We must be more open and critical, analyzing and considering information from a broader perspective

DR. EDUARDO ALLEGRINI

Cardiologist at Venado Tuerto Santa Fe (Argentina)

"Regarding my profile, I just want to highlight that I am a clinical cardiologist with 35 years of experience and training at the Argentine hospital General de Agudos Cosme Argerich under the leadership of master Carlos Alberto Bertolas, together with a group of colleagues with whom I shared my professional and human development,” explains Dr. Eduardo Allegrini with the serenity of a veteran. He continues: "In my hometown, I developed my activity of caring and teaching and cofounded our integrated cardiology society at the FAC, which I nurture until today.” Finalizing, the specialist reiterates his gratitude "for being able to access the valuable Practicum Script tool” at this stage of his life.

Madrid - April 8, 2018. As a senior physician, do you consider important to be able to question and compare, thanks to tools like Practicum Script?

I think I can see where this question is going. In life, it is always important to try to be driven by certainty and avoid error, particularly in medicine where mistakes can have a negative effect on our patients’ health, but this is not tied to "seniority" or youth; it is continuous learning, where errors can appear. Tools like Practicum help us improve our knowledge and reduce the chance of errors and their consequences.

As a doctor, I have a long career practicing Cardiology, from my passionate residency (during my training) to the present, I’ve had the opportunity to continue acquiring knowledge over time and a vast experience while practicing clinical Cardiology, thanks to continuing education, from areas such as those provided by FAC and SAC through all their training means (courses, journals, meetings) and everything that we currently have access to through social networks and dissemination of information on the web (which in itself is a lot and sometimes difficult to select and rank).

I believe that a doctor, whatever his age, may arrive at an equivocal or imprecise diagnosis, since there is constant concern to reason pathophysiologically before the patients’ semiological and imaging findings and, thus, approach what we aspire as a goal: the greatest possible accuracy to undertake the most appropriate treatment according to the reference framework of evidence-based medicine, scientific methodology, and our experience.

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Practicum Script has given me a very practical virtual reality using cases carefully presented via computer, in which I can interact with opinions from experts and review arguments from current and digested medical literature, thanks to its compelling source (UpToDate). Unfortunately, being wrong (and I must say that I do not like this expression) sometimes has serious consequences for the patient and negative emotional and legal effects on the acting physician. Medical practice is a very serious issue.

How have these 30 simulated cases contributed to you?
The access to Practicum Script has allowed me, in a special moment of my professional life, to reconnect with the passion of my time as a resident doctor when, in multitude and with a lot of study and anxiety to learn Cardiology, we interacted among peers, seeking to enrich one another, although at that time the access to information was limited. Everything was more difficult. This tool, which is very practical, has been of great value to revitalize my knowledge and my capacity for scientific reasoning through well-presented cases and current literature evidence.

You know that this course affects the debate...

I cannot define a particular case that was more controversial or difficult; there were many, each one with particular nuances, which logically offer debatable aspects. Maybe due to issues of time and personal dynamics, the debate on different topics among the involved professionals could be greater, but I understand that this is not easy to coordinate on a self-correcting platform in which sometimes the opinions and criteria of interpretation and management are so diverse. In this sense, I believe that roundtables in courses and meetings are the ideal setting for those comings and goings sometimes imposed on us when we face a problematic clinical situation.

From your experience as an instructor, why do you think that a curriculum that only contemplates seeing patients in its final stage is still maintained?

As a medical student, I understood that the basic science that makes up the curriculum is essential, which does not mean that one should insist today with the encyclopedism of other eras. Multimedia resources allow a more dynamic and real learning and access to any level of information depending on the interested or required depth. On this solid foundation of basic knowledge, the student's attention can be directed to the patient, which is the focus of our profession, instead of postponing [this attention] until the final training stage. In my experience as an instructor, I often see many communication (semiology) problems in young doctors, which improve through the intensive practice of the medical residency. Today, residency is the best way to complete our training, with the extremely valuable contribution of virtual resources (simulators) and tools, like Practicum Script, which take us close to very interesting clinical situations, practical and extremely useful at any stage of our training (even for ”veteran” professionals).

How important is it to deal directly with the patient?

The care of our patients, who are the focus of our attention, does not stop when their pathologies are resolved; their follow-up in terms of control, treatment, and secondary prevention usually extend over time, according to well-established guidelines. Perhaps this is difficult in large centers and cities, where medicine has been somewhat depersonalized. Also, it is not easy to maintain over time the doctor-patient relationship of affection, understanding, and trust that greatly contributes to the long-term success of our patients’ treatment,  based fundamentally on knowledge, intellectual honesty, and the basic principles of humanism applied to medicine.

Is it better to memorize or reason?

Right now, I would like to declare that clinical judgment can be trained. I think it is the path and the goal we all aspire. Our science is not exact. No matter how hard one tries, a doctor cannot be replaced by the development of diagnostic or therapeutic algorithms. These can only be part of referential frameworks that we should know as much as possible, especially those from expert consensuses and relevant and serious scientific societies.

I do not share the pretense of clinging to standardized models of thoughts and believing that guidelines are the only answer to our professional exercise. We must be more open and critical, analyzing and considering information from a broader perspective and stripping ourselves away from spurious and petty interests that can negatively affect our patients.