Diseases are not 2x2, which is why you must apply medical criteria and rely on Practicum

DR. SALVADOR CABALLERO DIMAS

Former director of the Hospital Sabinas Hidalgo in Nuevo León (Mexico)

The pediatrician Salvador Caballero Dimas has worked for 36 years at the Hospital Sabinas Hidalgo in Nueva León, Mexico. There, he received several awards and held several responsible positions, including those of Center Director, Head of the Department of Pediatrics, Head of the Pediatrics Unit, and Coordinator of External Appointment. Today, Dr. Caballero Dimas is 71 years old and retired, although he sees patients as a private doctor. In his opinion, "The simulator is like a synod: it gives us an opportunity to apply knowledge, stay up to date, read a lot, and feel our abilities, in addition to challenging us to know if we are doing the right thing."

Madrid - September 7, 2018. Practicum Script avoids the format of unique correct answers and focuses on differential diagnoses. In what way does this affect the confidence in decision making in the presence of the patient?
Embracing controversy is necessary for us to consider other criteria and to elucidate and expand our actions around diagnostic opportunities and assertive treatments. Differential diagnoses give us the opportunity to offer the patient a better chance to receive what is correct and lead to fewer errors in medical practice.

Practicum Script addresses dilemmatic and controversial situations. To what extent is it interesting to discuss results or considerations with other colleagues and the tutor?
The simulator is like a synod: it gives us an opportunity to apply knowledge, stay up to date, read a lot, and feel our abilities, in addition to challenging us to know if we are doing the right thing and go beyond reaching effective solutions for our patients’ illnesses, favoring a better quality of life. Professional communication nourishes us with an exchange of knowledge of successes and failures. The tutor takes us by the hand in supporting, doing the right thing, and giving us the confidence to continue with this tool, which is special for its great accessibility.

Statistics show that almost one-third of the cases treated on a daily basis are patients with multiple pathologies or comorbidities and that clinicians must make decisions in contexts where there isn’t sufficient external evidence. Taking into account your long experience as a medical professional, how would you define the so-called medical criteria in these situations?
Diseases are not 2x2; they may present in multiple forms despite being the same. It is precisely in this regard that we must use criterion, well-learned knowledge, complementary tests, imaging units, and other resources to reach a confident diagnosis.

In your opinion, does clinical reasoning training improve patient care?
Since clinical reasoning training expands possibilities and options to offer better patient care, it is indispensable.

What is your opinion about continuous training and evaluation of competences? 
Continuous training is very important for the development of excellent medical practice, as it will turn out in our patients maintaining a good quality of life. Certification is absolutely necessary for the medical career and for medical specialties. We have to offer confidence and security to our patients with our medical practice. The great asset that PS offers us is that it opens the doors for learning, formation of new ideas, and practical and efficient application of methods that support physicians in their daily practice, with professionalism and elevated human content. 

There are weekly studies associating burnout with an increased rate of medical error. Does providing specialists with better thinking skills translate into a stress-free, safer, and more reliable clinical practice? 
Burnout syndrome or professional exhaustion is very common. The demands of modern life and globalization make it more frequent, especially among educational professionals, in the health care and hospital environment, and in the areas of business and industry. 

Drs. Christina Maslach and Susan Jackson described the disorder in 1974. It encompasses three dimensions: emotional exhaustion, depersonalization, and poor job performance. The statistics in Mexico show a rate of 4.2%, while in Spain the number increases to almost 15%. 

Stress and professional burnout lead a professional to collapse. Therefore, it is necessary to move the professional to a work environment that is free of stress, calm, safe, and reliable for a good performance in terms of thinking skills, reasoning, and action processes with optimal efficiency. In our medical training, we experience it often as a trainee, intern, and specialist (due to) academic demands and (a requirement for) excellence and high-quality care.

We know that medical error is the third cause of death in the US. Are you aware of the figures in your country? 
I don’t know if we have these figures, and if we do, whether they are reliable. Quality management programs exist at the industry level and in the health care sector, which can paradoxically represent another reason for stress. In my personal experience, I remember a program of quality, assistance, and punctuality at one of the centers in which I have worked.

Could you tell me about the specific context of your health care practice and assess the use of PS in terms of this context? 
PS, as an effective tool in medical practice, leads health care professionals to act with confidence, efficiency, and tranquility, elaborating, with criteria, processes of updated clinical reasoning. With that, the patient will receive excellent care. Consequently, the care will be more fluid, effective, smarter, less stressful, and with fewer errors. 

On the other hand, the cases that PS presents are real. Since I started using PS, I follow with great interest those cases related to fever of unknown origin or with long duration, neuroinfections, tumors, pathologies of the respiratory system, immunological diseases, celiac disease, pneumonia, pleural effusion, and intestinal and cutaneous parasitoses. 

The use of PS provides us with information on clinical cases and reasoning processes, in addition to urging us to intelligently use the acquired knowledge and act with conscience and seriousness, seeking efficiency and effectiveness in our medical practice.