"Hemos perdido la fe en que con comunicación y una exploración cuidadosa es posible modificar el curso de una enfermedad." David Loxterkamp
Es imparable. La medicina tal y como la conocíamos está abocada a desaparecer bajo un manto de pantallas de ordenador, aplicaciones móviles, complejas tecnologías, infinitas burocracias y profesionales sobrecargados y agotados que no dan a basto en atender los requerimientos de sus pacientes y de los programas informáticos de sus empleadores.
Rescato un interesante diálogo extraído del
British Medical Journal entre un médico de familia y un arquitecto. Todo está cambiando demasiado rápido en ambas disciplinas, como lo está haciendo la sociedad en general. ¿Estamos preparados para adaptarnos a esos cambios? ¿Qué valores estamos primando como colectividad? ¿Cuáles estamos desechando?
En el fondo de la cuestión hay un tema filosófico que atañe a la ética y en consecuencia a la política. Los sistemas sanitarios públicos europeos se construyeron con esfuerzo sobre el valor
solidaridad, tratando de aportar
equidad a todos los ciudadanos, promoviendo la salud y trabajando para aliviar la enfermedad de todos por igual. Las corrientes del poder imperante han socavado este valor promoviendo otros como el beneficio económico y el sálvese quien pueda. No se imaginan lo importante que son los valores, en a penas una pequeña palabra se sostienen estructuras, sistemas, organizaciones y países. Son el cimiento de toda obra humana, si uno los cambia puede hacer que enormes pirámides se desplomen como si fueran naipes. No se crean que es accidental que los pacientes se convirtieran en usuarios y ahora en clientes...
Los médicos estamos en crisis como también lo está la medicina. Hay muchas presiones para que nos convirtamos en burócratas y tecnócratas hiperespecializados. Esto redunda en mayor eficiencia y beneficio para la organización sanitaria que cada vez más estará gestionada de forma privada y lucrativa ergo el beneficio real será para la junta de accionistas o el fondo de capital riesgo que mueva los hilos.
Del interesante texto que adjunto rescato la frase que comienza este post. Los médicos nos enfrentamos a una profunda crisis de fe y no solo en las organizaciones sanitarias y estructuras anexas (sindicatos, colegios de médicos, sociedades científicas). Enfrentamos una crisis de creencias frente a nuestra forma de hacer las cosas. Ya no nos parece suficiente la comunicación y la exploración clínica. Sin tecnología, sin aplicaciones, sin ordenadores... muchos serían totalmente incapaces de ejercer la medicina. Cabe preguntarse si todavía queda algún lugar para la comunicación de calidad, el cuidado de los procesos narrativos del paciente y la exploración física cuidadosa de su cuerpo. Si uno mira a los complejos hospitales no sabría que decir, si mira a los abarrotados centros de salud tampoco. Me gustaría ser capaz de decirles que todavía es posible una medicina humana que permita un contacto de calidad entre la persona en tiempo de enfermar y sus profesionales sanitarios pero todo indica que las férreas reglas del mercado lo van a poner cada vez más difícil.
What doctors have in common with architects—part 1: A manual art
- David Loxterkamp, medical director, Seaport Community Health Center, Belfast, Maine,
- Bruce Snider, architect and writer on US residential architecture
Have we lost touch?
DL:
Medicine and architecture belong to the physical arts. Their basic
units of measure—bodies and buildings—make a sturdy and recognizable
impression as you stand before them. But the old standards are changing.
Recent developments in genomics, population health, patient centered
care, and information technology, such as electronic health records,
have changed the way medicine intersects with society. Doctors
increasingly work in a virtual environment where touch is relegated to
technicians who treat by following doctors’ orders. It is reminiscent of
professional etiquette in the 18th century when, as Paul Starr noted,
“physicians, as gentlemen, declined to work with their hands; they
observed, speculated, and prescribed. Manual tasks were left to the
surgeons, who until 1745 belonged to the same guild as barbers.”
1
BS:
Architects too ply their trade increasingly in a virtual realm. When I
began my career in the early 1980s my colleagues and I worked at long
drafting tables, sitting on tall stools or standing. The radio played
classical music, and we talked to each other while we worked. Today,
interns and junior architects sit slumped before computer monitors,
earbuds firmly in place, moving only wrists and fingertips. The new
digital tools they use are vastly more powerful than my pencil and
straight edge. But in embracing them the profession has also abandoned a
tradition of draftsmanship and a design process, centered on hand
drawing, that went back at least to the Renaissance. How that change
will play out—in architects’ relations to their work and in the designs
they produce—remains to be seen. I believe it represents an historic
watershed, one that gets less attention than it deserves.
How has this loss changed the practice of our professions?
DL:
It is commonplace now for primary care doctors to spend more time on
the computer than with their patients. We study the screen instead of
the patient’s facial expression or posture; follow computer prompts
instead of the labyrinthine turns in their story; touch our keyboard but
not the body that longs to be examined. We decline to intuit the nature
of an illness before blood tests and imaging studies have quantified
and objectified the patient’s suffering. Documentation has replaced
communication; the inchoate illness of the patient is less true, less
reliable—less real—than what is digitally displayed. We have lost our
belief that conversation and a careful examination can alter the course
of an illness.
BS: In architecture the
shift from analog to digital follows generational lines. Many, if not
most, firms are still led by architects who trained when the norm was
sketching, drafting, and building models by hand and who still use the
old tools to design. But construction drawings, what lay people still
call “blueprints,” are almost invariably produced by younger associates
on computers rather than by hand. My time as a draftsman spanned the
crossover period between hand and computer drawing, and I found the
contrast between the two regimes stark. When I worked by hand, building
designs continued to evolve as I translated them into construction
drawings. My creative input was part of the process, and the process was
part of my training as a designer. Something about working on a screen,
however, cut off my ability to inhabit the building as I drew it, so I
became more of a technician than a designer.
The utility of touch
DL:
In medicine hands are still needed to palpate a ballotable effusion,
crepitant tendon, or fluctuant abscess. Only fingers can detect the
sandpaper feel of actinic keratosis, the knot of a trigger point, or the
matted induration of a suspicious lump. We learn from limbs that are
warm with cellulitis, cool from ischemia, tense in spasm, or pitted with
edema. But touch is more useful than the data it provides. A thorough
examination conveys our attention to detail, provides comfort, and lays a
firm foundation for the doctor-patient relationship. When we touch the
patient’s diseased part, we dismantle a barrier to intimacy and the
stigma of disease. Our actions signal to patients that we are not afraid
of the affliction, nor need they be. It is a gesture of connection and
hope, reassuring them of their wholeness despite bodily imperfection.
The
basic tools are still needed in patient care: ears to absorb the whole
story, eyes to meet a worried glance, hands to touch what is broken or
tender. The symbolic connectedness made real in those healing moments is
an integral part of the placebo response—a treatment more powerful than
most of the drugs and procedures in our evidence based arsenal.
BS:
In the old days I could easily recognize a colleague’s drawing by
sight, and plenty were beautiful enough to hang on a wall. When the last
hand drafting generation leaves the profession, that art form will go
with them. This we know. What we don’t know is how an attenuated tactile
and kinesthetic connection will affect the way architects design and
the buildings they create. An old school architect I know described
designing with a pencil and a roll of trace paper as “a trance state …
this mystical connection between the brain and the paper, via the hand.”
Drawing, she believes, is more than a way to represent and transmit a
design; it’s integral to the design process. Drawing, as natural to her
by now as breathing, puts her inside the building as she calls it into
being. Mastering that skill takes a great deal of practice, practice
that young architects—as bright, dedicated, and in love with buildings
as any that preceded them—don’t seem to be getting. I don’t know how to
identify the quality that distinguishes buildings designed by hand, and
I’m sure there isn’t a name for it, but I think we’re going to miss it.
Puede acceder al artículo completo original aquí.
http://www.bmj.com/content/350/bmj.h1810
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