuban-inspired" community model.</span></p><p class="MsoNormal"><span style="font-size: medium;">I remember years ago when I had to choose a speciality after passing the MIR, I wanted to be a doctor, in the broadest sense of the word. The possibilities that best suited me were internal medicine and family medicine, and I opted for the one that is undoubtedly closest to the patient, his family and his community. Today the paradigm has eroded after many years of inefficient management, lack of leadership, dwindling budgets and no reforms. No politician at the national level has dared to implement the far-reaching changes that experts have long called for. And with the pandemic, everything exploded. Many primary care doctors have not withstood the pressure and their departure or absence has stretched the remaining doctors to unprecedented levels. In Madrid it is estimated that 200,000 children and 800,000 adults do not have a paediatrician or doctor assigned to them, so they have to be attended by the rest of their colleagues. For months there have been many health centres in a critical situation without any manager doing anything to reinforce or defend them. This situation is causing the residents who are finishing their training to flee the community, which, together with the fact that a third of the staff are retiring in the next few years, demoralises the rest. </span></p><p class="MsoNormal"><span style="font-size: medium;">Madrid's three-month strike has underlined the doctors' message of relief to the public, who seem to have got the message from the massive demonstrations. Those who have not understood much are Madrid's top politicians, who still have not sat down to negotiate seriously and maintain an inflexible position. They want a liquid healthcare system that allows for public-private collaboration and they know that the way forward is to continue to strangle the most vulnerable part of the system: its doctors. It is true that all healthcare professionals are under pressure, but if we take a good look at the workloads, it is the paediatricians and family doctors who have been bearing the brunt of by far the heaviest burden for a long time. </span></p><p class="MsoNormal"><span style="font-size: medium;">What they may not be able to calculate accurately is the number of voters who do not agree that there should be no paediatricians for their children or doctors for their elders or for themselves. We will have to wait until May to find out. </span></p><p class="MsoNormal"><span style="font-size: medium;">For my part, I have to admit that the current situation generates a highly toxic level of background noise. I find it difficult to concentrate, to study, to reflect on clinical cases, to learn new things and to do research. At the end of the practice I have little strength left for the necessary continuing education and professional maintenance. I admit that I am afraid that the structure will collapse and continue to harm more colleagues and even myself. It is not easy to work under these conditions. In the rural clinic where I work, fortunately the staff is complete and the atmosphere is very good. I value it very much for its importance and exceptionality. But I still experience an abyss of vulnerability that the current management seems to be making worse. Society deserves to be cared for in the best possible conditions; keeping doctors overburdened, overworked and overworked is not very smart. If red lines continue to be crossed, many of us will continue to leave, that much is clear to me. It is also clear to me that those who will suffer the most will be the usual ones. And those who have private health insurance and decide to believe that it is better to lower taxes and dismantle public health care will end up finding, when it is their turn, that all that glitters is not gold.</span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyOrRoDoaYZu7IMBh56nd3WMnLP72UvtIbA9dUfAyjgc8XbtyADXWJZsMlesff-bil3d-NQNREhtNox__0gegK8vNItNXxj1dWxMnkFP384uuRdiSiCeKLl1IxKxQjnj-XY1Co_Eftw-QRKklZb5CsWCq66t7Y-2U4K7eW2yZjDl4lDwXcTAy5BGiH/s600/FkTwl8lWQAAq5h5%20(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="499" data-original-width="600" height="333" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyOrRoDoaYZu7IMBh56nd3WMnLP72UvtIbA9dUfAyjgc8XbtyADXWJZsMlesff-bil3d-NQNREhtNox__0gegK8vNItNXxj1dWxMnkFP384uuRdiSiCeKLl1IxKxQjnj-XY1Co_Eftw-QRKklZb5CsWCq66t7Y-2U4K7eW2yZjDl4lDwXcTAy5BGiH/w400-h333/FkTwl8lWQAAq5h5%20(1).jpg" width="400" /></span></a></div><span style="font-size: medium;"><br /></span><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><b><span style="font-size: medium;">初级保健的艰难困境</span></b></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;">机器翻译,抱歉有错误。</span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;">在马德里从事家庭医生的工作从来都不无聊。在这个时代,在媒体围绕初级保健危机以及儿科医生和医生与地区卫生部之间的冲突的密集轰炸下,更是如此。许多人认为,这种模式的生存取决于这场战争,他们说得很有道理,因为地区部长似乎致力于以护理和远程医疗为基础的 "液体医疗",摆脱目前 "受古巴启发的 "社区模式。</span></p><p class="MsoNormal"><span style="font-size: medium;">我记得多年前,当我通过MIR考试后必须选择专业时,我想成为一名医生,在最广泛的意义上。最适合我的可能性是内科和家庭医学,我选择了无疑是最接近病人、其家庭和社区的那一种。今天,在多年的低效管理、缺乏领导、预算减少和没有改革之后,这种模式已经被侵蚀。没有一个国家层面的政治家敢于实施专家们长期呼吁的具有深远意义的改革。而随着大流行病的发生,一切都爆发了。许多初级保健医生没有承受住压力,他们的离开或缺席使剩下的医生的工作压力达到了前所未有的程度。在马德里,估计有20万名儿童和80万名成人没有被指派给他们的儿科医生或医生,因此他们不得不由其他同事照顾。几个月来,有许多医疗中心处于危急状态,没有任何管理者做任何事情来加强或保护它们。这种情况导致正在完成培训的居民逃离社区,再加上三分之一的工作人员将在未来几年内退休的事实,使其他人士气低落。</span></p><p class="MsoNormal"><span style="font-size: medium;">马德里为期三个月的罢工强调了医生对公众的救济信息,公众似乎已经从大规模的示威活动中得到了信息。那些没有明白多少的人是马德里的高层政治家,他们仍然没有坐下来认真谈判,保持着僵硬的立场。他们想要一个允许公私合作的流动医疗系统,他们知道前进的道路是继续扼杀系统中最脆弱的部分:其医生。诚然,所有的卫生专业人员都面临着压力,但如果我们仔细观察一下工作量,长期以来首当其冲的是儿科医生和家庭医生。</span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><span style="font-size: medium;">他们可能无法准确计算的是,有多少选民不同意他们的孩子不应该有儿科医生,他们的长辈或自己不应该有医生。我们将不得不等到5月才能知道</span></p><p class="MsoNormal"><span style="font-size: medium;"><br /></span></p><p class="MsoNormal"><br /></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-44699598486573898672023-02-13T09:30:00.007+01:002023-02-15T09:39:30.679+01:00 La manifestación. The demonstration. 演示。<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRMKxa7c_ibBChFSda-0wLW9kYemkjJN81DZGTejM93wv8MoGzIcf8ZkZnnwfkNAoZS6-MQq3o-YJ5KzWt1kTy2_kfUhLI4RPtCVCpeG-NVBz0HC4dMqaC3l0Khp57RXp2F2f1J2RMVVOtf98cRmVsVQ5Bgwx_DKe91ZAhDw1F3wpH2d1a7NQKQlHh/s1572/FoxhAajWYAI5Xje%20(1).jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="1572" data-original-width="1080" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRMKxa7c_ibBChFSda-0wLW9kYemkjJN81DZGTejM93wv8MoGzIcf8ZkZnnwfkNAoZS6-MQq3o-YJ5KzWt1kTy2_kfUhLI4RPtCVCpeG-NVBz0HC4dMqaC3l0Khp57RXp2F2f1J2RMVVOtf98cRmVsVQ5Bgwx_DKe91ZAhDw1F3wpH2d1a7NQKQlHh/w275-h400/FoxhAajWYAI5Xje%20(1).jpg" width="275" /></span></a></div><span style="font-size: large;"><br /></span><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">Ayer me uní a la manifestación en defensa de la sanidad pública de Madrid. Ha habido varias antes, esta volvió a ser monumental. Cinco columnas diferentes que terminaban en Cibeles. En lugar de unirme a mis colegas médicos que partían del barrio de Salamanca elegí la columna sur, mucho más popular, en la que no pude evitar que las batas de mi familia destacaran. Me resultó muy revelador ir escuchando conversaciones que ponían de manifiesto el agobio de mucha gente que ve que con desazón cómo les están desmontando su sanidad pública. Una preocupación que ha convertido la sanidad en el primer motivo de zozobra de la población madrileña. Y hay que reconocer que los cientos de miles de madrileños que salieron a la calle tienen razón. Los pediatras y médicos de familia llevamos muchos años diciéndolo <a href="https://atensionprimaria.wordpress.com/2023/02/11/y-un-ano-despues-seguimos-igual/">sin que nos hayan hecho mucho caso</a>, ni siquiera dos meses de huelga han servido para algo. La sangría de médicos que abandonan la Atención Primaria de Madrid es una hemorragia que está matando la sanidad. Y el pronóstico es sombrío, es más fácil destruir una organización compleja que construirla. </span></p><p><span style="font-size: large;">Al terminar la manifestación nos fuimos a tomar unas cañas, a fin de cuentas estamos en Madrid. La libertad era esto. </span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjFzshjmqxF2xLPyGl0fbqiZAvdaiDUhDkYhmTnOHlHj-ilRWCE97HtIXmymj5LA5W6YtWun8ydSg7UqF8bx96AWS1uKVdK8ijhm-JnVKWESsp-FVoiQ8TD9m6Z3T8mauh2pXEwg62U3UOWk3P7hPAXI6Kd088ettvGqSASBzUYWo9Df_ACQNUCmBT/s1280/FoxhA21WAAADbUe%20(1).jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="1280" data-original-width="993" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjFzshjmqxF2xLPyGl0fbqiZAvdaiDUhDkYhmTnOHlHj-ilRWCE97HtIXmymj5LA5W6YtWun8ydSg7UqF8bx96AWS1uKVdK8ijhm-JnVKWESsp-FVoiQ8TD9m6Z3T8mauh2pXEwg62U3UOWk3P7hPAXI6Kd088ettvGqSASBzUYWo9Df_ACQNUCmBT/w310-h400/FoxhA21WAAADbUe%20(1).jpg" width="310" /></span></a></div><span style="font-size: large;"><br /></span><p><span style="font-size: large;"><br /></span></p><p><b><span style="font-size: large;">The demonstration.</span></b></p><p><span style="font-size: large;">Yesterday I joined the demonstration in defence of public health in Madrid. There have been several before, this one was monumental again. Five different columns ending at Cibeles square. Instead of joining my medical colleagues starting from the Salamanca neighbourhood, I chose the much more popular south column, where my family's white coats could not help but stand out. I found it very revealing to listen to conversations that revealed the anxiety of many people who see with dismay how their public health system is being dismantled. A concern that has turned healthcare into the number one cause of anxiety for the people of Madrid. And we must recognise that the hundreds of thousands of Madrilenians who took to the streets are right. We paediatricians and family doctors have been saying this for many years without them paying much attention to us, and not even two months of strike action have been of any use. The bloodletting of doctors leaving primary care in Madrid is a haemorrhage that is killing the health system. And the prognosis is bleak, it is easier to destroy a complex organisation than to build it up. </span></p><p><span style="font-size: large;">At the end of the demonstration we went for a few beers, after all we are in Madrid. This is what freedom was all about.</span></p><p><span style="font-size: large;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeKB7oOkvqKKIWDdTTvuG9-5J0xil7iWHi4hKnWBZv6zQl7wfX_-RGq8EHu25cT11Z3gMci0ANaxQaTVhSa55aXxEji5Rrug0KIfKdf2wUhtOHqYIJXcuCDi-ipKqCDpNIsV7TAt3_5bF7zjkOdIH1FIItJqmchFdLHFQwuZuZFOPVPa1tZfWNOOcc/s1280/FoxhBQMWIAAO7V5%20(1).jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="1280" data-original-width="921" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeKB7oOkvqKKIWDdTTvuG9-5J0xil7iWHi4hKnWBZv6zQl7wfX_-RGq8EHu25cT11Z3gMci0ANaxQaTVhSa55aXxEji5Rrug0KIfKdf2wUhtOHqYIJXcuCDi-ipKqCDpNIsV7TAt3_5bF7zjkOdIH1FIItJqmchFdLHFQwuZuZFOPVPa1tZfWNOOcc/w288-h400/FoxhBQMWIAAO7V5%20(1).jpg" width="288" /></span></a></div><span style="font-size: large;"><br /></span><p><span style="font-size: large;"><br /></span></p><p><b><span style="font-size: large;">演示。</span></b></p><p><span style="font-size: large;">自动翻译,抱歉有错误。</span></p><p><span style="font-size: large;">昨天我参加了在马德里举行的捍卫公共卫生的示威。以前也有过几次,这次又是不朽的。五个不同的纵队在Cibeles广场结束。我没有和我的医疗同事们一起从萨拉曼卡社区出发,而是选择了更受欢迎的南面纵队,在那里我的家人的白大褂不禁很显眼。我发现,听着那些揭示了许多人的焦虑的谈话,他们沮丧地看到他们的公共卫生系统正在被拆除。这种担忧已经使医疗卫生成为马德里人民焦虑的头号原因。我们必须认识到,成千上万的马德里人走上街头是正确的。我们儿科医生和家庭医生已经说了很多年,但他们并没有太注意我们,甚至两个月的罢工行动都没有起到任何作用。在马德里,医生离开初级保健的流血事件是一种大出血,正在扼杀卫生系统。而且预言是暗淡的,摧毁一个复杂的组织比建立它更容易。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">示威结束后,我们去喝了几杯啤酒,毕竟我们是在马德里。这就是自由的意义所在。</span></p><p><span style="font-size: large;"><br /></span></p><p><br /></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-80124630846332596682023-02-12T09:48:00.005+01:002023-02-12T09:48:45.049+01:00Gratitud. Gratitude. 感恩的心<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge9M7lyK8FkbCch_fTKGiju0wY9lTku5jaTVu457tMaOJkQQrKp0X29kxTBgsPQpZkAzhImPJzm9kOHUsOdZlk5xrmpxul9_HjRDh8ABhcql_jHOPjvT6veU3oQE-zZVmqut70x7W38n6cmAOCP2ua5E7U9LoP0lZSVQcPFRY4brjFVyNvqzCdFCSy/s3088/1FF3EEA5-8813-4E65-8440-58A4D9CF155B.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="2320" data-original-width="3088" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge9M7lyK8FkbCch_fTKGiju0wY9lTku5jaTVu457tMaOJkQQrKp0X29kxTBgsPQpZkAzhImPJzm9kOHUsOdZlk5xrmpxul9_HjRDh8ABhcql_jHOPjvT6veU3oQE-zZVmqut70x7W38n6cmAOCP2ua5E7U9LoP0lZSVQcPFRY4brjFVyNvqzCdFCSy/w640-h480/1FF3EEA5-8813-4E65-8440-58A4D9CF155B.jpeg" width="640" /></span></a></div><span style="font-size: medium;">De izquierda a derecha: Rafa Alonso, Ignacio Sánchez, Yale Tung y un servidor.</span><div><span style="font-size: medium;"><br /></span><p><span style="font-size: medium;"><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Esta semana he participado en las <a href="https://semfyc.eventszone.net/eco2023/">Jornadas de Ecografía de la Semfyc</a> en Alcalá de Henares, asistiendo en calidad de invitado y de novato. Me propusieron dar la conferencia de clausura y aproveché para mejorar mi incipiente formación dado que en este ámbito soy del todo novel.</span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Por un lado me sentía extraño dado que en Madrid los pediatras y médicos de familia llevamos dos meses de huelga y eso no parece muy compatible con dedicar mucha energía a la formación, pero por otro experimento una enorme gratitud por haber participado en un acontecimiento cuyo valor excede su función. Además de aprender me he llevado a casa un buen montón de abrazos a personas que admiro y la satisfacción de reconocer que sigo siendo médico, y eso, peso a las amargas circunstancias, es para mí motivo de alegría. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">El formato de las Jornadas ha sido muy bueno, 400 inscritos acogidos por un equipo profesional y una organización que han cumplido objetivos. Ha sido todo muy fácil, con un menú a base de talleres, salas prácticas, mesas, comunicaciones y demás. Una mayoría de residentes (80%), acompañados de tutores y compañeros senior, 2/3 de fuera de Madrid según mi estimación. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Creo que vamos en buena dirección favoreciendo este tipo de encuentros prácticos que permiten adquirir habilidades técnicas y compartir conocimiento. En mi caso lo prefiero en comparación al nuevo formato docente de 20 charlas teóricas en un día que considero excesivo. Un encuentro médico debe obligatoriamente cuidar los pasillos, permitir cafés, favorecer conversaciones. Sin ellas nuestros curriculum formativos seguirán creciendo pero no crearemos ni cuidaremos relaciones profesionales que son imprescindibles dado que siempre habrá compañeros que podrán aportarnos su experiencia, conocimientos, narrativas y además escuchar las nuestras. </span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Mención especial tiene haber podido conocer personalmente a Yale Tung. Participó en una mesa plenaria y nos regaló un buen montón de pistas formativas. Un material valiosísimo que por mi cuenta me hubiera requerido años de búsqueda y que él nos hilvanó de la manera más sencilla. Yale, además de ser un internista de prestigio en el Hospital La Paz de Madrid, y un ecografista líder en el panorama internacional, es buena persona. Quizá ese adjetivo parezca simple pero no lo es. No es fácil encontrar médicos asistenciales que transmitan esa mezcla de facilidad, alegría, sencillez y cercanía que él irradia.</span></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14.3px; text-indent: 18px;"><span style="font-size: medium;"><span style="font-family: Palatino-Roman;"></span><br /></span></p>
<p style="font-family: Palatino; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 18px;"><span style="font-family: Palatino-Roman;"><span style="font-size: medium;">Los que llevamos tiempo en estas lides sabemos lo que cuesta organizar un evento. Las horas de trabajo que hay detrás y que no se ven. Por eso doy las gracias a todo el equipo que ha logrado la proeza de reunir y formar a 400 médicos en Madrid. Hoy nos veremos en la manifestación de la Castellana, la vida sigue. </span></span></p><div><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: Palatino-Roman;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWNEXNdvMGawsPWMq5IUUHuyF0mjCMvunKxhrIufriLrY9iQmtE0sl6RrXnR7qSRfTQhfTldXxuCpWEEZY7wcJvNw6AciUYoGbdf_eVEqTtnUlu6WjoowHs596msT7-PNryl3X6NoE8id7TpWMrtKrU1pYGtZgwLlcol3YOY-PzMkTCONN1fuBL0kQ/s1088/2575DAF7-DC47-45E8-AE7D-C44A6834FA97.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="680" data-original-width="1088" height="250" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWNEXNdvMGawsPWMq5IUUHuyF0mjCMvunKxhrIufriLrY9iQmtE0sl6RrXnR7qSRfTQhfTldXxuCpWEEZY7wcJvNw6AciUYoGbdf_eVEqTtnUlu6WjoowHs596msT7-PNryl3X6NoE8id7TpWMrtKrU1pYGtZgwLlcol3YOY-PzMkTCONN1fuBL0kQ/w400-h250/2575DAF7-DC47-45E8-AE7D-C44A6834FA97.jpeg" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: Palatino-Roman;"><span style="font-size: medium;"><br /></span></span></div><div><div><span style="font-size: medium;"><b>Gratitude</b></span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">This week I participated in the Semfyc Ultrasound Conference in Alcalá de Henares, attending as a guest and as a novice. I was asked to give the closing lecture and I took the opportunity to improve my incipient training, given that I am a complete novice in this field.</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">On the one hand I felt strange given that in Madrid paediatricians and family doctors have been on strike for two months and that does not seem very compatible with devoting a lot of energy to training, but on the other hand I feel an enormous gratitude for having participated in an event whose value exceeds its function. In addition to learning, I have taken home a lot of hugs from people I admire and the satisfaction of recognising that I am still a doctor, and that, despite the bitter circumstances, is a source of joy for me. </span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">The format of the Conference has been very good, 400 registered participants welcomed by a professional team and an organisation that has fulfilled its objectives. It was all very easy, with a menu based on workshops, practical rooms, tables, communications and so on. A majority of residents (80%), accompanied by tutors and senior colleagues, 2/3 from outside Madrid according to my estimate. </span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">I think we are moving in the right direction by favouring this type of practical meetings that allow us to acquire technical skills and share knowledge. In my case, I prefer it to the new teaching format of 20 theoretical talks in one day, which I consider excessive. A medical meeting must necessarily take care of the corridors, allow for coffee breaks, encourage conversations. Without them, our training curricula will continue to grow, but we will not create or nurture professional relationships, which are essential, given that there will always be colleagues who can contribute their experience, knowledge and narratives and also listen to our own. </span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">It is worth mentioning that I was able to meet Yale Tung in person. He participated in a plenary table and gave us a lot of formative hints. Valuable material that would have taken me years of searching on my own, and which he put together for us in the simplest of ways. Yale, besides being a prestigious internist at the Hospital La Paz in Madrid, and a leading ultrasonographer on the international scene, is a good person. That adjective may sound simple, but it is not. It is not easy to find doctors who transmit that mixture of ease, joy, simplicity and closeness that he radiates.</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">Those of us who have been in this field for a long time know what it takes to organise an event. The hours of work that go into it and that are not seen. That is why I would like to thank the whole team that has achieved the feat of bringing together and training 400 doctors in Madrid. We will see you today at the demonstration in the Castellana, life goes on. </span></div></div><div><span style="font-size: medium;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR2LBlYM_koUWsZb0BDl7Diqu3jAwIZzL1yRAnKBUAI7IWR7rtGL01E9ImkGpVt4vo9dLjp5-bOkCR_5UiOodShp3hcH81U5Kw44V-JdOGbrzZ-cQDW3xp4sthtGUhgM8nvhy1xpwoFw-kovLWPirLCEsUTm0PUzHZwCnh5ehgx5l3ISYwjJCVdynW/s1088/53DF1945-0728-4987-ADA1-604C3AB23364.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="816" data-original-width="1088" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR2LBlYM_koUWsZb0BDl7Diqu3jAwIZzL1yRAnKBUAI7IWR7rtGL01E9ImkGpVt4vo9dLjp5-bOkCR_5UiOodShp3hcH81U5Kw44V-JdOGbrzZ-cQDW3xp4sthtGUhgM8nvhy1xpwoFw-kovLWPirLCEsUTm0PUzHZwCnh5ehgx5l3ISYwjJCVdynW/w400-h300/53DF1945-0728-4987-ADA1-604C3AB23364.jpeg" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;"><br /></span></div><div><div><span style="font-size: medium;"><b>感恩的心</b></span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">机器翻译,抱歉有错误。</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">本周我参加了在阿尔卡拉德埃纳雷斯举行的Semfyc超声会议,以嘉宾和新手的身份出席。我被要求做闭幕演讲,鉴于我在这个领域完全是个新手,我利用这个机会提高了我刚开始的训练。</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">一方面,我感到很奇怪,因为在马德里,儿科医生和家庭医生已经罢工了两个月,这似乎与投入大量精力进行培训不太相符,但另一方面,我对参加了一个价值超过其功能的活动感到非常感激。除了学习,我还带回家了很多我敬佩的人的拥抱,以及认识到我仍然是一名医生的满足感,尽管环境很苦,但这是我快乐的来源。</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">会议的形式非常好,400名注册与会者受到专业团队和组织的欢迎,实现了其目标。这一切都非常简单,菜单上有研讨会、实践室、桌子、通信等。据我估计,大多数住院医师(80%)在导师和高级同事的陪同下,有2/3来自马德里以外。</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">我认为我们正朝着正确的方向前进,赞成这种实际的会议,使我们能够获得技术技能和分享知识。就我而言,我更喜欢这种方式,而不是在一天内进行20次理论讲座的新教学形式,我认为这种方式过份。医疗会议必然要照顾到走廊,允许喝咖啡休息,鼓励谈话。没有他们,我们的培训课程将继续增长,但我们将无法建立或培养专业关系,而这些关系是至关重要的,因为总会有同事可以贡献他们的经验、知识和叙述,也可以倾听我们自己的意见。</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">值得一提的是,我能够亲自见到耶鲁大学的学生。他参加了全体会议,给了我们很多形成性的提示。这些宝贵的材料本来需要我自己花数年时间去寻找,而他以最简单的方式为我们整理了这些材料。耶鲁除了是马德里拉巴斯医院著名的内科医生和国际舞台上领先的超声学专家外,还是一个好人。这个形容词可能听起来很简单,但它并不简单。要找到像他所散发的那种混合着轻松、快乐、简单和亲密的医生并不容易。</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">我们这些在这个领域工作了很长时间的人知道组织一个活动需要什么。融入其中的工作时间,而这些都是看不到的。这就是为什么我要感谢整个团队,他们实现了在马德里汇集和培训400名医生的壮举。我们今天会在卡斯特拉纳的示威中见到你,生活还在继续。</span></div></div><div><br /></div></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5g3usTuOB-Rh216NSKyoi_WHzEpLc6_8oCnORu-pwNf25TJnR4P1ghVHoMVRMQHD94YBqMmXN83DIQzMAWhkTMum_z9-N6JEabKgO7hcJRfj8gJNSBlDJTPLxR2pMLBmL0_mBIEtjJAZRCgUarx8gXWecDShKWPtoE9r_tawx4g20lTBAC_kNBUaZ/s768/54745403-5011-4C8F-A42A-FD0EE5AB5387.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="768" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5g3usTuOB-Rh216NSKyoi_WHzEpLc6_8oCnORu-pwNf25TJnR4P1ghVHoMVRMQHD94YBqMmXN83DIQzMAWhkTMum_z9-N6JEabKgO7hcJRfj8gJNSBlDJTPLxR2pMLBmL0_mBIEtjJAZRCgUarx8gXWecDShKWPtoE9r_tawx4g20lTBAC_kNBUaZ/s320/54745403-5011-4C8F-A42A-FD0EE5AB5387.jpeg" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRkXS97WIJ-BznK349auLnm9ksTHZgtVEA6cdgSpVRLojgsP83kkROqcAdem56UfRRDcTQjoIc85d5cXkrxEzfZ4xNO0Om7eq1cpJ1YwMaoyDlAS5ml4lzC5CoN4etFy_9-or_RuISEuapdeDkWjUMj6Sp7G7XzkHEXfNj3NSWA9Iph2x5LJyU1Ii5/s1088/B759DC97-CA87-48CC-92CF-A98D3E63C5C4.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="711" data-original-width="1088" height="209" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRkXS97WIJ-BznK349auLnm9ksTHZgtVEA6cdgSpVRLojgsP83kkROqcAdem56UfRRDcTQjoIc85d5cXkrxEzfZ4xNO0Om7eq1cpJ1YwMaoyDlAS5ml4lzC5CoN4etFy_9-or_RuISEuapdeDkWjUMj6Sp7G7XzkHEXfNj3NSWA9Iph2x5LJyU1Ii5/s320/B759DC97-CA87-48CC-92CF-A98D3E63C5C4.jpeg" width="320" /></a></div><br /><div><br /></div>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com1tag:blogger.com,1999:blog-4060378544967004941.post-74301817899808033582023-02-02T12:20:00.003+01:002023-02-02T12:20:49.737+01:00La penitencia. Penance. 忏悔。<p><span style="font-size: large;"> </span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpJ4mjB8kS3rlCtrMdyCYoyIQwzlsmC315hfE14QS00_JbuPHG02WOVAv7tShx1ypL9sDSCkW5UE8iOEaXmXyEcIQWHDNxbtW8ccHzXQOcJ4i51Sa0O-oNMgVaSzwvTlSz-3OCPyMT7wQyPDBLQXr54KZ1GX3oB-z5J4uZzgKQ_pC7bagyJc3uMmpb/s2400/twitter_Fn6EJ9LXEBwgI7U.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="2400" data-original-width="1600" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpJ4mjB8kS3rlCtrMdyCYoyIQwzlsmC315hfE14QS00_JbuPHG02WOVAv7tShx1ypL9sDSCkW5UE8iOEaXmXyEcIQWHDNxbtW8ccHzXQOcJ4i51Sa0O-oNMgVaSzwvTlSz-3OCPyMT7wQyPDBLQXr54KZ1GX3oB-z5J4uZzgKQ_pC7bagyJc3uMmpb/w266-h400/twitter_Fn6EJ9LXEBwgI7U.jpg" width="266" /></span></a></div><span style="font-size: large;"><br /></span><p></p><p style="text-align: center;"><span style="background-color: white; color: #222222; font-family: UICTFontTextStyleBody;">Fotos de <a href="https://twitter.com/miguelhllucas/status/1620878576341106688?s=61&t=PLa5_cv-5uGb_WMgGlB8ZA">Miguel Hernández Lucas</a></span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><span style="background-color: white; color: #222222; font-family: UICTFontTextStyleBody;">Llevo dos semanas seguidas sin pisar la con</span><span style="background-color: white; color: #222222; font-family: UICTFontTextStyleBody;">sulta por causa de la huelga de médicos de familia de Madrid, la más larga que recuerdo. Ayer estuve en una manifestación, otra más, y no puedo dejar de pensar en esta crisis. Durante años hemos trabajado como el burro con anteojeras arando el campo. Sin parar. Detenerme estos días está permitiendo que afloren muchos fantasmas largo tiempo escondidos en los profundos fondos de armario de nuestra especialidad. Estamos viviendo una especie de cuaresma de purificación. Un desierto. Y en el pasado se nos decía que era necesario ayudarse de la oración, el ayuno y la abstinencia para superar las dificultades que inevitablemente encontraremos. Tras ver la nómina de enero creo que de ayuno y abstinencia vamos bien servidos, y en cuanto a la oración voy progresando, gracias a los generosos tiempos de silencio que esta quincena me está proveyendo. </span></span></p><p style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px; min-height: 27.2px;"><span style="font-size: large;"><span style="font-family: UICTFontTextStyleBody;"></span><br /></span></p><p style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: UICTFontTextStyleBody;"><span style="font-size: large;">Es descorazonador ver como la negociación no avanza. No puede hacerlo, no hay voluntad política para ello. Porque esta situación, como comprenderán, es altamente política. La Consejería de Sanidad sigue la suya y denosta la de los demás. Y así seguimos, el Consejero contando a los medios lo malos que son sus facultativos y sus subalternos atendiendo al comité de huelga al que no pueden responder cómo implementarán las famosas agendas de 34 pacientes diarios. Algo que, como convertir el agua en vino, nadie sabe cómo podrá hacerse. </span></span></p><p style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px; min-height: 27.2px;"><span style="font-size: large;"><span style="font-family: UICTFontTextStyleBody;"></span><br /></span></p><p style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: UICTFontTextStyleBody;"><span style="font-size: large;">Seguimos sin entender que no es cuestión de negociar un número concreto de pacientes al día, sino de garantizar que ninguna agenda médica supere lo admisible. Porque durante mucho tiempo hemos asumido que ver 50, 60 o 70 pacientes era lo que había, pero objetivamente es una barbaridad tanto para profesionales como para pacientes. Blindar la seguridad de pediatras y médicos de familia para proteger su salud mental debería ser la base del sistema. Y por supuesto la del resto de profesionales, aunque me temo que si tuvieran agendas parecidas ya habría ardido la sanidad hace mucho tiempo. </span></span></p><p style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px; min-height: 27.2px;"><span style="font-size: large;"><span style="font-family: UICTFontTextStyleBody;"></span><br /></span></p><p style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: UICTFontTextStyleBody;"><span style="font-size: large;">La negociación con un sindicato o en una mesa sectorial es un puente pero no puede ser el único a la hora de afrontar un problema tan complejo como gestionar la Atención Primaria que precisa acciones poliédricas en muchos ejes. Será necesario crear más, dado que la política de parches parece haber dado todo lo que podía. Las ideas y propuestas de mejora que están aflorando estos días son muy valiosas. Será necesario canalizarlas y trabajar por su implementación en líneas de arriba a abajo y de abajo a arriba. </span></span></p><p style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px; min-height: 27.2px;"><span style="font-size: large;"><span style="font-family: UICTFontTextStyleBody;"></span><br /></span></p><p dir="auto" style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: UICTFontTextStyleBody;"><span style="font-size: large;">Reconozco que me flaquea la fe. He perdido la confianza en mis gestores y con alarma percibo que de alguna forma si la situación revienta me da igual. En estos momentos de desesperación me veo haciendo huelga hasta final de año y comiendo patatas. Lo único que tengo por cierto es que nadie asumirá la responsabilidad por el servicio devastado y la enorme cantidad de profesionales enfermos, heridos o de baja por esta situación. Un millón de madrileños no tiene pediatra o médico de familia asignado. En poco tiempo serán bastantes más. Y no hay plan real con medidas concretas para afrontarlo, solo palabras, palabras, palabras. </span></span></p><p dir="auto" style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: UICTFontTextStyleBody;"><span style="font-size: large;"><br /></span></span></p><p dir="auto" style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: UICTFontTextStyleBody;"><span style="font-size: large;"><br /></span></span></p><p dir="auto" style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidxg6bF0YpWN3dkV7OokwL3gWtSR2vLA1gaKeSx4t6JAKWlGJh_h5TVDrdg1aQvAjk_Z6a7K-P_ppZX5OLDoLMLShB-0Lvrccj698lBeoZGbd1q4BjzR011iA_C9L3Pf93Xk3SMdw_EHJ17cT03FXxKSLj3ZeaP9zkkqT-0-9_4OgO03a5PVFOrF9e/s1600/twitter_Fn6EdZyWQAIGGEN.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="1067" data-original-width="1600" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidxg6bF0YpWN3dkV7OokwL3gWtSR2vLA1gaKeSx4t6JAKWlGJh_h5TVDrdg1aQvAjk_Z6a7K-P_ppZX5OLDoLMLShB-0Lvrccj698lBeoZGbd1q4BjzR011iA_C9L3Pf93Xk3SMdw_EHJ17cT03FXxKSLj3ZeaP9zkkqT-0-9_4OgO03a5PVFOrF9e/w400-h266/twitter_Fn6EdZyWQAIGGEN.jpg" width="400" /></span></a></div><p dir="auto" style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><span style="font-size: large;"><br /></span><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><br /></span></div><span style="font-size: large;"><br /><span style="font-family: UICTFontTextStyleBody;"><br /></span></span><p></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><b>Penance.</b></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">I have been two weeks in a row without going to the doctor's surgery because of the family doctors' strike in Madrid, the longest I can remember. Yesterday I was at a demonstration, yet another one, and I can't stop thinking about this crisis. For years we have worked like the donkey with blinkers ploughing the field. Without stopping. Stopping these days is allowing many ghosts long hidden in the deep cupboard depths of our speciality to surface. We are living a kind of Lent of purification. A desert. And in the past we were told that prayer, fasting and abstinence were necessary to overcome the difficulties we will inevitably encounter. After looking at January's payroll I think we are well served by fasting and abstinence, and as for prayer I am making progress, thanks to the generous times of silence that this fortnight is providing me with. </span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">It is disheartening to see how the negotiations are not progressing. It cannot, there is no political will for it. Because this situation, as you will understand, is highly political. The Regional Ministry of Health follows its own line and denigrates that of others. And so we go on, the Regional Minister telling the media how bad his doctors are and his subordinates attending to the strike committee to whom they cannot answer how they will implement the famous 34-patient-daily agendas. Something that, like turning water into wine, nobody knows how it can be done. </span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">We still do not understand that it is not a question of negotiating a specific number of patients per day, but of ensuring that no medical agenda exceeds what is admissible. Because for a long time we have assumed that seeing 50, 60 or 70 patients was the norm, but objectively it is an outrage for both professionals and patients. Shielding the safety of paediatricians and family doctors to protect their mental health should be the basis of the system. And of course that of other professionals, although I fear that if they had similar agendas the health system would have burnt down long ago. </span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">Negotiation with a trade union or at a sectoral table is a bridge, but it cannot be the only one when it comes to tackling a problem as complex as managing primary care, which requires multifaceted actions on many axes. It will be necessary to create more, given that the patchwork policy seems to have given all it could. The ideas and proposals for improvement that are emerging these days are very valuable. It will be necessary to channel them and work for their implementation along top-down and bottom-up lines. </span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">I admit that my faith is shaken. I have lost confidence in my managers and with alarm I perceive that somehow if the situation blows up I don't care. In these moments of despair I see myself going on strike until the end of the year and eating potatoes. The only thing I know for sure is that no one will take responsibility for the devastated service and the enormous number of professionals sick, injured or on sick leave because of this situation. One million Madrilenians have no paediatrician or family doctor assigned to them. In a short time they will be many more. And there is no real plan with concrete measures to tackle it, just words, words, words.</span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></div><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgY_p5dVjKBuAds_v-WGNs2gj6ubpMuanLTQh_3sYdFr0u8dtFh9Vwbk3gPKAet5JPwAUMgzlB7V3VvH0WoAR2Gu8bEqaILhR0_dYDUqh5EKYZ7jAkEoRt8B_AfXcj2Kic4p9TtxpQ0Avzyj1-Nqup5xLWHnn_EKLAmHGwQ8wVFthalcSMBIbsHlfnP/s1600/twitter_Fn6EV-mXEBoI6zj.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgY_p5dVjKBuAds_v-WGNs2gj6ubpMuanLTQh_3sYdFr0u8dtFh9Vwbk3gPKAet5JPwAUMgzlB7V3VvH0WoAR2Gu8bEqaILhR0_dYDUqh5EKYZ7jAkEoRt8B_AfXcj2Kic4p9TtxpQ0Avzyj1-Nqup5xLWHnn_EKLAmHGwQ8wVFthalcSMBIbsHlfnP/w400-h266/twitter_Fn6EV-mXEBoI6zj.jpg" width="400" /></a></div><br /><br /></span><p></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><b>忏悔。</b></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">机器翻译,原谅错误。</span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">由于马德里的家庭医生罢工,我已经连续两周没有去医生的手术室了,这是我记忆中最长的一次。昨天我参加了一个示威活动,又是一个示威活动,我无法停止思考这场危机。多年来,我们一直像戴着眼罩的驴子一样在田里耕作。不停的说。这些天的停顿是让许多长期隐藏在我们专业领域深柜深处的幽灵浮出水面。我们正在过一种净化的大斋节。一片沙漠。而在过去,我们被告知,祈祷、禁食和禁欲是克服我们将不可避免地遇到的困难所必需的。在看了一月份的工资单后,我认为禁食和节制对我们很有帮助,至于祈祷,我正在取得进展,感谢这两周为我提供的慷慨的沉默时间。</span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">令人沮丧的是,谈判没有取得进展。它不能,没有政治意愿。因为正如你们所理解的,这种情况是高度政治化的。地区卫生部遵循自己的路线,诋毁他人的路线。于是我们继续,地区部长告诉媒体他的医生有多么糟糕,他的下属参加罢工委员会,他们无法回答他们将如何实施著名的每天34名病人的议程。有些事情,就像把水变成酒一样,没有人知道如何能做到。</span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">我们仍然不明白,这不是一个每天谈判具体病人数量的问题,而是要确保任何医疗议程都不超过可受理的范围。因为长期以来,我们一直认为看50、60或70个病人是正常的,但客观地说,这对专业人员和病人都是一种侮辱。屏蔽儿科医生和家庭医生的安全,保护他们的心理健康,应该是这个系统的基础。当然还有其他专业人士,尽管我担心如果他们有类似的议程,卫生系统早就被烧毁了。</span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">与工会或部门谈判是一座桥梁,但当涉及到解决像管理初级保健这样复杂的问题时,它不能成为唯一的桥梁,因为这需要在许多轴上采取多方面的行动。鉴于拼凑的政策似乎已经给予了它所能给予的一切,将有必要创造更多。这些天来出现的改进意见和建议是非常有价值的。有必要对它们进行引导,并按照自上而下和自下而上的路线努力实施。</span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="color: #222222; font-family: UICTFontTextStyleBody; font-size: large;">我承认,我的信仰已经动摇。我已经对我的经理们失去了信心,而且随着警报声的响起,我察觉到,不知为何,如果情况爆炸了,我也不关心。在这些绝望的时刻,我看到自己罢工到年底,吃土豆。我唯一可以肯定的是,没有人会对受到破坏的服务以及因这种情况而生病、受伤或请病假的大量专业人员承担责任。100万马德里人没有为他们指派儿科医生或家庭医生。在很短的时间内,将会有更多的人。而且没有真正的计划和具体措施来解决这个问题,只是说说而已。</span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-size: large;"><br /></span></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"></p><p dir="auto" style="background-color: white; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com1tag:blogger.com,1999:blog-4060378544967004941.post-15738773325201188942023-01-29T10:50:00.001+01:002023-01-29T10:52:14.799+01:00¿Podría ChatGPT ayudar a médicos y gestores sanitarios? Could ChatGPT help doctors and health managers? ChatGPT可以帮助医生和健康管理人员吗?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqH7ULVX6xfcLLIxKnJ293-RliPl-5a6xFP-8I57F9X5Tz8L13BWA1GwSjU-AvyQtzXOKpUjq4YivrxFJw6mZGZFkOrQUtEeCReW-DOzqiqnz11OFbddpw8Z0OjxKSNmAK4zmgn0v8UFqb5ke5MYurxOyskHAmgia1Jbsbo-H5-42zgyIy-YjwCrGD/s720/2D608B5D-578C-4616-B171-3D1A435DA288.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="533" data-original-width="720" height="296" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqH7ULVX6xfcLLIxKnJ293-RliPl-5a6xFP-8I57F9X5Tz8L13BWA1GwSjU-AvyQtzXOKpUjq4YivrxFJw6mZGZFkOrQUtEeCReW-DOzqiqnz11OFbddpw8Z0OjxKSNmAK4zmgn0v8UFqb5ke5MYurxOyskHAmgia1Jbsbo-H5-42zgyIy-YjwCrGD/w400-h296/2D608B5D-578C-4616-B171-3D1A435DA288.jpeg" width="400" /></a></div><br /><p><br /></p><p><br /></p><p><br /></p><p>Trabajo en la Atención Primaria de Madrid desde hace más de veinte años. En este tiempo he tratado de hablar con directivos, gestores, técnicos de servicios centrales, gerentes e incluso con el mismo Consejero de Sanidad en varias ocasiones. Si bien he sido atendido y escuchado con educación no tengo muy claro que mis aportaciones les hayan servido de ayuda. </p><p>La situación actual es de bloqueo e incomunicación entre la alta dirección y los profesionales asistenciales. Es más fácil que un médico hable con una máquina que con sus responsables. Por eso he dedicado un rato de la mañana del domingo a dialogar (tratar al menos) con ChatGPT para humildemente sugerir a políticos y gestores que si no se atreven a escuchar a sus profesionales al menos escuchen a una máquina. Al sistema se le supone un nivel académico de bachillerato, no insulta y da respuestas políticamente correctas. No se van a asustar. </p><p>Y si luego siguen alguna sugerencia, ya habremos avanzado bastante.</p><p><b><br /></b></p><p><b>¿Cómo puede un médico utilizar Chatgpt con los pacientes?</b></p><p><br /></p><p>ChatGPT, un gran modelo lingüístico entrenado por OpenAI, puede ser utilizado por los médicos para mejorar la experiencia del paciente y agilizar los flujos de trabajo clínicos. Existen varias formas de utilizar ChatGPT con los pacientes, entre ellas:</p><p><br /></p><p>Triaje médico: ChatGPT puede utilizarse para clasificar a los pacientes evaluando sus síntomas y proporcionando la orientación adecuada. Por ejemplo, un paciente podría utilizar ChatGPT para describir sus síntomas, y el modelo podría responder con una lista de posibles diagnósticos y los siguientes pasos recomendados. Esto podría ayudar a los médicos a identificar a los pacientes de alto riesgo y priorizar su atención.</p><p>Educación médica: ChatGPT puede utilizarse para proporcionar a los pacientes recursos educativos e información sobre su enfermedad. Por ejemplo, un paciente podría preguntar a ChatGPT sobre las causas y síntomas de una enfermedad concreta, y el modelo podría ofrecerle una explicación detallada. Esto podría ayudar a los pacientes a comprender mejor su enfermedad y a tomar decisiones informadas sobre su tratamiento.</p><p>Gestión de la medicación: ChatGPT puede utilizarse para ayudar a los pacientes a gestionar su medicación. Por ejemplo, un paciente puede preguntar a ChatGPT sobre los efectos secundarios de una medicación concreta, y el modelo puede proporcionar una lista de posibles efectos secundarios y recomendaciones para controlarlos. Esto podría ayudar a los pacientes a gestionar sus medicamentos de forma más eficaz y reducir el riesgo de reacciones adversas.</p><p>Programación de citas: ChatGPT puede utilizarse para concertar citas con los médicos. Por ejemplo, un paciente podría utilizar ChatGPT para solicitar una cita, y el modelo podría responder con una lista de horas disponibles e instrucciones sobre cómo programar la cita. Esto podría ayudar a los pacientes a concertar citas más fácilmente y reducir la carga del personal de la clínica.</p><p>Atención de seguimiento: ChatGPT puede utilizarse para hacer un seguimiento de los pacientes después de su cita. Por ejemplo, un paciente podría utilizar ChatGPT para preguntar por los resultados de una prueba, y el modelo podría proporcionar los resultados e instrucciones para la atención de seguimiento. Esto podría ayudar a los pacientes a mantenerse informados sobre su salud y asegurarse de que reciben la atención adecuada.</p><p>Telemedicina: ChatGPT puede utilizarse para ofrecer consultas de telemedicina. Por ejemplo, un paciente podría utilizar ChatGPT para describir sus síntomas y el modelo podría responder con un diagnóstico y un plan de tratamiento. Esto podría ayudar a los pacientes a recibir atención médica a distancia, lo que puede ser especialmente útil para pacientes de zonas rurales o remotas.</p><p>En general, ChatGPT puede ser una herramienta valiosa tanto para médicos como para pacientes. Al proporcionar respuestas rápidas y precisas a las consultas de los pacientes, ChatGPT puede ayudar a mejorar la experiencia del paciente y agilizar los flujos de trabajo clínicos. Además, al proporcionar a los pacientes recursos educativos e información sobre su enfermedad, ChatGPT puede ayudarles a entender mejor su enfermedad y a tomar decisiones informadas sobre su tratamiento.</p><p><br /></p><p><br /></p><p><b>¿Cómo pueden los gestores sanitarios mejorar estas posibilidades?</b></p><p>Los gestores sanitarios pueden mejorar las posibilidades de utilizar ChatGPT con los pacientes tomando varias medidas:</p><p><br /></p><p>Formación y educación: Los gestores sanitarios deben asegurarse de que los médicos y demás personal clínico reciben una formación adecuada sobre el uso de ChatGPT. Esto incluye proporcionar formación sobre cómo introducir la información del paciente, cómo interpretar las respuestas del modelo y cómo utilizarlo para proporcionar atención al paciente. Además, los gestores sanitarios deben informar a los pacientes sobre cómo utilizar ChatGPT y qué pueden esperar al interactuar con el modelo.</p><p>Integración con los sistemas existentes: Los gestores sanitarios deben trabajar para integrar ChatGPT con los sistemas existentes, como las historias clínicas electrónicas y los sistemas de programación de citas. Esto permitirá una transferencia fluida de la información de los pacientes y garantizará que el modelo tenga acceso a datos precisos y actualizados de los pacientes.</p><p>Garantía de calidad y supervisión: Los gestores sanitarios deben establecer protocolos de garantía de calidad para asegurarse de que el modelo proporciona respuestas precisas y adecuadas. Esto incluye la supervisión del rendimiento del modelo, el análisis de los comentarios de los pacientes y la realización de los ajustes necesarios en el modelo.</p><p>Cumplimiento de la normativa: Los gestores sanitarios deben asegurarse de que el uso de ChatGPT cumple todas las normativas pertinentes, como las leyes de privacidad de datos y las directrices de práctica médica.</p><p>Colaboración con otros departamentos: Los gestores sanitarios deben colaborar con otros departamentos, como el de TI, para garantizar que ChatGPT se integra eficazmente con los sistemas y la infraestructura existentes. También deben trabajar con los equipos de marketing y comunicación para garantizar que el público conozca este servicio, cómo acceder a él y cómo puede beneficiarle.</p><p>Mejora continua: Los gestores sanitarios deben evaluar continuamente el rendimiento y la usabilidad de ChatGPT, y realizar los ajustes necesarios para mejorar la experiencia del paciente y agilizar los flujos de trabajo clínicos. Esto puede incluir la incorporación de nuevas funciones o actualizaciones, así como la incorporación de los comentarios de los pacientes y del personal clínico.</p><p>Siguiendo estos pasos, los gestores sanitarios pueden garantizar que ChatGPT se utiliza de forma eficaz y adecuada para mejorar la experiencia del paciente y agilizar los flujos de trabajo clínicos.</p><p><br /></p><p>Normalmente, a los gestores sanitarios y a los políticos no les gusta mejorar los cambios. ¿Cómo podemos ayudarles?</p><p>Puede resultar complicado implantar nuevas tecnologías, como ChatGPT, en el sector sanitario, ya que puede haber resistencia por parte de los gestores sanitarios y los políticos. Sin embargo, hay varias estrategias que pueden utilizarse para ayudarles a ver las ventajas de la tecnología y vencer la resistencia al cambio:</p><p><br /></p><p>Demostrar las ventajas: Una de las formas más eficaces de convencer a gestores sanitarios y políticos de las ventajas de ChatGPT es mostrarles ejemplos concretos de cómo la tecnología ha mejorado la atención al paciente y agilizado los flujos de trabajo clínicos. Esto podría incluir datos sobre satisfacción del paciente, resultados clínicos y ahorro de costes.</p><p>Responder a las preocupaciones: Es importante abordar cualquier preocupación que los gestores sanitarios y los políticos puedan tener sobre la tecnología, como los problemas de privacidad y seguridad. Proporcionar información clara y detallada sobre cómo se utiliza la tecnología y cómo se protegen los datos de los pacientes puede ayudar a aliviar cualquier preocupación que puedan tener.</p><p>Crear una coalición de apoyo: Crear una coalición de apoyo puede ayudar a demostrar que la tecnología no sólo es beneficiosa, sino que cuenta con un amplio respaldo. Para ello, se puede recabar la opinión y el apoyo de profesionales sanitarios, pacientes y otras partes interesadas.</p><p>Comunicar los riesgos de la no implantación: Puede ser útil comunicar los riesgos de no implantar ChatGPT, como la pérdida de oportunidades para mejorar la atención al paciente y el aumento de los costes a largo plazo.</p><p>Ofrecer apoyo: Los gestores sanitarios y los políticos pueden estar más dispuestos a implantar nuevas tecnologías si cuentan con apoyo para facilitar la transición. Por ejemplo, proporcionando formación y educación sobre el uso de la tecnología, o disponiendo de personal de apoyo especializado para resolver cualquier problema que pueda surgir.</p><p>Mostrar la escalabilidad de la tecnología: Demostrar que la tecnología puede ampliarse y aplicarse en múltiples entornos y con distintos fines puede ayudar a demostrar su valor potencial y aumentar las posibilidades de obtener apoyo.</p><p>Utilizando una combinación de estas estrategias, es posible ayudar a los gestores sanitarios y a los políticos a ver las ventajas de ChatGPT y vencer la resistencia al cambio. No hay que olvidar que el cambio requiere tiempo y persistencia, por lo que es importante seguir comunicando las ventajas de la tecnología y abordar cualquier preocupación que pueda surgir.</p><p><br /></p><p><br /></p><p>En la situación actual nos enfrentamos a un gran número de historiales médicos electrónicos no compatibles entre sí. ¿Cómo podemos gestionar los sistemas de conexión utilizando la inteligencia artificial?</p><p>En la situación actual, en la que existe un gran número de historias clínicas electrónicas (HCE) que no son compatibles entre sí, se puede utilizar la inteligencia artificial (IA) para ayudar a gestionar los sistemas de conexión. He aquí algunas formas en que la IA puede utilizarse para gestionar la conectividad de los RME:</p><p><br /></p><p>Integración de datos: Las herramientas de integración de datos impulsadas por IA pueden utilizarse para extraer, transformar y cargar datos de diferentes sistemas de EMR en un repositorio centralizado. Esto puede ayudar a garantizar que los datos de los pacientes sean precisos y estén actualizados, y que sean accesibles para los proveedores de atención sanitaria a través de diferentes sistemas.</p><p>Normalización de datos: Las herramientas de normalización de datos impulsadas por IA se pueden utilizar para estandarizar los datos en diferentes sistemas de EMR. Esto puede ayudar a garantizar que los datos de los pacientes sean coherentes y puedan compararse y analizarse fácilmente en todos los sistemas.</p><p>Procesamiento del lenguaje natural (PLN): Las herramientas NLP potenciadas por IA se pueden utilizar para extraer y clasificar datos de pacientes de diferentes sistemas EMR. Esto puede ayudar a garantizar que los datos de los pacientes sean precisos y estén actualizados, y que sean accesibles para los profesionales sanitarios en los distintos sistemas.</p><p>Mapeo de datos: Las herramientas de mapeo de datos impulsadas por IA pueden utilizarse para mapear los datos de los pacientes de diferentes sistemas de EMR a un modelo de datos común. Esto puede ayudar a garantizar que los datos de los pacientes sean precisos y estén actualizados, y que sean accesibles para los proveedores de asistencia sanitaria a través de diferentes sistemas.</p><p>Análisis predictivo: Las herramientas de análisis predictivo impulsadas por IA se pueden utilizar para identificar patrones y tendencias en los datos de los pacientes a través de diferentes sistemas EMR. Esto puede ayudar a identificar posibles problemas de salud y a los profesionales sanitarios a tomar decisiones más informadas.</p><p>Automatización: Las herramientas de automatización impulsadas por IA se pueden utilizar para automatizar tareas repetitivas, como la introducción y la gestión de datos, reduciendo los esfuerzos manuales y aumentando la precisión de los datos.</p><p>Mediante el uso de estas herramientas basadas en IA, los profesionales sanitarios pueden gestionar y acceder más fácilmente a los datos de los pacientes en diferentes sistemas de RME. Es importante señalar que, aunque la IA puede utilizarse para ayudar a gestionar la conectividad de los RME, sigue siendo necesario contar con una infraestructura informática sólida y un equipo fuerte para mantener y operar los sistemas. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSUwiXFvTyU8ov_xuOpLMlc8zMFv1HKf04t56fWrUQlIbbXYDvu-YYxR2QmBg2xUwDlKQtuOTy0EFLpO5yY5bn35o_cAusIo7MmbjIOAWjkmPrsehyNB7jgRt8_xeDbJCbmP3PyXz6SibYX-6RlRGB4aJkm9E3peuff8sJy2qU-z8jzHdz6rCp2unC/s1619/3065FC55-4616-41F0-A42D-B26EF32310A3.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1619" data-original-width="1327" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSUwiXFvTyU8ov_xuOpLMlc8zMFv1HKf04t56fWrUQlIbbXYDvu-YYxR2QmBg2xUwDlKQtuOTy0EFLpO5yY5bn35o_cAusIo7MmbjIOAWjkmPrsehyNB7jgRt8_xeDbJCbmP3PyXz6SibYX-6RlRGB4aJkm9E3peuff8sJy2qU-z8jzHdz6rCp2unC/w524-h640/3065FC55-4616-41F0-A42D-B26EF32310A3.jpeg" width="524" /></a></div><br /><p><br /></p><p><br /></p><p><b>Could ChatGPT help doctors and health managers? </b></p><div><br /></div><p>I have been working in Primary Care in Madrid for more than twenty years. During this time I have tried to talk to directors, managers, central service technicians, managers and even the Regional Health Minister himself on several occasions. Although I have been attended to and listened to politely, it is not clear to me that my contributions have helped them. </p><p><br /></p><p>The current situation is one of deadlock and lack of communication between senior management and health care professionals. It is easier for a doctor to talk to a machine than to his or her managers. That is why I spent some time on Sunday morning talking (at least trying) with ChatGPT to humbly suggest to politicians and managers that if they do not dare to listen to their professionals, they should at least listen to a machine. The system is supposed to have a high school academic level, it does not insult and gives politically correct answers. They will not be frightened. </p><p><br /></p><p>And if they then follow some suggestions, we will have come a long way.</p><div class="w-full border-b border-black/10 dark:border-gray-900/50 text-gray-800 dark:text-gray-100 group dark:bg-gray-800" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 0; --tw-translate-y: 0; -webkit-text-size-adjust: 100%; border-color: rgba(0, 0, 0, 0.1); border-style: solid; border-width: 0px 0px 1px; box-sizing: border-box; color: rgba(52,53,65,var(--tw-text-opacity)); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", 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flex-col gap-1 md:gap-3 lg:w-[calc(100%-115px)]" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; position: relative; row-gap: 0.75rem; width: calc(100% - 115px);"><div class="flex flex-grow flex-col gap-3" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; 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border-box; column-gap: 1rem; display: flex; flex-direction: column; min-height: 20px; row-gap: 1rem; white-space: pre-wrap;">Write a 500 Words essay about how can a doctor use Chatgpt with patients</div></div><div class="text-gray-400 flex self-end lg:self-center justify-center mt-2 gap-3 md:gap-4 lg:gap-1 lg:absolute lg:top-0 lg:translate-x-full lg:right-0 lg:mt-0 lg:pl-2 visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 100%; --tw-translate-y: 0; align-self: center; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: rgba(172,172,190,var(--tw-text-opacity)); column-gap: 0.25rem; display: flex; justify-content: center; margin-top: 0px; padding-left: 0.5rem; position: absolute; right: 0px; row-gap: 0.25rem; top: 0px; transform: translate(var(--tw-translate-x),var(--tw-translate-y)) rotate(var(--tw-rotate)) skewX(var(--tw-skew-x)) skewY(var(--tw-skew-y)) scaleX(var(--tw-scale-x)) scaleY(var(--tw-scale-y)); visibility: visible;"><button class="p-1 rounded-md hover:bg-gray-100 hover:text-gray-700 dark:text-gray-400 dark:hover:bg-gray-700 dark:hover:text-gray-200 disabled:dark:hover:text-gray-400 md:invisible md:group-hover:visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-color: transparent; background-image: none; border-color: rgb(217, 217, 227); border-radius: 0.375rem; border-width: 0px; cursor: pointer; font-family: inherit; font-size: 16px; line-height: inherit; margin: 0px; padding: 0.25rem; visibility: visible;"><svg class="h-4 w-4" fill="none" height="1em" stroke-linecap="round" stroke-linejoin="round" stroke-width="2" stroke="currentColor" viewbox="0 0 24 24" width="1em" xmlns="http://www.w3.org/2000/svg"><path d="M11 4H4a2 2 0 0 0-2 2v14a2 2 0 0 0 2 2h14a2 2 0 0 0 2-2v-7"></path><path d="M18.5 2.5a2.121 2.121 0 0 1 3 3L12 15l-4 1 1-4 9.5-9.5z"></path></svg></button></div><div class="flex justify-between" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 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rgba(0,0,0,0.5); --tw-prose-invert-pre-code: #d1d5db; --tw-prose-invert-quote-borders: #374151; --tw-prose-invert-quotes: #f3f4f6; --tw-prose-invert-td-borders: #374151; --tw-prose-invert-th-borders: #4b5563; --tw-prose-lead: #4b5563; --tw-prose-links: #111827; --tw-prose-pre-bg: #1f2937; --tw-prose-pre-code: #e5e7eb; --tw-prose-quote-borders: #e5e7eb; --tw-prose-quotes: #111827; --tw-prose-td-borders: #e5e7eb; --tw-prose-th-borders: #d1d5db; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-body); font-size: 1rem; line-height: 1.75; max-width: none; width: 653px; word-wrap: break-word;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px 0px 1.25em;">ChatGPT, a large language model trained by OpenAI, can be used by doctors to improve the patient experience and streamline clinical workflows. There are several ways in which ChatGPT can be used with patients, including:</p><ol style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; counter-reset: item 0; display: flex; flex-direction: column; list-style-image: initial; list-style-position: initial; margin: 1.25em 0px; padding: 0px 0px 0px 1rem;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Medical triage: ChatGPT can be used to triage patients by assessing their symptoms and providing appropriate guidance. For example, a patient could use ChatGPT to describe their symptoms, and the model could respond with a list of potential diagnoses and recommended next steps. This could help doctors to identify high-risk patients and prioritize their care.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Medical education: ChatGPT can be used to provide patients with educational resources and information about their condition. For example, a patient could ask ChatGPT about the causes and symptoms of a specific condition, and the model could provide a detailed explanation. This could help patients to understand their condition better and make informed decisions about their care.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Medication management: ChatGPT can be used to help patients manage their medications. For example, a patient could ask ChatGPT about the side effects of a specific medication, and the model could provide a list of potential side effects and recommendations for managing them. This could help patients to manage their medications more effectively and reduce the risk of adverse reactions.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Appointment scheduling: ChatGPT can be used to schedule appointments with doctors. For example, a patient could use ChatGPT to request an appointment, and the model could respond with a list of available times and instructions for how to schedule the appointment. This could help patients to schedule appointments more easily and reduce the burden on clinic staff.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Follow-up care: ChatGPT can be used to follow up with patients after their appointment. For example, a patient could use ChatGPT to ask about the results of a test, and the model could provide the results and instructions for follow-up care. This could help patients to stay informed about their health and ensure that they receive the appropriate care.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Telemedicine: ChatGPT can be used to provide telemedicine consultations. For example, a patient could use ChatGPT to describe their symptoms and the model could respond with a diagnosis and treatment plan. This could help patients to receive medical care remotely, which can be especially helpful for patients in rural or remote areas.</p></li></ol><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 1.25em 0px 0px;">Overall, ChatGPT can be a valuable tool for doctors and patients alike. By providing quick and accurate responses to patient queries, ChatGPT can help to improve the patient experience and streamline clinical workflows. Additionally, by providing patients with educational resources and information about their condition, ChatGPT can help patients to understand their condition better and make informed decisions about their care.</p></div></div></div><div class="flex justify-between" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: flex; justify-content: space-between;"><div class="text-gray-400 flex self-end lg:self-center justify-center mt-2 gap-3 md:gap-4 lg:gap-1 lg:absolute lg:top-0 lg:translate-x-full lg:right-0 lg:mt-0 lg:pl-2 visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 100%; --tw-translate-y: 0; align-self: center; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: rgba(172,172,190,var(--tw-text-opacity)); column-gap: 0.25rem; display: flex; justify-content: center; margin-top: 0px; padding-left: 0.5rem; position: absolute; right: 0px; row-gap: 0.25rem; top: 0px; transform: translate(var(--tw-translate-x),var(--tw-translate-y)) rotate(var(--tw-rotate)) skewX(var(--tw-skew-x)) skewY(var(--tw-skew-y)) scaleX(var(--tw-scale-x)) scaleY(var(--tw-scale-y)); visibility: visible;"><button class="p-1 rounded-md hover:bg-gray-100 hover:text-gray-700 dark:text-gray-400 dark:hover:bg-gray-700 dark:hover:text-gray-200 disabled:dark:hover:text-gray-400" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-color: transparent; background-image: none; border-color: rgb(217, 217, 227); border-radius: 0.375rem; border-width: 0px; cursor: pointer; font-family: inherit; font-size: 16px; line-height: inherit; margin: 0px; padding: 0.25rem;"><svg class="h-4 w-4" fill="none" height="1em" stroke-linecap="round" stroke-linejoin="round" stroke-width="2" stroke="currentColor" viewbox="0 0 24 24" width="1em" xmlns="http://www.w3.org/2000/svg"><path d="M14 9V5a3 3 0 0 0-3-3l-4 9v11h11.28a2 2 0 0 0 2-1.7l1.38-9a2 2 0 0 0-2-2.3zM7 22H4a2 2 0 0 1-2-2v-7a2 2 0 0 1 2-2h3"></path></svg></button><button class="p-1 rounded-md hover:bg-gray-100 hover:text-gray-700 dark:text-gray-400 dark:hover:bg-gray-700 dark:hover:text-gray-200 disabled:dark:hover:text-gray-400" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-color: transparent; background-image: none; border-color: rgb(217, 217, 227); border-radius: 0.375rem; border-width: 0px; cursor: pointer; font-family: inherit; font-size: 16px; line-height: inherit; margin: 0px; padding: 0.25rem;"><svg class="h-4 w-4" fill="none" height="1em" stroke-linecap="round" stroke-linejoin="round" stroke-width="2" stroke="currentColor" viewbox="0 0 24 24" width="1em" xmlns="http://www.w3.org/2000/svg"><path d="M10 15v4a3 3 0 0 0 3 3l4-9V2H5.72a2 2 0 0 0-2 1.7l-1.38 9a2 2 0 0 0 2 2.3zm7-13h2.67A2.31 2.31 0 0 1 22 4v7a2.31 2.31 0 0 1-2.33 2H17"></path></svg></button></div></div></div></div></div><div class="w-full border-b border-black/10 dark:border-gray-900/50 text-gray-800 dark:text-gray-100 group dark:bg-gray-800" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 0; --tw-translate-y: 0; -webkit-text-size-adjust: 100%; border-color: rgba(0, 0, 0, 0.1); border-style: solid; border-width: 0px 0px 1px; box-sizing: border-box; color: rgba(52,53,65,var(--tw-text-opacity)); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 14px; width: 1106px;"><div class="text-base gap-4 md:gap-6 m-auto md:max-w-2xl lg:max-w-2xl xl:max-w-3xl p-4 md:py-6 flex lg:px-0" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1.5rem; display: flex; font-size: 1rem; line-height: 1.5rem; margin: auto; max-width: 48rem; padding: 1.5rem 0px; row-gap: 1.5rem;"><div class="w-[30px] flex flex-col relative items-end" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-end; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; 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--tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-image: none; border: 0px; box-sizing: border-box; display: inline-block; margin: 0px; max-width: 100%; opacity: 1; overflow: hidden; padding: 0px; position: relative;"><span style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-image: none; border: 0px; box-sizing: border-box; display: block; margin: 0px; max-width: 100%; opacity: 1; padding: 0px;"><img alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%2730%27%20height=%2730%27/%3e" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-image: none; border: 0px; box-sizing: border-box; display: block; margin: 0px; max-width: 100%; opacity: 1; padding: 0px; vertical-align: middle;" /></span><img alt="vigidel@gmail.com" class="rounded-sm" data-nimg="intrinsic" decoding="async" src="https://chat.openai.com/_next/image?url=https%3A%2F%2Fs.gravatar.com%2Favatar%2F018cc948d92d54c9acc3a0ee0faa29c9%3Fs%3D480%26r%3Dpg%26d%3Dhttps%253A%252F%252Fcdn.auth0.com%252Favatars%252Fvi.png&w=64&q=75" srcset="https://chat.openai.com/_next/image?url=https%3A%2F%2Fs.gravatar.com%2Favatar%2F018cc948d92d54c9acc3a0ee0faa29c9%3Fs%3D480%26r%3Dpg%26d%3Dhttps%253A%252F%252Fcdn.auth0.com%252Favatars%252Fvi.png&w=32&q=75 1x, https://chat.openai.com/_next/image?url=https%3A%2F%2Fs.gravatar.com%2Favatar%2F018cc948d92d54c9acc3a0ee0faa29c9%3Fs%3D480%26r%3Dpg%26d%3Dhttps%253A%252F%252Fcdn.auth0.com%252Favatars%252Fvi.png&w=64&q=75 2x" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border-radius: 0.125rem; border: none; box-sizing: border-box; display: block; height: 0px; inset: 0px; margin: auto; max-height: 100%; max-width: 100%; min-height: 100%; min-width: 100%; padding: 0px; position: absolute; vertical-align: middle; width: 0px;" /></span></div></div><div class="relative flex w-[calc(100%-50px)] flex-col gap-1 md:gap-3 lg:w-[calc(100%-115px)]" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; position: relative; row-gap: 0.75rem; width: calc(100% - 115px);"><div class="flex flex-grow flex-col gap-3" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; flex-grow: 1; row-gap: 0.75rem;"><div class="min-h-[20px] flex flex-col items-start gap-4 whitespace-pre-wrap" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-start; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1rem; display: flex; flex-direction: column; min-height: 20px; row-gap: 1rem; white-space: pre-wrap;">How can health managers improve these possibilities?</div></div><div class="text-gray-400 flex self-end lg:self-center justify-center mt-2 gap-3 md:gap-4 lg:gap-1 lg:absolute lg:top-0 lg:translate-x-full lg:right-0 lg:mt-0 lg:pl-2 visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 100%; --tw-translate-y: 0; align-self: center; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: rgba(172,172,190,var(--tw-text-opacity)); column-gap: 0.25rem; display: flex; justify-content: center; margin-top: 0px; padding-left: 0.5rem; position: absolute; right: 0px; row-gap: 0.25rem; top: 0px; transform: translate(var(--tw-translate-x),var(--tw-translate-y)) rotate(var(--tw-rotate)) skewX(var(--tw-skew-x)) skewY(var(--tw-skew-y)) scaleX(var(--tw-scale-x)) scaleY(var(--tw-scale-y)); visibility: visible;"><button class="p-1 rounded-md hover:bg-gray-100 hover:text-gray-700 dark:text-gray-400 dark:hover:bg-gray-700 dark:hover:text-gray-200 disabled:dark:hover:text-gray-400 md:invisible md:group-hover:visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-color: transparent; background-image: none; border-color: rgb(217, 217, 227); border-radius: 0.375rem; border-width: 0px; cursor: pointer; font-family: inherit; font-size: 16px; line-height: inherit; margin: 0px; padding: 0.25rem; visibility: hidden;"><svg class="h-4 w-4" fill="none" height="1em" stroke-linecap="round" stroke-linejoin="round" stroke-width="2" stroke="currentColor" viewbox="0 0 24 24" width="1em" xmlns="http://www.w3.org/2000/svg"><path d="M11 4H4a2 2 0 0 0-2 2v14a2 2 0 0 0 2 2h14a2 2 0 0 0 2-2v-7"></path><path d="M18.5 2.5a2.121 2.121 0 0 1 3 3L12 15l-4 1 1-4 9.5-9.5z"></path></svg></button></div><div class="flex justify-between" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: flex; justify-content: space-between;"></div></div></div></div><div class="w-full border-b border-black/10 dark:border-gray-900/50 text-gray-800 dark:text-gray-100 group bg-gray-50 dark:bg-[#444654]" style="--tw-bg-opacity: 1; --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 0; --tw-translate-y: 0; -webkit-text-size-adjust: 100%; border-color: rgba(0, 0, 0, 0.1); border-style: solid; border-width: 0px 0px 1px; box-sizing: border-box; color: rgba(52,53,65,var(--tw-text-opacity)); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 14px; width: 1106px;"><div class="text-base gap-4 md:gap-6 m-auto md:max-w-2xl lg:max-w-2xl xl:max-w-3xl p-4 md:py-6 flex lg:px-0" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1.5rem; display: flex; font-size: 1rem; line-height: 1.5rem; margin: auto; max-width: 48rem; padding: 1.5rem 0px; row-gap: 1.5rem;"><div class="w-[30px] flex flex-col relative items-end" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-end; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: flex; flex-direction: column; position: relative; width: 30px;"><div class="relative h-[30px] w-[30px] p-1 rounded-sm text-white flex items-center justify-center" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 0; --tw-translate-y: 0; align-items: center; background-color: #10a37f; border-radius: 0.125rem; 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--tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; position: relative; row-gap: 0.75rem; width: calc(100% - 115px);"><div class="flex flex-grow flex-col gap-3" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; flex-grow: 1; row-gap: 0.75rem;"><div class="min-h-[20px] flex flex-col items-start gap-4 whitespace-pre-wrap" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-start; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1rem; display: flex; flex-direction: column; min-height: 20px; row-gap: 1rem; white-space: pre-wrap;"><div class="markdown prose w-full break-words dark:prose-invert light" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-prose-body: #374151; --tw-prose-bold: #111827; --tw-prose-bullets: #d1d5db; --tw-prose-captions: #6b7280; --tw-prose-code: #111827; --tw-prose-counters: 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--tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-body); font-size: 1rem; line-height: 1.75; max-width: none; width: 653px; word-wrap: break-word;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px 0px 1.25em;">Health managers can improve the possibilities of using ChatGPT with patients by taking several steps:</p><ol style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; counter-reset: item 0; display: flex; flex-direction: column; list-style-image: initial; list-style-position: initial; margin: 1.25em 0px; padding: 0px 0px 0px 1rem;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Training and education: Health managers should ensure that doctors and other clinical staff are properly trained on how to use ChatGPT. This includes providing training on how to input patient information, how to interpret the model's responses, and how to use the model to provide patient care. Additionally, health managers should provide education to patients on how to use ChatGPT and what to expect when interacting with the model.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Integration with existing systems: Health managers should work to integrate ChatGPT with existing systems, such as electronic health records and appointment scheduling systems. This will allow for seamless transfer of patient information and ensure that the model has access to accurate and up-to-date patient data.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Quality assurance and monitoring: Health managers should establish quality assurance protocols to ensure that the model is providing accurate and appropriate responses. This includes monitoring the model's performance, analyzing patient feedback, and making adjustments to the model as needed.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Compliance with regulations: Health managers should ensure that the use of ChatGPT complies with all relevant regulations, such as data privacy laws and medical practice guidelines.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Collaboration with other departments: Health managers should work with other departments, such as IT, to ensure that ChatGPT is integrated effectively with existing systems and infrastructure. They should also work with marketing and communication teams to ensure that the public is aware of this service, how to access it, and how it can benefit them.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Continual improvement: Health managers should continuously evaluate the performance and usability of ChatGPT, and make necessary adjustments to improve the patient experience and streamline clinical workflows. This can include incorporating new features or updates, as well as incorporating feedback from patients and clinical staff.</p></li></ol><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 1.25em 0px 0px;">By taking these steps, health managers can ensure that ChatGPT is used effectively and appropriately to improve the patient experience and streamline clinical workflows.</p></div></div></div><div class="flex justify-between" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: flex; justify-content: space-between;"><div class="text-gray-400 flex self-end lg:self-center justify-center mt-2 gap-3 md:gap-4 lg:gap-1 lg:absolute lg:top-0 lg:translate-x-full lg:right-0 lg:mt-0 lg:pl-2 visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 100%; --tw-translate-y: 0; align-self: center; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: rgba(172,172,190,var(--tw-text-opacity)); column-gap: 0.25rem; display: flex; justify-content: center; margin-top: 0px; padding-left: 0.5rem; position: absolute; right: 0px; row-gap: 0.25rem; top: 0px; transform: translate(var(--tw-translate-x),var(--tw-translate-y)) rotate(var(--tw-rotate)) skewX(var(--tw-skew-x)) skewY(var(--tw-skew-y)) scaleX(var(--tw-scale-x)) scaleY(var(--tw-scale-y)); visibility: visible;"><button class="p-1 rounded-md hover:bg-gray-100 hover:text-gray-700 dark:text-gray-400 dark:hover:bg-gray-700 dark:hover:text-gray-200 disabled:dark:hover:text-gray-400" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-color: transparent; background-image: none; border-color: rgb(217, 217, 227); border-radius: 0.375rem; border-width: 0px; cursor: pointer; font-family: inherit; font-size: 16px; line-height: inherit; margin: 0px; padding: 0.25rem;"><svg class="h-4 w-4" fill="none" height="1em" stroke-linecap="round" stroke-linejoin="round" stroke-width="2" stroke="currentColor" viewbox="0 0 24 24" width="1em" xmlns="http://www.w3.org/2000/svg"><path d="M14 9V5a3 3 0 0 0-3-3l-4 9v11h11.28a2 2 0 0 0 2-1.7l1.38-9a2 2 0 0 0-2-2.3zM7 22H4a2 2 0 0 1-2-2v-7a2 2 0 0 1 2-2h3"></path></svg></button><button class="p-1 rounded-md hover:bg-gray-100 hover:text-gray-700 dark:text-gray-400 dark:hover:bg-gray-700 dark:hover:text-gray-200 disabled:dark:hover:text-gray-400" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-color: transparent; background-image: none; border-color: rgb(217, 217, 227); border-radius: 0.375rem; border-width: 0px; cursor: pointer; font-family: inherit; font-size: 16px; line-height: inherit; margin: 0px; padding: 0.25rem;"><svg class="h-4 w-4" fill="none" height="1em" stroke-linecap="round" stroke-linejoin="round" stroke-width="2" stroke="currentColor" viewbox="0 0 24 24" width="1em" xmlns="http://www.w3.org/2000/svg"><path d="M10 15v4a3 3 0 0 0 3 3l4-9V2H5.72a2 2 0 0 0-2 1.7l-1.38 9a2 2 0 0 0 2 2.3zm7-13h2.67A2.31 2.31 0 0 1 22 4v7a2.31 2.31 0 0 1-2.33 2H17"></path></svg></button></div></div></div></div></div><div class="w-full border-b border-black/10 dark:border-gray-900/50 text-gray-800 dark:text-gray-100 group dark:bg-gray-800" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 0; --tw-translate-y: 0; -webkit-text-size-adjust: 100%; border-color: rgba(0, 0, 0, 0.1); border-style: solid; border-width: 0px 0px 1px; box-sizing: border-box; color: rgba(52,53,65,var(--tw-text-opacity)); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 14px; width: 1106px;"><div class="text-base gap-4 md:gap-6 m-auto md:max-w-2xl lg:max-w-2xl xl:max-w-3xl p-4 md:py-6 flex lg:px-0" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1.5rem; display: flex; font-size: 1rem; line-height: 1.5rem; margin: auto; max-width: 48rem; padding: 1.5rem 0px; row-gap: 1.5rem;"><div class="w-[30px] flex flex-col relative items-end" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-end; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: flex; flex-direction: column; position: relative; width: 30px;"><div class="relative flex" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: flex; position: relative;"><span style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-image: none; border: 0px; box-sizing: border-box; display: inline-block; margin: 0px; max-width: 100%; opacity: 1; overflow: hidden; padding: 0px; position: relative;"><span style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-image: none; border: 0px; box-sizing: border-box; display: block; margin: 0px; max-width: 100%; opacity: 1; padding: 0px;"><img alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%2730%27%20height=%2730%27/%3e" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-image: none; border: 0px; box-sizing: border-box; display: block; margin: 0px; max-width: 100%; opacity: 1; padding: 0px; vertical-align: middle;" /></span><img alt="vigidel@gmail.com" class="rounded-sm" data-nimg="intrinsic" decoding="async" src="https://chat.openai.com/_next/image?url=https%3A%2F%2Fs.gravatar.com%2Favatar%2F018cc948d92d54c9acc3a0ee0faa29c9%3Fs%3D480%26r%3Dpg%26d%3Dhttps%253A%252F%252Fcdn.auth0.com%252Favatars%252Fvi.png&w=64&q=75" srcset="https://chat.openai.com/_next/image?url=https%3A%2F%2Fs.gravatar.com%2Favatar%2F018cc948d92d54c9acc3a0ee0faa29c9%3Fs%3D480%26r%3Dpg%26d%3Dhttps%253A%252F%252Fcdn.auth0.com%252Favatars%252Fvi.png&w=32&q=75 1x, https://chat.openai.com/_next/image?url=https%3A%2F%2Fs.gravatar.com%2Favatar%2F018cc948d92d54c9acc3a0ee0faa29c9%3Fs%3D480%26r%3Dpg%26d%3Dhttps%253A%252F%252Fcdn.auth0.com%252Favatars%252Fvi.png&w=64&q=75 2x" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border-radius: 0.125rem; border: none; box-sizing: border-box; display: block; height: 0px; inset: 0px; margin: auto; max-height: 100%; max-width: 100%; min-height: 100%; min-width: 100%; padding: 0px; position: absolute; vertical-align: middle; width: 0px;" /></span></div></div><div class="relative flex w-[calc(100%-50px)] flex-col gap-1 md:gap-3 lg:w-[calc(100%-115px)]" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; position: relative; row-gap: 0.75rem; width: calc(100% - 115px);"><div class="flex flex-grow flex-col gap-3" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; flex-grow: 1; row-gap: 0.75rem;"><div class="min-h-[20px] flex flex-col items-start gap-4 whitespace-pre-wrap" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-start; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1rem; display: flex; flex-direction: column; min-height: 20px; row-gap: 1rem; white-space: pre-wrap;">Usually health managers and politicians dont like to improve changes. How can we help them?</div></div><div class="text-gray-400 flex self-end lg:self-center justify-center mt-2 gap-3 md:gap-4 lg:gap-1 lg:absolute lg:top-0 lg:translate-x-full lg:right-0 lg:mt-0 lg:pl-2 visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 100%; --tw-translate-y: 0; align-self: center; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: rgba(172,172,190,var(--tw-text-opacity)); column-gap: 0.25rem; display: flex; justify-content: center; margin-top: 0px; padding-left: 0.5rem; position: absolute; right: 0px; row-gap: 0.25rem; top: 0px; transform: translate(var(--tw-translate-x),var(--tw-translate-y)) rotate(var(--tw-rotate)) skewX(var(--tw-skew-x)) skewY(var(--tw-skew-y)) scaleX(var(--tw-scale-x)) scaleY(var(--tw-scale-y)); visibility: visible;"><button class="p-1 rounded-md hover:bg-gray-100 hover:text-gray-700 dark:text-gray-400 dark:hover:bg-gray-700 dark:hover:text-gray-200 disabled:dark:hover:text-gray-400 md:invisible md:group-hover:visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-color: transparent; background-image: none; border-color: rgb(217, 217, 227); border-radius: 0.375rem; border-width: 0px; cursor: pointer; font-family: inherit; font-size: 16px; line-height: inherit; margin: 0px; padding: 0.25rem; visibility: hidden;"><svg class="h-4 w-4" fill="none" height="1em" stroke-linecap="round" stroke-linejoin="round" stroke-width="2" stroke="currentColor" viewbox="0 0 24 24" width="1em" xmlns="http://www.w3.org/2000/svg"><path d="M11 4H4a2 2 0 0 0-2 2v14a2 2 0 0 0 2 2h14a2 2 0 0 0 2-2v-7"></path><path d="M18.5 2.5a2.121 2.121 0 0 1 3 3L12 15l-4 1 1-4 9.5-9.5z"></path></svg></button></div><div class="flex justify-between" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: flex; justify-content: space-between;"></div></div></div></div><div class="w-full border-b border-black/10 dark:border-gray-900/50 text-gray-800 dark:text-gray-100 group bg-gray-50 dark:bg-[#444654]" style="--tw-bg-opacity: 1; --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 0; --tw-translate-y: 0; -webkit-text-size-adjust: 100%; border-color: rgba(0, 0, 0, 0.1); border-style: solid; border-width: 0px 0px 1px; box-sizing: border-box; color: rgba(52,53,65,var(--tw-text-opacity)); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 14px; width: 1106px;"><div class="text-base gap-4 md:gap-6 m-auto md:max-w-2xl lg:max-w-2xl xl:max-w-3xl p-4 md:py-6 flex lg:px-0" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1.5rem; display: flex; font-size: 1rem; line-height: 1.5rem; margin: auto; max-width: 48rem; padding: 1.5rem 0px; row-gap: 1.5rem;"><div class="w-[30px] flex flex-col relative items-end" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-end; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: flex; flex-direction: column; position: relative; width: 30px;"><div class="relative h-[30px] w-[30px] p-1 rounded-sm text-white flex items-center justify-center" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; 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lg:w-[calc(100%-115px)]" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; position: relative; row-gap: 0.75rem; width: calc(100% - 115px);"><div class="flex flex-grow flex-col gap-3" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; flex-grow: 1; row-gap: 0.75rem;"><div class="min-h-[20px] flex flex-col items-start gap-4 whitespace-pre-wrap" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-start; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1rem; display: flex; flex-direction: column; min-height: 20px; row-gap: 1rem; white-space: pre-wrap;"><div class="markdown prose w-full break-words dark:prose-invert light" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-prose-body: #374151; --tw-prose-bold: #111827; --tw-prose-bullets: #d1d5db; --tw-prose-captions: #6b7280; --tw-prose-code: #111827; --tw-prose-counters: #6b7280; --tw-prose-headings: #111827; --tw-prose-hr: #e5e7eb; --tw-prose-invert-body: #d1d5db; --tw-prose-invert-bold: #fff; --tw-prose-invert-bullets: #4b5563; --tw-prose-invert-captions: #9ca3af; --tw-prose-invert-code: #fff; --tw-prose-invert-counters: #9ca3af; --tw-prose-invert-headings: #fff; --tw-prose-invert-hr: #374151; --tw-prose-invert-lead: #9ca3af; --tw-prose-invert-links: #fff; --tw-prose-invert-pre-bg: rgba(0,0,0,0.5); --tw-prose-invert-pre-code: #d1d5db; --tw-prose-invert-quote-borders: #374151; --tw-prose-invert-quotes: #f3f4f6; --tw-prose-invert-td-borders: #374151; --tw-prose-invert-th-borders: #4b5563; --tw-prose-lead: #4b5563; --tw-prose-links: #111827; --tw-prose-pre-bg: #1f2937; --tw-prose-pre-code: #e5e7eb; --tw-prose-quote-borders: #e5e7eb; --tw-prose-quotes: #111827; --tw-prose-td-borders: #e5e7eb; --tw-prose-th-borders: #d1d5db; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-body); font-size: 1rem; line-height: 1.75; max-width: none; width: 653px; word-wrap: break-word;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px 0px 1.25em;">It can be challenging to implement new technologies, such as ChatGPT, in the healthcare industry, as there may be resistance from health managers and politicians. However, there are several strategies that can be used to help them see the benefits of the technology and overcome resistance to change:</p><ol style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; counter-reset: item 0; display: flex; flex-direction: column; list-style-image: initial; list-style-position: initial; margin: 1.25em 0px; padding: 0px 0px 0px 1rem;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Demonstrating the benefits: One of the most effective ways to convince health managers and politicians of the benefits of ChatGPT is to show them concrete examples of how the technology has improved patient care and streamlined clinical workflows. This could include data on patient satisfaction, clinical outcomes, and cost savings.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Addressing concerns: It's important to address any concerns that health managers and politicians may have about the technology, such as privacy and security concerns. By providing clear and detailed information about how the technology is being used and how patient data is being protected, you can help to alleviate any concerns they may have.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Building a coalition of support: Building a coalition of support can help to demonstrate that the technology is not only beneficial but also has wide-spread support. This can include getting input and buy-in from healthcare providers, patients, and other stakeholders.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Communicating the risks of not implementing: It can be helpful to communicate the risks of not implementing ChatGPT, such as missed opportunities for improving patient care and increasing costs in the long run.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Offering support: Health managers and politicians may be more willing to implement new technologies if they have support in place to help with the transition. This could include providing training and education on how to use the technology, or having dedicated support staff available to help with any issues that may arise.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Showing the technology's scalability: Showing how the technology can be scaled and applied in multiple settings and for different purposes can help to demonstrate its potential value and increase the chances of getting support.</p></li></ol><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 1.25em 0px 0px;">By using a combination of these strategies, it is possible to help health managers and politicians see the benefits of ChatGPT and overcome resistance to change. It is important to remember that change takes time and persistence, so it's important to continue to communicate the benefits of the technology and address any concerns that may arise.</p></div></div></div><div class="flex justify-between" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: flex; justify-content: space-between;"><div class="text-gray-400 flex self-end lg:self-center justify-center mt-2 gap-3 md:gap-4 lg:gap-1 lg:absolute lg:top-0 lg:translate-x-full lg:right-0 lg:mt-0 lg:pl-2 visible" style="--tw-border-spacing-x: 0; 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--tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-image: none; border: 0px; box-sizing: border-box; display: inline-block; margin: 0px; max-width: 100%; opacity: 1; overflow: hidden; padding: 0px; position: relative;"><span style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-image: none; border: 0px; box-sizing: border-box; display: block; margin: 0px; max-width: 100%; opacity: 1; padding: 0px;"><img alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%2730%27%20height=%2730%27/%3e" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-image: none; border: 0px; box-sizing: border-box; display: block; margin: 0px; max-width: 100%; opacity: 1; padding: 0px; vertical-align: middle;" /></span><img alt="vigidel@gmail.com" class="rounded-sm" data-nimg="intrinsic" decoding="async" src="https://chat.openai.com/_next/image?url=https%3A%2F%2Fs.gravatar.com%2Favatar%2F018cc948d92d54c9acc3a0ee0faa29c9%3Fs%3D480%26r%3Dpg%26d%3Dhttps%253A%252F%252Fcdn.auth0.com%252Favatars%252Fvi.png&w=64&q=75" srcset="https://chat.openai.com/_next/image?url=https%3A%2F%2Fs.gravatar.com%2Favatar%2F018cc948d92d54c9acc3a0ee0faa29c9%3Fs%3D480%26r%3Dpg%26d%3Dhttps%253A%252F%252Fcdn.auth0.com%252Favatars%252Fvi.png&w=32&q=75 1x, https://chat.openai.com/_next/image?url=https%3A%2F%2Fs.gravatar.com%2Favatar%2F018cc948d92d54c9acc3a0ee0faa29c9%3Fs%3D480%26r%3Dpg%26d%3Dhttps%253A%252F%252Fcdn.auth0.com%252Favatars%252Fvi.png&w=64&q=75 2x" style="--tw-border-spacing-x: 0; 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--tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; position: relative; row-gap: 0.75rem; width: calc(100% - 115px);"><div class="flex flex-grow flex-col gap-3" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; flex-grow: 1; row-gap: 0.75rem;"><div class="min-h-[20px] flex flex-col items-start gap-4 whitespace-pre-wrap" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-start; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1rem; display: flex; flex-direction: column; min-height: 20px; row-gap: 1rem; white-space: pre-wrap;">In the present situation we face a large number of electronic medical récords no compatible among them. How can we manage conection systems using artificial inteligence?</div></div><div class="text-gray-400 flex self-end lg:self-center justify-center mt-2 gap-3 md:gap-4 lg:gap-1 lg:absolute lg:top-0 lg:translate-x-full lg:right-0 lg:mt-0 lg:pl-2 visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-text-opacity: 1; --tw-translate-x: 100%; --tw-translate-y: 0; align-self: center; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: rgba(172,172,190,var(--tw-text-opacity)); column-gap: 0.25rem; display: flex; justify-content: center; margin-top: 0px; padding-left: 0.5rem; position: absolute; right: 0px; row-gap: 0.25rem; top: 0px; transform: translate(var(--tw-translate-x),var(--tw-translate-y)) rotate(var(--tw-rotate)) skewX(var(--tw-skew-x)) skewY(var(--tw-skew-y)) scaleX(var(--tw-scale-x)) scaleY(var(--tw-scale-y)); visibility: visible;"><button class="p-1 rounded-md hover:bg-gray-100 hover:text-gray-700 dark:text-gray-400 dark:hover:bg-gray-700 dark:hover:text-gray-200 disabled:dark:hover:text-gray-400 md:invisible md:group-hover:visible" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; background-color: transparent; background-image: none; border-color: 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w-[calc(100%-50px)] flex-col gap-1 md:gap-3 lg:w-[calc(100%-115px)]" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; position: relative; row-gap: 0.75rem; width: calc(100% - 115px);"><div class="flex flex-grow flex-col gap-3" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 0.75rem; display: flex; flex-direction: column; flex-grow: 1; row-gap: 0.75rem;"><div class="min-h-[20px] flex flex-col items-start gap-4 whitespace-pre-wrap" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; align-items: flex-start; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; column-gap: 1rem; display: flex; flex-direction: column; min-height: 20px; row-gap: 1rem; white-space: pre-wrap;"><div class="markdown prose w-full break-words dark:prose-invert light" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-prose-body: #374151; --tw-prose-bold: #111827; --tw-prose-bullets: #d1d5db; --tw-prose-captions: #6b7280; --tw-prose-code: #111827; --tw-prose-counters: #6b7280; --tw-prose-headings: #111827; --tw-prose-hr: #e5e7eb; --tw-prose-invert-body: #d1d5db; --tw-prose-invert-bold: #fff; --tw-prose-invert-bullets: #4b5563; --tw-prose-invert-captions: #9ca3af; --tw-prose-invert-code: #fff; --tw-prose-invert-counters: #9ca3af; --tw-prose-invert-headings: #fff; --tw-prose-invert-hr: #374151; --tw-prose-invert-lead: #9ca3af; --tw-prose-invert-links: #fff; --tw-prose-invert-pre-bg: rgba(0,0,0,0.5); --tw-prose-invert-pre-code: #d1d5db; --tw-prose-invert-quote-borders: #374151; --tw-prose-invert-quotes: #f3f4f6; --tw-prose-invert-td-borders: #374151; --tw-prose-invert-th-borders: #4b5563; --tw-prose-lead: #4b5563; --tw-prose-links: #111827; --tw-prose-pre-bg: #1f2937; --tw-prose-pre-code: #e5e7eb; --tw-prose-quote-borders: #e5e7eb; --tw-prose-quotes: #111827; --tw-prose-td-borders: #e5e7eb; --tw-prose-th-borders: #d1d5db; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-body); font-size: 1rem; line-height: 1.75; max-width: none; width: 653px; word-wrap: break-word;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px 0px 1.25em;">In the present situation, where there are a large number of electronic medical records (EMRs) that are not compatible with each other, artificial intelligence (AI) can be used to help manage the connection systems. Here are a few ways that AI can be used to manage EMR connectivity:</p><ol style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; counter-reset: item 0; display: flex; flex-direction: column; list-style-image: initial; list-style-position: initial; margin: 1.25em 0px; padding: 0px 0px 0px 1rem;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Data integration: AI-powered data integration tools can be used to extract, transform, and load data from different EMR systems into a centralized repository. This can help to ensure that patient data is accurate and up-to-date, and that it is accessible to healthcare providers across different systems.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Data normalization: AI-powered data normalization tools can be used to standardize data across different EMR systems. This can help to ensure that patient data is consistent and can be easily compared and analyzed across systems.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Natural language processing (NLP): AI-powered NLP tools can be used to extract and classify patient data from different EMR systems. This can help to ensure that patient data is accurate and up-to-date, and that it is accessible to healthcare providers across different systems.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Data mapping: AI-powered data mapping tools can be used to map patient data from different EMR systems to a common data model. This can help to ensure that patient data is accurate and up-to-date, and that it is accessible to healthcare providers across different systems.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Predictive analytics: AI-powered predictive analytics tools can be used to identify patterns and trends in patient data across different EMR systems. This can help to identify potential health issues and help healthcare providers make more informed decisions.</p></li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px; padding-left: 0.375em;"><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 0px;">Automation: AI-powered automation tools can be used to automate repetitive tasks, such as data entry and data management, reducing the manual efforts and increasing the data accuracy.</p></li></ol><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 1.25em 0px 0px;">By using these AI-powered tools, healthcare providers can more easily manage and access patient data across different EMR systems. It is important to note that, while AI can be used to help manage EMR connectivity, it is still necessary to have a solid IT infrastructure and a strong team to maintain and operate the systems.</p><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 1.25em 0px 0px;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWcvvKCOMyHXysyH5U9_dGG4wqjNoxtM7gvUziKw_P6DQW7TJjxvSyLJdDppGIL9e2U3QE_S5IIiGEdOXB2964xBYfyycfaktMkD-qL6y8y9QudVmng1MKaBRZYJqGfqnflcEHD-14gbPDmqQKQbovnsXzZSPqXChSxgKAam1La0cHenSNmPwBOkDU/s1280/23D0EFC3-DD07-40AB-AC0E-059EC8B639F7.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="924" data-original-width="1280" height="289" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWcvvKCOMyHXysyH5U9_dGG4wqjNoxtM7gvUziKw_P6DQW7TJjxvSyLJdDppGIL9e2U3QE_S5IIiGEdOXB2964xBYfyycfaktMkD-qL6y8y9QudVmng1MKaBRZYJqGfqnflcEHD-14gbPDmqQKQbovnsXzZSPqXChSxgKAam1La0cHenSNmPwBOkDU/w400-h289/23D0EFC3-DD07-40AB-AC0E-059EC8B639F7.jpeg" width="400" /></a></div><br /><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 1.25em 0px 0px;"><br /></p><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; margin: 1.25em 0px 0px;"><b>ChatGPT可以帮助医生和健康管理人员吗?
</b>
机器翻译,抱歉有错误。
我在马德里从事初级保健工作已经超过20年。在这段时间里,我曾试图与董事、经理、中央服务技术人员、经理甚至区域卫生部长本人在多个场合交谈。虽然我受到了关注,并被礼貌地听取了意见,但我不清楚我的贡献是否对他们有帮助。
目前的情况是高级管理层和卫生保健专业人员之间的僵局和缺乏沟通。对医生来说,与机器交谈比与他或她的经理交谈更容易。这就是为什么我在周日上午花了一些时间与ChatGPT交谈(至少是尝试),谦虚地建议政治家和管理者,如果他们不敢听从专业人士的意见,至少应该听从一台机器的意见。这个系统应该具有高中的学术水平,它不侮辱人,并给出政治上正确的答案。他们不会受到惊吓。
如果他们随后遵循一些建议,我们就会有很大的进步。</p></div></div></div></div></div></div>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-30827935216009610092023-01-28T09:15:00.002+01:002023-01-28T09:15:38.874+01:00¿Es posible gestionar mejor los centros de salud? Is it possible to manage health centres better? 是否有可能更好地管理保健中心?<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaiPvl5QT2A5-nKdf_DrUG1VJQMllrOATvCY9n33uvlHHLfNWFQKKl1r63zNn9gEUVyoWsWfFmTxGYtDvmmiqTytxqKZjz-74FlTNeyO8lgclwf2mkwQOkQEYKzC1DC8rsYqjOImiHfI6UnDVD7ckEH_hK4bN_e7Xr-lWtEvpiaapPRGfI5kZ2XTrh/s1606/710672DE-9249-4CB2-9896-A1CAAA80DD6A.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1606" data-original-width="1080" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaiPvl5QT2A5-nKdf_DrUG1VJQMllrOATvCY9n33uvlHHLfNWFQKKl1r63zNn9gEUVyoWsWfFmTxGYtDvmmiqTytxqKZjz-74FlTNeyO8lgclwf2mkwQOkQEYKzC1DC8rsYqjOImiHfI6UnDVD7ckEH_hK4bN_e7Xr-lWtEvpiaapPRGfI5kZ2XTrh/w430-h640/710672DE-9249-4CB2-9896-A1CAAA80DD6A.jpeg" width="430" /></a></div><br /><div style="text-align: center;"><span style="font-size: large;">Azul y verde. Mark Rothko </span></div><p></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Tras siete semanas de huelga la Consejería de Sanidad de Madrid quiere solucionar la falta de médicos pidiendo que hagamos horas extras. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Las haremos. Pero no será suficiente. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Ni para los 200.000 niños y niñas sin pediatra asignado ni para los 800.000 madrileños que no tienen médico de familia. Tampoco resolverá el agotamiento de los profesionales ni hará que médicos jóvenes se queden en la Comunidad ni otros vengan atraídos. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Entonces ¿qué se puede hacer?</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">1. Lo primero hablar y escuchar. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">La Consejería de Sanidad está dando ejemplo de romper puentes de comunicación. No escucha a los sindicatos pero tampoco escucha a Sociedades Científicas, Foros y asociaciones profesionales, Colegio de Médicos, Organización Médica Colegial, expertos en gestión sanitaria ni profesionales asistenciales. Tampoco los cuadros directivos y de gestión se han caracterizado los últimos años por salir del despacho, más bien todo lo contrario. La institución mantiene un canal de comunicación vertical unidireccional que lleva mucho tiempo sin proporcionar una escucha de calidad a sus profesionales y en consecuencia sin atender sus necesidades. De poco sirve diseñar planes de mejora, libros blancos o comisiones diversas que no tengan en cuenta la postura de todos los profesionales y carezcan de compromiso para implementar lo que en ellos se establezca.</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">2. Convertir en prioridad la defensa del paciente y de los profesionales. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Es preciso un observatorio de Atención Primaria transparente que cuantifique la sobrecarga asistencial y la falta de profesionales en tiempo real. Esta herramienta puede permitir localizar a los profesionales en riesgo de sobrecarga y protegerlos con medidas ordenarías de refuerzo y evitación de daños. Así mismo es fundamental implementar herramientas y ajustes que permitan que el propio sistema evite la sobrecarga y objetive cuándo y dónde posicionar suplentes y medidas de refuerzo extraordinarias. Si los profesionales sienten que su seguridad laboral está garantizada podrán desarrollar su labor de forma más eficaz y comprometida. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">3. Gestionar mejor la burocracia. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Facilitar que toda la burocracia que pueda hacer el paciente, la haga el paciente. Es urgente priorizar el auto certificado de incapacidad laboral breve como tienen habilitado otros países. Revisar la lista de informes y certificados actual para optimizarlos, minimizarlos y redirigirlos a quien corresponda (mutuas laborales, servicios de prevención, Colegio de Médicos, Medicina privada, trabajador social, enfermería…).</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">4. Mejorar la historia clínica electrónica (HCE) y los sistemas de información. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">En la actualidad en la sanidad pública existen varios modelos de HCE por Comunidad Autónoma. Eso dificulta la integración de la información, multiplica el gasto y permite sistemas de menos calidad. El diseño suele estar basado más en las necesidades de gestión y control de la Consejería que en la labor clínica de los profesionales. Sería aconsejable definir un nuevo marco normativo que permita unificar la HCE de Atención Primaria en un nuevo sistema de código abierto cuya mejora continua pueda hacerse de forma descentralizada pero siguiendo un esquema y una coordinación central que vele por el mismo. Una herramienta bien diseñada que pueda evolucionar incorporando mejoras continuas puede facilitar mucho la labor clínica y la efectividad y seguridad de los profesionales. Incorporar voz a texto, sistemas de seguridad farmacoterapéutica, inteligencia artificial, sistemas de comunicación con otros niveles asistenciales… y hacerlo de forma continua y progresiva es básico para evitar la obsolescencia del sistema. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">5. Recuperar la autonomía de gestión de área sanitaria.</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">En Madrid aún recordamos cuando había diferentes áreas sanitarias con gerentes y equipos directivos que estaban permanentemente en contacto con sus profesionales. Eso es hoy anecdótico. Cada vez hay peor comunicación, es más vertical y el nivel de resolubilidad menor. Así mismo los directores de equipo carecen de ningún tipo de autonomía de gestión, lo que impide la flexibilidad y adecuación a sus problemas y realidades puntuales. No se ha conseguido equiparar la figura de los mismos a los de jefe de servicio hospitalarios, minimizando su carga asistencial, lo que los sigue manteniendo como cargos de poca autonomía y gran penosidad, al tener que cargar con el malestar de las plantillas. Tras más de una década no se ha evaluado la gestión en modo de área única ni se ha replanteado recuperar el modelo anterior o avanzar hacia otro distinto. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">6. Potenciar la labor docente y a los tutores. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Si queremos motivar a los jóvenes médicos, será imprescindible cuidar a los estudiantes de docencia pregrado y a los MIR. Esto implica tener un sistema de formación incentivado con tutores cuyo estatuto incluya mejoras y flexibilidad para compatibilizar labor asistencial y docencia. El que los tutores se plantean su dimisión en masa como ahora es signos de la gravedad de la situación. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">7. Potenciar la salud comunitaria a nivel institucional. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Solo si contamos con la población para recuperar su capacidad y responsabilidad a la hora de cuidar de la salud propia y ajena podremos conseguir que el sistema sanitario cumpla su labor. El cuidado de la salud no se puede delegar íntegramente en la sanidad. Recuperar los consejos de salud de barrios y pueblos, volver a abrir puentes de comunicación y apoyo entre asociaciones, ayuntamientos, ciudadanía y profesionales debería ser una prioridad de la mano de políticas públicas que favorezcan el fortalecimiento del asociacionismo y las redes de vecinos. Favorecer campañas de difusión de mensajes de educación para la salud que partan tanto de la Consejería de Sanidad como de los propios consejos de salud de barrio ayudaría a mejorar la formación y la información de la sociedad. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">8. Incluir la búsqueda de consenso en políticas de salud en la agenda política nacional y de las comunidades.</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Hasta ahora la gestión sanitaria ha estado en la agenda política autonómica como forma de confrontación. No es la posición más correcta para su mejora y fortalecimiento tal y como se deduce de la situación actual. La sociedad y los profesionales sanitarios han tomado consciencia de la ruptura del sistema sanitario que constituyó la pandemia y que tras esta no se ha reforzado ni replanteado absolutamente nada. En nuestra sanidad el presupuesto de novedades farmacéuticas y el monto de farmacia suelen estar más blindados que lo que el de los profesionales, tal vez debería ser al revés. Así como el gobierno de España es responsable de las políticas nacionales y del presupuesto del Estado y las Comunidades de la gestión sanitaria regional, es fundamental que se establezcan prioridades y se decida si la sanidad pública merece políticas de consenso que la sostengan e inversión suficiente que la haga viable. A dia de hoy carecemos de ambas. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">9. Asumir el decrecimiento sanitario.</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Si como Nación asumimos que el presupuesto sanitario no puede crecer, tal y como indican los datos de las últimas décadas, tal vez haya llegado el momento de asumir que llevamos tiempo en fase de decrecimiento (dado que un capital que se mantiene estable en el tiempo tiende a perder valor como todo el mundo sabe). Esto implicaría de forma urgente por un lado una priorización y por otro asumir limitaciones. Todo no se puede mantener, por lo que se hará imprescindible priorizar lo más importante de lo menos. También lo será crear nuevas reglas de uso del sistema con herramientas de copago y limitación del número con consultas o servicios a los que el ciudadano pueda acceder. Estas cuestiones son claramente dolorosas e impopulares pero curar una gangrena también lo es y no por ello es inteligente demorarlo. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">10. Recuperar la ilusión. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Los profesionales hemos sufrido mucho con la pandemia. Más de lo que imaginamos. Pero hemos mantenido la posición pese a todas las dificultades. Es cierto que la gestión de la Atención Primaria que padecemos es muy mejorable y que el maltrato institucional está muy arraigado, pero también lo es que nuestros pacientes siguen confiando en sus profesionales y que en actual estado de cosas seguimos siendo imprescindibles para la sociedad. Volver a ilusionarnos es otra prioridad que habrá que trabajar con cierta independencia de las circunstancias que seguirán tendiendo a la marejada o a la fuerte marejada. Esto también lo tendremos que hacer nosotros mismos con el apoyo de las sociedades científicas y organizaciones propias. Como bien nos enseñan los pacientes es posible crecer en la adversidad y seguir sonriendo en mitad de la catástrofe. De todo se sale, de esta situación también. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Bibliografía recomendada:</span></p><p><span style="font-size: medium;"><br /></span></p><p><a href="https://www.elsevier.es/es-revista-atencion-primaria-practica-24-sumario-vol-4-num-s1-S2605073022X00059">https://www.elsevier.es/es-revista-atencion-primaria-practica-24-sumario-vol-4-num-s1-S2605073022X00059</a></p><p><br /></p><p><br /></p><p><br /></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi47_JDAkoPFBPZh3nKp2Z9chh3HbxxANZvIKytF0W4nUgcAUY5PTAs-IZEKuhCHnM4c8oelw2U8NB1tZ4IfWWRuvGWQAqePj3trFdfvIH_gSAJuOM8fEfWDPO8ZFH_SzpNUnAbelXF6qqPRHmEeAW_Mdby00XQvqzmjTf964qnrCWSJ-LrEElsGP4H/s2732/3CF7FEAB-295C-4232-A505-509449924228.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2732" data-original-width="2048" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi47_JDAkoPFBPZh3nKp2Z9chh3HbxxANZvIKytF0W4nUgcAUY5PTAs-IZEKuhCHnM4c8oelw2U8NB1tZ4IfWWRuvGWQAqePj3trFdfvIH_gSAJuOM8fEfWDPO8ZFH_SzpNUnAbelXF6qqPRHmEeAW_Mdby00XQvqzmjTf964qnrCWSJ-LrEElsGP4H/w300-h400/3CF7FEAB-295C-4232-A505-509449924228.png" width="300" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p><span style="font-size: medium;"><br /></span></p><p><b><span style="font-size: medium;">Is it possible to manage health centres better?</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">After seven weeks of strike, the Madrid Health Department wants to solve the lack of doctors by asking us to work overtime. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">We will do it. But it will not be enough. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">Neither for the 200,000 children without a paediatrician assigned to them nor for the 800,000 Madrilenians who do not have a family doctor. Nor will it solve the exhaustion of professionals, nor will it make young doctors stay in the Community or attract others. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">So what can be done?</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">1. First of all, talk and listen. </span></p><p><span style="font-size: medium;">The Regional Ministry of Health is setting an example of breaking down bridges of communication. It does not listen to the unions, but neither does it listen to scientific societies, professional forums and associations, the College of Physicians, the Medical Association, the Collegiate Medical Organisation, health management experts or health care professionals. Nor have the management and executive staff in recent years been characterised by leaving the office, quite the contrary. The institution maintains a one-way vertical communication channel that has long failed to provide a quality listening ear to its professionals and consequently failed to meet their needs. There is little point in designing improvement plans, white papers or various commissions that do not take into account the position of all professionals and lack the commitment to implement what is established in them.</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">2. Making the defence of patients and professionals a priority. </span></p><p><span style="font-size: medium;">A transparent primary care observatory is needed to quantify the overload of care and the lack of professionals in real time. This tool could make it possible to locate professionals at risk of overload and protect them with measures to order reinforcement and avoid harm. It is also essential to implement tools and adjustments that allow the system itself to prevent overload and to target when and where to position substitutes and extraordinary reinforcement measures. If professionals feel that their job security is guaranteed, they will be able to carry out their work more effectively and with greater commitment. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">3. Manage bureaucracy better. </span></p><p><span style="font-size: medium;">Make it easier for all the bureaucracy that can be done by the patient to be done by the patient. It is urgent to prioritise the short self-certificate of incapacity for work as other countries have enabled. Review the current list of reports and certificates in order to optimise them, minimise them and redirect them to whoever corresponds (mutual labour insurance companies, prevention services, College of Doctors, private medicine, social workers, nurses, etc.).</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">4. Improve the electronic health record (EHR) and information systems. </span></p><p><span style="font-size: medium;">Currently in the public health system there are several EHR models per Autonomous Community. This makes it difficult to integrate information, multiplies costs and allows for systems of lower quality. The design is often based more on the management and control needs of the Regional Ministry than on the clinical work of professionals. It would be advisable to define a new regulatory framework to unify the primary care EHR in a new open source system whose continuous improvement can be decentralised but following a central coordination scheme that oversees it. A well-designed tool that can evolve by incorporating continuous improvements can greatly facilitate clinical work and the effectiveness and safety of professionals. Incorporating voice-to-text, pharmacotherapeutic safety systems, artificial intelligence, communication systems with other levels of care... and doing so continuously and progressively is essential to avoid system obsolescence. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">5. Recover the autonomy of health area management.</span></p><p><span style="font-size: medium;">In Madrid we still remember when there were different healthcare areas with managers and management teams that were in permanent contact with their professionals. Today this is anecdotal. Communication is getting worse and worse, it is more vertical and the level of resolvability is lower. Likewise, team managers lack any kind of management autonomy, which prevents them from being flexible and adapting to their specific problems and realities. The figure of team managers has not been brought into line with that of hospital service chiefs, minimising their care load, which continues to maintain them as positions of little autonomy and great hardship, as they have to bear the burden of the discomfort of the staff. After more than a decade, there has been no evaluation of management in the single-area mode, nor has there been any rethinking of recovering the previous model or moving towards a different one. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">6. Promote teaching and tutors. </span></p><p><span style="font-size: medium;">If we want to motivate young doctors, it will be essential to take care of undergraduate teaching students and interns. This implies having an incentivised training system with tutors whose statute includes improvements and flexibility to reconcile care work and teaching. The fact that tutors are considering resigning en masse as they are now is a sign of the seriousness of the situation. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">7. Strengthen community health at the institutional level. </span></p><p><span style="font-size: medium;">Only if we count on the population to recover its capacity and responsibility to care for its own and other people's health can we ensure that the health system does its job. Health care cannot be delegated entirely to the health system. Restoring neighbourhood and town health councils, reopening bridges of communication and support between associations, town councils, citizens and professionals should be a priority, together with public policies that favour the strengthening of associations and neighbourhood networks. Favouring campaigns to disseminate health education messages from both the Regional Ministry of Health and the neighbourhood health councils themselves would help to improve training and information for society. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">8. Include the search for consensus on health policies in the national and community political agenda.</span></p><p><span style="font-size: medium;">Until now, health management has been on the regional political agenda as a form of confrontation. This is not the most correct position to improve and strengthen it, as can be deduced from the current situation. Society and health professionals have become aware of the breakdown of the health system that constituted the pandemic and that, in its aftermath, absolutely nothing has been strengthened or rethought. In our healthcare system, the budget for pharmaceutical novelties and the amount of pharmacies is usually more protected than that of professionals; perhaps it should be the other way round. Just as the Spanish government is responsible for national policies and the State budget and the Communities for regional health management, it is essential that priorities are established and it is decided whether public health deserves consensus policies that sustain it and sufficient investment to make it viable. To date, both are lacking. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">9. Assume health care degrowth.</span></p><p><span style="font-size: medium;">If, as a nation, we assume that the health budget cannot grow, as the data of recent decades indicate, perhaps the time has come to assume that we have been in a phase of decline for some time (since capital that remains stable over time tends to lose value, as everyone knows). This would urgently imply, on the one hand, a prioritisation and, on the other hand, the assumption of limitations. Not everything can be maintained, so it will be essential to prioritise the most important from the least. It will also be necessary to create new rules for using the system with co-payment tools and limiting the number of consultations or services that citizens can access. These issues are clearly painful and unpopular, but so is curing gangrene, and it is not wise to delay. </span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">10. Recovering the illusion. </span></p><p><span style="font-size: medium;">We professionals have suffered a lot with the pandemic. More than we imagined. But we have maintained our position despite all the difficulties. It is true that the management of primary care that we are suffering can be much improved and that institutional mistreatment is deeply rooted, but it is also true that our patients continue to trust their professionals and that in the current state of affairs we continue to be essential to society. Getting our hopes up again is another priority that we will have to work on regardless of the circumstances, which will continue to tend towards a tidal wave or a strong tidal wave. We will also have to do this ourselves with the support of our own scientific societies and organisations. As patients teach us so well, it is possible to grow in adversity and to keep smiling in the midst of catastrophe. There is a way out of everything, and out of this situation too. </span></p><p><span style="font-size: medium;"><br /></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQPyOEOKheKlbHzYSNtep2A4s7XbEhJkis6ortewpxPLFrE0bMM_ktgTteeY1YNzoq_LSoS5YW7Yr02OvduzEstjYhYiXjxceDJXsGQLusNw9FhiSHiSsXtEjUSuF_4rtGf4wGi4-wXVg_3KX_HLYVTO_HGSMPogvmQDjztMsTSmZvVv6nLvibQS0M/s2048/8E58C4BB-7C5A-42B2-A110-9DBB63EAFB35.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1362" data-original-width="2048" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQPyOEOKheKlbHzYSNtep2A4s7XbEhJkis6ortewpxPLFrE0bMM_ktgTteeY1YNzoq_LSoS5YW7Yr02OvduzEstjYhYiXjxceDJXsGQLusNw9FhiSHiSsXtEjUSuF_4rtGf4wGi4-wXVg_3KX_HLYVTO_HGSMPogvmQDjztMsTSmZvVv6nLvibQS0M/w400-h266/8E58C4BB-7C5A-42B2-A110-9DBB63EAFB35.jpeg" width="400" /></a></div><br /><span style="font-size: medium;"><br /></span><p></p><p><span style="font-size: medium;"><br /></span></p><p><b><span style="font-size: medium;">是否有可能更好地管理保健中心?</span></b></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">自动翻译,抱歉有错误。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">经过七周的罢工后,马德里卫生局希望通过要求我们加班来解决医生不足的问题。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">我们将做到这一点。但这是不够的。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">既不是为了20万名没有指派儿科医生的儿童,也不是为了80万名没有家庭医生的马德里人。它也不会解决专业人员的疲惫问题,也不会使年轻医生留在社区或吸引其他人。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">那么可以做什么呢?</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">1. 首先,交谈和倾听。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">地区卫生部正在树立一个打破沟通桥梁的榜样。它不听工会的意见,但也不听科学协会、专业论坛和协会、医生学院、医学协会、高校医学组织、健康管理专家或医疗保健专业人士的意见。近年来,管理层和执行人员也没有离开办公室的特点,恰恰相反。该机构保持着一个单向的垂直沟通渠道,长期以来未能为其专业人员提供高质量的倾听,因此未能满足他们的需求。如果设计的改进计划、白皮书或各种委员会没有考虑到所有专业人员的立场,并且缺乏实施其中所确定内容的承诺,那么就没有什么意义。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">2. 把保护病人和专业人士作为优先事项。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">需要一个透明的初级保健观察站来实时量化护理的超负荷和专业人员的缺乏。这个工具可以使我们有可能找到有超负荷风险的专业人员,并通过命令强化和避免伤害的措施来保护他们。同样重要的是实施工具和调整,使系统本身能够防止超载,并针对何时何地安置替代物和非常规强化措施。如果专业人员感到他们的工作安全得到了保障,他们将能够更有效地开展工作,并作出更大的承诺。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">3.更好地管理官僚机构。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">让所有可以由病人完成的官僚主义更容易被病人完成。当务之急是像其他国家一样,优先考虑无工作能力的简短自我证明。审查目前的报告和证书清单,以优化它们,尽量减少它们,并将它们转给相应的人(劳动互助保险公司、预防服务、医生学院、私人医疗、社会工作者、护士等)。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">4. 改进电子健康记录(EHR)和信息系统。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">目前在公共卫生系统中,每个自治区有几种EHR模式。这使得信息难以整合,成本成倍增加,并使系统的质量降低。设计往往更多的是基于地区部的管理和控制需要,而不是基于专业人士的临床工作。最好是定义一个新的监管框架,将初级保健EHR统一到一个新的开源系统中,该系统的持续改进可以分散进行,但要遵循一个中央协调计划来监督。一个精心设计的工具,能够通过纳入持续改进而不断发展,可以极大地促进临床工作和专业人员的有效性和安全性。将语音转文字、药物治疗安全系统、人工智能、与其他级别护理的沟通系统......并持续和逐步地这样做,对于避免系统过时至关重要。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">5. 恢复卫生领域管理的自主权。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">在马德里,我们仍然记得,当时有不同的医疗保健领域,有经理和管理团队与他们的专业人员保持长期联系。今天,这只是传闻。沟通越来越差,它更垂直,可解决的水平也更低。同样,团队经理缺乏任何形式的管理自主权,这使他们无法灵活地适应具体问题和现实。团队经理的数字没有与医院服务主管的数字保持一致,最大限度地减少他们的护理负担,这使他们继续保持着几乎没有自主权的职位,而且非常辛苦,因为他们必须承担起员工的不适感。十多年过去了,没有对单一地区模式的管理进行评估,也没有对恢复以前的模式或走向另一种模式进行反思。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">6. 促进教学和辅导员。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">如果我们想激励年轻医生,就必须照顾好本科生教学和实习生。这意味着要有一个激励的培训系统,导师的章程包括改进和灵活性,以便协调护理工作和教学。导师们正在考虑像现在这样集体辞职,这表明了情况的严重性。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">7. 在机构层面上加强社区卫生。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">只有当我们依靠民众恢复其照顾自己和他人健康的能力和责任时,我们才能确保卫生系统完成其工作。医疗保健不能完全委托给卫生系统。恢复邻里和城镇卫生委员会,重新打开协会、城镇委员会、公民和专业人士之间的沟通和支持的桥梁,以及有利于加强协会和邻里网络的公共政策,应该是一个优先事项。倾向于从地区卫生部和街区卫生委员会本身开展传播健康教育信息的运动,将有助于改善社会的培训和信息。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">8. 将寻求卫生政策的共识纳入国家和社区政治议程。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">到目前为止,卫生管理一直作为一种对抗的形式出现在区域政治议程上。从目前的情况可以推断出,这并不是改善和加强的最正确立场。社会和卫生专业人员已经意识到构成大流行病的卫生系统的崩溃,而且在大流行病之后,完全没有得到加强或反思。在我们的医疗系统中,药品新品种的预算和药店的数量通常比专业人士的预算更有保障;也许应该反过来。正如西班牙政府负责国家政策和国家预算,各社区负责区域卫生管理一样,必须确定优先事项,并决定公共卫生是否值得维持的共识政策和足够的投资,使其可行。迄今为止,这两方面都很缺乏。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">9. 假设医疗保健的下降。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">如果作为一个国家,我们假设卫生预算不能增长,正如最近几十年的数据所表明的那样,也许现在已经到了假设我们已经处于衰退阶段一段时间的时候了(鉴于大家都知道,长期保持稳定的资本往往会失去价值)。这一方面意味着优先次序的确定,另一方面也意味着对限制的假设。并非所有的东西都可以维护,所以必须将最重要的东西和最不重要的东西区分开来。也有必要制定新的规则,使用系统的共同支付工具,并限制公民可以获得的咨询或服务的数量。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">10. 恢复幻象。</span></p><p><span style="font-size: medium;"><br /></span></p><p><span style="font-size: medium;">我们专业人员在大流行病中遭受了很多痛苦。比我们想象的要多。但是,尽管有种种困难,我们还是保持了自己的地位。诚然,我们正在遭受的初级保健的管理可以大大改善,机构的虐待行为根深蒂固,但我们的病人继续信任他们的专业人员,在目前的状况下,我们继续对社会至关重要,这也是事实。让我们的希望再次升起是另一个优先事项,无论情况如何,我们都必须努力,这将继续倾向于潮汐或强烈的浪潮。我们还必须在我们自己的科学协会和组织的支持下自己做这件事。正如病人告诉我们的那样,在逆境中成长,在灾难中保持微笑是可能的。一切都有办法,也有办法摆脱这种情况。</span></p><p><br /></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-59466828157139629142023-01-17T16:41:00.005+01:002023-01-17T16:41:55.757+01:00Diga treinta y tres. Say thirty-three. 说三十三。<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6YB4NVuHJRXbWyxpZ781pF-JtCVGdtpLkaRgH9MzawOq5LNowYAplvKOBKbuZvAmY_i3eCTRk20ymqDCTtk6y9gLfit_aYWCgYKaRiHX-rgRT7juQOu3-BDcaPeEnf6by0XNoKwdReshRkTJEo7VaIXOMHcO1mnKvnLfmcCQyIA-PdVA75M8x5F9C/s4032/670EB4E3-3675-4BB4-AAC8-0EEB6CA901D8.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="4032" data-original-width="3024" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6YB4NVuHJRXbWyxpZ781pF-JtCVGdtpLkaRgH9MzawOq5LNowYAplvKOBKbuZvAmY_i3eCTRk20ymqDCTtk6y9gLfit_aYWCgYKaRiHX-rgRT7juQOu3-BDcaPeEnf6by0XNoKwdReshRkTJEo7VaIXOMHcO1mnKvnLfmcCQyIA-PdVA75M8x5F9C/w300-h400/670EB4E3-3675-4BB4-AAC8-0EEB6CA901D8.jpeg" width="300" /></a></div><br /><p><br /></p><p class="p2" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 27.2px;"><span class="s1" style="font-family: UICTFontTextStyleBody; font-size: 21.05px;"></span><br /></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-family: UICTFontTextStyleBody; font-size: 21.05px;">En este tiempo no es fácil leer poesía. Vamos demasiado deprisa y la lírica tiene ritmos que rompen la lógica de un sistema hiperproductivista como el nuestro. Por eso es preciso reconocer que el asomarse a un libro de poemas es una actividad de riesgo. Y digo libro con pleno sentido. Los versos piden papel y abominan pantallas. Su levedad precisa de un poquito de materia a la que acariciar, susurrar, subrayar o pintar. Y de esa interacción entre el poeta, su mensaje escrito y el lector hay una posibilidad de que surja algo que con la prosa es casi imposible: el milagro. Leyendo 33, la última propuesta de <a href="https://www.amazon.es/33-Juan-Manuel-Casado-Buend%C3%ADa/dp/8412459172">Juan Manuel Casado Buendía</a>, he de reconocer que me ha pasado. Quizá con mayor fuerza que en obras anteriores dado que en esta ocasión el título es fundamental. Un número natural, el epítome de lo concreto, nos abre la puerta a un espacio poético, el cenit de lo indeterminado. Y lo hace con 33 (35) poemas, un formato que se puede leer de una sentada y que de esta forma produce un efecto semejante a la degustación de una copa de vino a pequeños sorbos pero apurándola hasta el fin. El caldo es de calidad, no hablamos de un artista joven, hablamos de barricas de roble. El sabor es generoso y mezcla tonos de añoranza con regustos de futuro y un profundo matiz de clarividencia serena. Se abre en el paladar de forma progresiva dejando un regusto a melodía de Chopin, que llega suave desde el otro lado de la casa, con algún tono azul y otros naranjas. Espero lo disfruten. </span></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-family: UICTFontTextStyleBody; font-size: 21.05px;"><br /></span></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWYfpHJo32GbqOJQPlR4KKjSUz4owaSkORQr8yiHCiZOuA2u3kLbeO0MT8oW6cJRkEsRaMkEKb9OuXpdRNrGTHV7aGtLn-5tJjnR4RfCuTerwgMNqtG_6ZyvcGUSKtF4Z3zTWAo3-95APfmjUczDpsRmLyyTrBKCckT9BxNujX-rLASFVNuwiGEdfv/s3348/0009C0DB-5192-4E32-B98E-B42A34E8BF3D.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="3348" data-original-width="2819" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWYfpHJo32GbqOJQPlR4KKjSUz4owaSkORQr8yiHCiZOuA2u3kLbeO0MT8oW6cJRkEsRaMkEKb9OuXpdRNrGTHV7aGtLn-5tJjnR4RfCuTerwgMNqtG_6ZyvcGUSKtF4Z3zTWAo3-95APfmjUczDpsRmLyyTrBKCckT9BxNujX-rLASFVNuwiGEdfv/s320/0009C0DB-5192-4E32-B98E-B42A34E8BF3D.jpeg" width="269" /></a></div><br /><span class="s1" style="font-family: UICTFontTextStyleBody; font-size: 21.05px;"><br /></span><p></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-family: UICTFontTextStyleBody; font-size: 21.05px;"><br /></span></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><b>Say thirty-three. </b></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-family: UICTFontTextStyleBody; font-size: 21.05px;"></span></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;">In this day and age it is not easy to read poetry. We go too fast and poetry has rhythms that break the logic of a hyper-productive system like ours. That is why it is necessary to recognise that looking at a book of poems is a risky activity. And I say book in the truest sense of the word. The verses demand paper and abominate screens. Their lightness requires a little bit of matter to caress, whisper, underline or paint. And from this interaction between the poet, his written message and the reader there is a possibility of something that is almost impossible with prose: the miracle. Reading 33, the latest work by Juan Manuel Casado Buendía, I have to admit that this has happened to me. Perhaps with greater force than in previous works, given that on this occasion the title is fundamental. A natural number, the epitome of the concrete, opens the door to a poetic space, the zenith of the indeterminate. And it does so with 33 (35) poems, a format that can be read in one sitting and thus produces an effect similar to the tasting of a glass of wine in small sips, but drinking it to the end. The wine is of high quality, we are not talking about a young artist, we are talking about oak barrels. The taste is generous and mixes tones of longing with aftertaste of the future and a deep shade of serene clairvoyance. It opens on the palate in a progressive way leaving an aftertaste of Chopin's melody, which comes softly from the other side of the house, with some blue and some orange tones. I hope you enjoy it. </p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCJMgiRHSuy0SBWcafMiYOvNiA8HKxQ60xkVoBYfWx-Hhsz0uvtBI7mVWhZBQPdE6T2Fq8pTjdq95QP2xxMFWwvNoNXgXTwbPLZKK_R26Zsj-d1cpB52jtRDTATfbWXyqsr7raCSNUr3-WMhKBDdIfuaJ2vhmYIKCDqjFu9ZG7kBvycurpH3sgJIf_/s4032/9C91B89A-29B1-4776-ABF1-0CBD31AF30F7.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="4032" data-original-width="3024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCJMgiRHSuy0SBWcafMiYOvNiA8HKxQ60xkVoBYfWx-Hhsz0uvtBI7mVWhZBQPdE6T2Fq8pTjdq95QP2xxMFWwvNoNXgXTwbPLZKK_R26Zsj-d1cpB52jtRDTATfbWXyqsr7raCSNUr3-WMhKBDdIfuaJ2vhmYIKCDqjFu9ZG7kBvycurpH3sgJIf_/s320/9C91B89A-29B1-4776-ABF1-0CBD31AF30F7.jpeg" width="240" /></a></div><br /><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><b>说三十三。</b></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;">机器翻译,抱歉有错误。</p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p class="p1" style="-webkit-text-size-adjust: auto; font-size: 21.1px; font-stretch: normal; line-height: normal; margin: 0px;">在这个时代,阅读诗歌是不容易的。我们走得太快了,诗歌的节奏打破了像我们这样的超生产系统的逻辑。这就是为什么有必要认识到,看一本诗集是一种有风险的活动。我说的书是最真实的意义上的书。这些诗句要求用纸,厌恶屏幕。他们的轻盈需要一点物质来抚摸、低语、划线或描绘。从诗人、他的书面信息和读者之间的这种互动中,有可能出现散文中几乎不可能出现的东西:奇迹。在阅读胡安-曼努埃尔-卡萨多-布恩迪亚的最新作品《33》时,我不得不承认,这种情况已经发生在我身上。也许比以前的作品更有力度,因为在这个场合,标题是根本。一个自然数,具体的缩影,打开了通往诗意空间的大门,那是不确定的顶点。而且它用33(35)首诗做到了这一点,这种形式可以让人一口气读完,从而产生一种类似于小口小口地品尝一杯酒,但喝到最后的效果。酒的质量很高,我们谈论的不是一个年轻的艺术家,我们谈论的是橡木桶。味道是慷慨的,混合了渴望的色调和对未来的回味,以及宁静的千里眼的深色阴影。它在口中逐渐打开,留下了肖邦旋律的回味,它顺利地从房子的另一边走来,有一些蓝色和一些橙色的色调。我希望你喜欢它。</p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-41613072883279954412023-01-10T16:40:00.004+01:002023-01-10T16:40:18.469+01:00De doctor Google a doctor Chatgpt. From doctor Google to doctor Chatgpt. 从谷歌博士到Chatgpt博士<p><span style="font-size: large;"> </span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBlbUf-gzXkhny7n1EZaD_GpJVvKbwTF3nIdO4tb3cxNPWf3rsXi1MSxtUs5VsSIeOlTmTRgolGSjjEKHtupaYEhonMRAouoFPOkgOX4wXqakMxPeyBvpTfBzPVhqfaUone8y6Lponm9a6Rv7MluRlYRaf99kJLCjL7EQcxnF2byRzNKiPuYNDtDhK/s1855/B4781260-A993-4C20-889D-CB42F8CD8742.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="1855" data-original-width="1450" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBlbUf-gzXkhny7n1EZaD_GpJVvKbwTF3nIdO4tb3cxNPWf3rsXi1MSxtUs5VsSIeOlTmTRgolGSjjEKHtupaYEhonMRAouoFPOkgOX4wXqakMxPeyBvpTfBzPVhqfaUone8y6Lponm9a6Rv7MluRlYRaf99kJLCjL7EQcxnF2byRzNKiPuYNDtDhK/w500-h640/B4781260-A993-4C20-889D-CB42F8CD8742.jpeg" width="500" /></span></a></div><p></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><i>Tengo goteo nasal, algo de tos y dolor de garganta, ¿qué hago?</i></span></p><p><span style="font-size: large;"><i><br /></i></span></p><p><span style="font-size: large;"><i>Si tiene goteo nasal, tos y dolor de garganta, es probable que esté resfriado o tenga gripe. Estos síntomas están causados por una infección vírica y suelen desaparecer por sí solos en una o dos semanas. Mientras tanto, hay varias cosas que puedes hacer para aliviar los síntomas y sentirte más cómodo:</i></span></p><p><span style="font-size: large;"><i><br /></i></span></p><p><span style="font-size: large;"><i>Descansa mucho: Cuando el cuerpo lucha contra una infección, necesita más energía para curarse. Asegúrate de dormir lo suficiente cada noche y tómatelo con calma durante el día.</i></span></p><p><span style="font-size: large;"><i>Mantente hidratado: Bebe mucha agua, zumo o caldo para mantener la garganta húmeda y aliviar la tos.</i></span></p><p><span style="font-size: large;"><i>Utiliza un humidificador: Poner un humidificador en la habitación puede ayudar a hidratar el aire y aliviar la congestión y la tos.</i></span></p><p><span style="font-size: large;"><i>Toma medicamentos sin receta: Puedes tomar medicamentos sin receta como ibuprofeno o paracetamol para reducir la fiebre y aliviar los dolores. También puedes usar descongestionantes y antihistamínicos para el goteo nasal.</i></span></p><p><span style="font-size: large;"><i>Evita fumar y el aire contaminado: Mantente alejado del humo del tabaco y del aire contaminado, ya que pueden irritarte los pulmones y empeorar los síntomas.</i></span></p><p><span style="font-size: large;"><i>Haz gárgaras con agua salada templada: Esto puede ayudar a aliviar el dolor de garganta. Mezcla una cucharadita de sal en una taza de agua tibia y haz gárgaras con ella.</i></span></p><p><span style="font-size: large;"><i>También es importante tener en cuenta que, si tienes fiebre alta, dificultad para respirar, dolor de pecho, dolor de oído o dolor de cabeza intenso, debes buscar atención médica, ya que puede tratarse de una infección grave.</i></span></p><p><span style="font-size: large;"><i><br /></i></span></p><p><span style="font-size: large;"><i>Recuerde que es importante quedarse en casa y evitar el contacto con otras personas en la medida de lo posible si está enfermo, para evitar propagar la infección.</i></span></p></blockquote><p><span style="font-size: large;"><br /></span></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="font-size: large;"> </span></p></blockquote><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">Es muy común que antes de ir al médico los pacientes consulten sus síntomas en Google o cualquier otro motor de búsqueda. La ayuda suele ser escasa dada la variable calidad de la información que los buscadores vierten, lo que causa más ansiedad al que buscando se encuentra involuntariamente con palabras como cáncer o nombres aterradores.</span></p><p><span style="font-size: large;">Esta situación va a cambiar de mano de algoritmos de Inteligencia artificial que terminarán metiéndose en nuestras pantallas, móviles y relojes. Los asistentes sanitarios virtuales serán uno de los mayores inventos en los próximos meses y proliferarán como setas de la mano de las grandes tecnológicas.</span></p><p><span style="font-size: large;">Dentro de los sistemas actuales destaca Chatgpt que sirve para casi todo y suele dar respuestas bastante razonables como el ejemplo que les traigo.</span></p><p><span style="font-size: large;">¿Sustituirán a enfermeras y médicas? Probablemente no pero si se diseñan y se utilizan bien tal vez ayuden a solucionar problemas menores y eviten que algún catarro acabe en la urgencia de hospital o un grano como consulta sin cita en el centro de salud.</span></p><p><span style="font-size: large;">Los sistemas sanitarios públicos terminarán incorporándolo pero será bastante después de que todos tengamos algún sistema similar en el bolsillo.</span></p><p><span style="font-size: large;">De paso se lo recomendaremos a nuestros políticos y gestores sanitarios, que si hicieran caso seguro mejorarían la maltrecha sanidad.</span></p><p><span style="font-size: large;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDbzgAKT2wZ9E1G1yW9-d92giNSBiHb_dNGZbEUDZi9hdaIXRIIi53aqCfuMoobdQSVMEAuZy7Eie-HiKm8wV3fNbzNPH3iKKibFPaw5CkNsMycWdvLOHXFnxTvMCo0exkLVkbAQUcInJQAXMINhLcWjPGI5He4tzS9Sb73awFC9dPt_qvNDGT7kIO/s1954/49FBE809-6B40-4344-AECE-C7E9A7E36108.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="1165" data-original-width="1954" height="382" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDbzgAKT2wZ9E1G1yW9-d92giNSBiHb_dNGZbEUDZi9hdaIXRIIi53aqCfuMoobdQSVMEAuZy7Eie-HiKm8wV3fNbzNPH3iKKibFPaw5CkNsMycWdvLOHXFnxTvMCo0exkLVkbAQUcInJQAXMINhLcWjPGI5He4tzS9Sb73awFC9dPt_qvNDGT7kIO/w640-h382/49FBE809-6B40-4344-AECE-C7E9A7E36108.jpeg" width="640" /></span></a></div><span style="font-size: large;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBwbCCEd-BRQ4HkaTUKSh3HCU39LYB_2W-vifSOMTu8hTCPmUcJx1rRvURgnNvGiTVMWKClPlCsi1iLaOTTIaN_cwcfAMM7SX3Jf8JTyHHnatZhVt6UJhXzJd1gW54Ph54ZyevQ0H6WYUolp2Mr7Hcql4hOYTFqKtPTTvSfHewcQMGLflUoKyEk9A2/s1897/54E72298-F2A7-40BB-93D4-CC70530BE9A5.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="1230" data-original-width="1897" height="414" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBwbCCEd-BRQ4HkaTUKSh3HCU39LYB_2W-vifSOMTu8hTCPmUcJx1rRvURgnNvGiTVMWKClPlCsi1iLaOTTIaN_cwcfAMM7SX3Jf8JTyHHnatZhVt6UJhXzJd1gW54Ph54ZyevQ0H6WYUolp2Mr7Hcql4hOYTFqKtPTTvSfHewcQMGLflUoKyEk9A2/w640-h414/54E72298-F2A7-40BB-93D4-CC70530BE9A5.jpeg" width="640" /></span></a></div><span style="font-size: large;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgddMgXvZhv5JU4zxSL0OEExY47gjTbk7rK08U4-Ek9WHALLpG_gA1ZwwdlcsGngblOOs0YzVUmHWTmJWEcV3UXzawPjY83bz-1lmUBvU1cOviTkD6zRDIAOKLNdBP_OiyHxlxhoZs-4cq9TaY6fw830ezE3yd8IYmEOBdFJHpx1rsHX5D1R-Uj9OdN/s1931/C8E6D337-0E85-4FA0-9B2E-75A70493119F.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="1275" data-original-width="1931" height="422" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgddMgXvZhv5JU4zxSL0OEExY47gjTbk7rK08U4-Ek9WHALLpG_gA1ZwwdlcsGngblOOs0YzVUmHWTmJWEcV3UXzawPjY83bz-1lmUBvU1cOviTkD6zRDIAOKLNdBP_OiyHxlxhoZs-4cq9TaY6fw830ezE3yd8IYmEOBdFJHpx1rsHX5D1R-Uj9OdN/w640-h422/C8E6D337-0E85-4FA0-9B2E-75A70493119F.jpeg" width="640" /></span></a></div><span style="font-size: large;"><br /></span><p><b><span style="font-size: large;">From doctor Google to doctor Chatgpt. </span></b></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">It is very common that before going to the doctor, patients consult their symptoms on Google or any other search engine. Help is often scarce given the variable quality of the information that the search engines provide, which causes more anxiety to those who involuntarily come across words such as cancer or frightening names when searching.</span></p><p><span style="font-size: large;">This situation is set to change with artificial intelligence algorithms that will eventually find their way into our screens, mobiles and watches. Virtual health assistants will be one of the biggest inventions in the coming months and will proliferate like mushrooms at the hands of the big technology companies.</span></p><p><span style="font-size: large;">Among the current systems, Chatgpt stands out as it can be used for almost anything and tends to give quite reasonable answers, such as the example I bring you.</span></p><p><span style="font-size: large;">Will they replace nurses and doctors? Probably not, but if they are designed and used well, they may help to solve minor problems and prevent a cold from ending up in the hospital emergency room or a pimple from ending up as a walk-in consultation at the health centre.</span></p><p><span style="font-size: large;">Public health systems will eventually incorporate it, but it will be long after we all have a similar system in our pockets.</span></p><p><span style="font-size: large;">At the same time, we will recommend it to our politicians and health managers, who, if they would listen, would surely improve our ailing health system.</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><b>从谷歌博士到Chatgpt博士</b>。 </span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">机器翻译,抱歉有错误。</span></p><p><span style="font-size: large;">在去看医生之前,病人在谷歌或其他搜索引擎上咨询他们的症状,这是非常普遍的现象。鉴于搜索引擎倾泻出来的信息质量参差不齐,帮助往往是稀缺的,这给那些在搜索时无意中遇到癌症等词汇或令人恐惧的名字的人造成了更大的焦虑。</span></p><p><span style="font-size: large;">这种情况将随着人工智能算法的出现而改变,这些算法最终将进入我们的屏幕、手机和手表。虚拟健康助理将是未来几个月最大的发明之一,并将像蘑菇一样在大型科技公司手中扩散。</span></p><p><span style="font-size: large;">在目前的系统中,Chatgpt脱颖而出,因为它几乎可以用于任何事情,而且往往能给出相当合理的答案,比如我给大家带来的例子。</span></p><p><span style="font-size: large;">他们会取代护士和医生吗?也许不是,但如果设计和使用得当,它们可能有助于解决小问题,并防止感冒最终进入医院急诊室,或一个痘痘最终成为健康中心的随身咨询。</span></p><p><span style="font-size: large;">公共卫生系统最终会将其纳入,但这将是在我们所有人的口袋里都有一个类似的系统之后很久。</span></p><p><span style="font-size: large;">同时,我们将把它推荐给我们的政治家和卫生管理人员,如果他们愿意听,肯定会改善我们病态的卫生系统。</span></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com0tag:blogger.com,1999:blog-4060378544967004941.post-23383500300662856672022-12-19T10:16:00.005+01:002022-12-19T10:19:38.329+01:00Atención Primaria hundida. Primary care in the doldrums. 处于低迷状态的初级保健。<p><span style="font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA1-a02pU21UT3zywP3HAluhsdRw3ltD0UVFlOGs2l0P2vsFBBYCXhrZPfat91KWu17etgRh8rtp5NxHySjowRgsSBOTOk3qf4c4-YGa_rHMPQtKUlwA46ap1x-vN2I_G1kAwDrZhY5mZLi8Cwo_ZqQLXXGCV-0d42p9ajHTl5wbuxb8WLKg7ewO4A/s680/FkUpf_VXkAANP6C%20(1).jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="453" data-original-width="680" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA1-a02pU21UT3zywP3HAluhsdRw3ltD0UVFlOGs2l0P2vsFBBYCXhrZPfat91KWu17etgRh8rtp5NxHySjowRgsSBOTOk3qf4c4-YGa_rHMPQtKUlwA46ap1x-vN2I_G1kAwDrZhY5mZLi8Cwo_ZqQLXXGCV-0d42p9ajHTl5wbuxb8WLKg7ewO4A/w400-h266/FkUpf_VXkAANP6C%20(1).jpg" width="400" /></a></span></div><span style="font-size: large;"><br /></span><p></p><p><span style="font-size: large;"><span style="background-color: white; color: #0f1419; font-family: TwitterChirp, -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif; font-size: 20px; white-space: pre-wrap;">"Primero fueron al pediatra con sus hijos y no había pediatra. Luego fueron a urgencias rurales por problemas y no había médico. Luego al centro de salud y no había médico de familia"...</span></span></p><p><span style="font-size: large;"><span style="background-color: white; color: #0f1419; font-family: TwitterChirp, -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif; font-size: 20px; white-space: pre-wrap;"><br /></span></span></p><p><span style="font-size: large;">Entramos en la quinta semana de huelga de pediatras y médicos de familia de Madrid. La situación es de bloqueo dado que cada parte mantiene su posición y sus valores. La Consejería de Sanidad repite que es un pequeño conflicto laboral fruto de unos pocos exaltados, los 5000 facultativos siguen gritando que se ahogan. </span></p><p><span style="font-size: large;">Lo que me queda claro es que los médicos de Madrid hemos tomado conciencia por fin de la situación real: la Atención Primaria está en fibrilación ventricular, no ha muerto todavía pero lo hará sin duda si nadie aplica una necesaria descarga de energía. Lo que pocos saben es que ese desfibrilador no vendrá. Vienen parches eso sí, vendrán médicos extracomunitarios, vendrán pequeños ajustes cosméticos, vendrá mucha propaganda institucional y extrainstitucional. Vendrán buenas palabras y nuevos discursos. Pero el corazón se parará. </span></p><p><span style="font-size: large;">Ayer participé en una concentración en la plaza de Chamberí, entre varios cientos de médicos pude ver a dos enfermeras con una pancarta y a algún médico residente, pocos. ¿Qué significa esto? probablemente cada vez veremos menos residentes, lo que es dramático. Probablemente cada vez veremos menos profesionales de otras categorías que se animen a defender a los médicos más presionados del sistema ocupados como están con sus propias trifulcas. Son muchos años de defender cada uno lo suyo, hay que reconocer que ahí si lo ha hecho bien la organización. </span></p><p><span style="font-size: large;">Entre los jóvenes médicos que huyen de la Atención Primaria y los más mayores que rezan por aguantar unos pocos años más, el núcleo de la protesta lo ocupan los que están en medio y tienen dudas razonables de que su salud física y mental resista lo necesario. Por mi parte creo que el enorme esfuerzo que ha constituido esta huelga ha cumplido su objetivo que era lanzar un mensaje claro al mundo sanitario y a la sociedad. <b>Sin Atención Primaria de calidad solo quedará una medicina de beneficencia</b>. Si eso es lo que quiere la sociedad, e imponen sus legítimos representantes, eso es lo que habrá. Dejaremos de sufrir cuando seamos capaces de aceptarlo. </span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><br /></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbiSrlxeOE3KRlvF2diwWZgnLl39Yar_bs594uDRy5ey8OgdIHZ6V0ih_fBfUR5SRKBY_FflI_zlaN8FOTF48bhV1rsYI55WdT6YvgpcIZhNuwXOThSwaQPHjYflpT7afe31vPjMrEwKzd-PhXvzrt2lFzdeuf85SNTYx6nBVlfMkbhNDk69kpuWHi/s600/FkTwl8lWQAAq5h5%20(1).jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="499" data-original-width="600" height="333" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbiSrlxeOE3KRlvF2diwWZgnLl39Yar_bs594uDRy5ey8OgdIHZ6V0ih_fBfUR5SRKBY_FflI_zlaN8FOTF48bhV1rsYI55WdT6YvgpcIZhNuwXOThSwaQPHjYflpT7afe31vPjMrEwKzd-PhXvzrt2lFzdeuf85SNTYx6nBVlfMkbhNDk69kpuWHi/w400-h333/FkTwl8lWQAAq5h5%20(1).jpg" width="400" /></a></div><br /><span style="font-size: large;"><br /></span><p></p><p><b><span style="font-size: large;"> Primary care in the doldrums.</span></b></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">We are entering the fifth week of the strike by paediatricians and family doctors in Madrid. The situation is deadlocked as each side maintains its position and values. The Regional Ministry of Health repeats that it is a small labour conflict caused by a few hotheads, the 5,000 doctors continue to shout that they are drowning. </span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">What is clear to me is that we doctors in Madrid have finally become aware of the real situation: primary care is in ventricular fibrillation, it has not yet died but will undoubtedly do so if no one applies the necessary energy discharge. What few know is that this defibrillator will not come. Patches will come, yes, non-EU doctors will come, small cosmetic adjustments will come, a lot of institutional and extra-institutional propaganda will come. There will be fine words and new speeches. But the heart will stop. </span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">Yesterday I took part in a rally in the Plaza de Chamberí, among several hundred doctors I could see two nurses with a banner and a few resident doctors. What does this mean? We will probably see fewer and fewer residents, which is dramatic. We will probably see fewer and fewer professionals of other categories who will dare to defend the most pressured doctors in the system, busy as they are with their own squabbles. After many years of defending each one's own interests, we must recognise that the organisation has done well in this respect. </span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">Between the young doctors who are fleeing primary care and the older ones who are praying to hold on for a few more years, the core of the protest is occupied by those who are in the middle and have reasonable doubts that their physical and mental health can withstand what is necessary. For my part, I believe that the enormous effort that this strike has constituted has fulfilled its objective, which was to send a clear message to the healthcare world and to society. <b>Without quality primary care there will only be charity medicine</b>. If that is what society wants, and that is what its legitimate representatives impose, that is what we will have. We will stop suffering when we are able to accept it. </span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><br /></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHHCHnuaFtEy7N56_l_28qG99wOkjHeZawtsE0A5pv5Ppv0JYCiF1zRKOYNlsnPWyyy7y6n9XRXBLwPZFFr2IdoWVCjkAQD6D56Tf7Z__rTzfj6ZRRFu_IjViuQSFW_lLuLFt4H66mOSw2xH6LqRRZ1Ll1qcjbpco9-PijObMhCR9rLdzFObfyFnL-/s551/Fj97o2GXgAM8R6C%20(1).jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="380" data-original-width="551" height="221" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHHCHnuaFtEy7N56_l_28qG99wOkjHeZawtsE0A5pv5Ppv0JYCiF1zRKOYNlsnPWyyy7y6n9XRXBLwPZFFr2IdoWVCjkAQD6D56Tf7Z__rTzfj6ZRRFu_IjViuQSFW_lLuLFt4H66mOSw2xH6LqRRZ1Ll1qcjbpco9-PijObMhCR9rLdzFObfyFnL-/s320/Fj97o2GXgAM8R6C%20(1).jpg" width="320" /></a></div><br /><span style="font-size: large;"><br /></span><p></p><p><b><span style="font-size: large;">处于低迷状态的初级保健。</span></b></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">自动翻译,请原谅错误。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">马德里的儿科医生和家庭医生的罢工正在进入第五周。由于双方都坚持自己的立场和价值观,局势陷入了僵局。卫生委员会重复说这是一个小的劳资冲突,是少数高高在上的人的结果,5000名医生继续喊着他们正在被淹没。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">我清楚的是,我们马德里的医生终于意识到了真实的情况:初级保健处于心室颤动状态,它还没有死亡,但如果没有人应用必要的能量放电,毫无疑问会死亡。很少有人知道的是,这个除颤器不会来。补丁会来,是的,非欧盟的医生会来,小的外观调整会来,大量的机构和机构外的宣传会来。将有精美的文字和新的演讲。但心脏会停止。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">昨天我参加了马德里的一个集会,在几百名医生中,我可以看到两个拿着横幅的护士和几个住院医生。 这意味着什么? 我们可能会看到越来越少的住院医生,这很有戏剧性。我们可能会看到越来越少的其他类别的专业人士敢于为系统中压力最大的医生辩护,因为他们正忙于自己的争吵。在多年来维护各自的利益之后,我们必须承认,本组织在这方面做得很好。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">在逃离初级保健的年轻医生和祈求再坚持几年的老医生之间,抗议活动的核心被那些处于中间的人所占据,他们有理由怀疑自己的身体和精神健康是否能承受住必要的东西。就我而言,我相信这次罢工所构成的巨大努力已经实现了它的目标,那就是向医疗卫生界和社会发出一个明确的信息。没有高质量的初级保健,就只有慈善医疗。如果这就是社会想要的,这就是社会的合法代表所强加的,这就是将出现的。当我们能够接受它时,我们将停止痛苦。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><br /></span></p><p><br /></p>La consulta del doctor Casadohttp://www.blogger.com/profile/09141024581027078502noreply@blogger.com1