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Experience allows us to reach a diagnosis just by observing the behavior of the patient, his cough, or the way he walks

DR. JORGE ANTONIO LÓPEZ GUTIÉRREZ

Pediatric Emergency Physician, Hospital Regional ISSSTE, Mérida, Yucatán (Mexico)

Attending physician in the Pediatric Emergency Service of Hospital Regional ISSSTE in Mérida, Yucatán (Mexico), Dr. José Antonio López Gutiérrez believes that the value of Practicum lies in the fact that it provides continuous knowledge update and a possibility to accumulate experience through the simulation. "I can’t diagnose efficiently what I don’t know," he says. This and, particularly, the implementation of thinking skills are areas covered by the simulator.

Madrid - October 5, 2018. How is your work environment and what type of patients do you see?
I am a pediatrician in the Pediatric Emergency Service of Hospital Regional ISSSTE in Mérida (Yucatán). From an economic point of view, I see middle-class patients. Infectious conditions requiring hospitalization have decreased substantially due to successful immunizations and new therapeutic strategies such as RO, nebulizations, etc. We have now an increasing number of patients with cancer, as well as immunologic and allergic problems.

How does Practicum Script fit into your care practice?
It is greatly helpful to keep us updated and for case review, but above all, it reinforces our clinical reasoning in the various pathologies that the patient in front of us may present on a daily basis.

What benefits does the simulator offer for specialists? 
The importance, definitely, is that it requires from us before each clinical case to solve the different clinical situations in terms of diagnostic methodology and decision making on clinical and laboratory tests, differential diagnosis, and therapeutic options. We often don’t get to see the types of cases presented, given the type of institution in which we work.

Do you think this simulation exercise reinforces your confidence in making decisions for the patient? 
Without any doubt. After reviewing a given clinical presentation and seeing a patient with similar symptoms, we immediately remember the diagnostic methodology and the differential diagnosis. This allows us to administer the best possible therapy. 

Do you think medical errors are associated with gaps in clinical reasoning?
I think this is correct. These errors are due to deficiencies in clinical reasoning, and these deficiencies, in turn, occur because general pediatricians (or pediatricians with a subspecialty) always have gaps in some specific fields in which knowledge is insufficient, given the vertiginous pace of medical advances. I can’t diagnose efficiently what I do not know, and here lies the importance of Practicum Script.

Medicine is not an absolute science. How is medical error addressed in Pediatrics and Neonatology? 
I personally believe that medical errors in Pediatrics and Neonatology, as in other specialties, should be addressed by trying to correct them, updating diagnoses and flowcharts, and seeking knowledge update, in general, to ensure that we do not err again. 

What do you think about comparing your results with those from a panel of experts?
I am not bothered by confronting my knowledge with that of others considered to be experts. They select the cases looking for challenges for those who try to solve the clinical situations, but in many occasions, I have given answers that were only considered incorrect due to semantics or because I looked at a clinical situation from a different perspective but with the same objective. (Practicum Script has been working with machine learning engineers and regional auditors to solve this issue of semantics.)

How do you deal with dilemmatic situations without categorical evidence?
When I do not know for sure a patient’s diagnosis, I try to adjust my decisions as much as possible using approximations. For example, if I believe that the problem is infectious, I may empirically choose antibiotics while waiting for culture results and other studies, in addition to offering general supportive measures while searching for support in the subspecialty that I consider necessary in that case. Complementary clinical and laboratory tests offer great support.

Your years of experience are a guarantee. What role does clinical expertise play in patients who fall outside the norm?
The famous clinical eye doesn’t exist. What exists is the experience of many years of examining, evaluating, and managing hundreds and thousands of patients. This often allows us to observe the patient's behavior, his cough, and the way he walks, lies down, or responds, in order to reach a diagnosis that is very close to the real one. On many occasions, this happens without clinical or laboratory tests.

You know that the cases are real. Do you really observe a translation of what is presented in the simulation exercise to your care practice? Can you mention a specific case?
The clinical cases and our routine care are definitely very similar in the areas of Infectious Diseases, Gastroenterology, and Oncology, among others. There are too many cases to mention just a single one.

 

Testimonies

For me, the program is very interesting, since it allows me to sharpen my interrogation and direct it more towards a specific pathology and to have more knowledge of laboratory and cabinet exams. I think it is very important that we keep our medical sagacity throughout our practice and that in the few minutes it takes to answer any of the cases that Practicum Script presents, you acquire more knowledge.

Dr. Miguel Olivares Alcocer

Pediatrician in Guanajuato (Mexico)

I would like to express my gratitude to the Practicum Institute of Health Sciences Research for the opportunity given to Latin American physicians  to access and take different courses of our specialty for the benefit of our dear patients, in my case in Mexico. It has encouraged me to improve myself and keep abreast of the advances in Pediatrics and put into practice the knowledge acquired in the hospital where I work. Thanks friends and congratulations to this valuable team of Practicum Script Education.

Dr. Heriberto Fuentes García

Pediatrician in Sonora (Mexico)

I am grateful for this study tool that, through Nestlé and with this method, allows us to review different issues with cases that confront us in decision-making and serve us in the daily consultation.

Dr. Josué Refugio de León Padilla

Pediatrician in Jalisco (Mexico)

It is an excellent educational support platform for the pediatrician, offers very specific clinical challenges with alternatives for diagnosis and differential diagnoses, with the support of experts, a bibliography and a forum to share opinions. It's easy to navigate and it's fun, a tool that's worth using and making the most of it.

Dr. Guillermo Yanowsky-Reyes

Surgery Pediatrician in Guadalajara (Mexico)
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