What patients consider to be a good doctor, and what doctors consider to be a good patient / Cómo definen los pacientes a un buen médico, y cómo definen los médicos a un buen paciente

ABSTRACT Background: From a patient's point of view, an 'ideal' doctor could be defined as one having personal qualities for interpersonal relationships, technical skills and good intentions. However, doctors' opinions about what it means to be a 'good' patient have not been systematically investigated. Aim: To explore how patients define the characteristics of a 'good' and a 'bad' doctor, and how doctors define a 'good' and a 'bad' patient. Material and Methods: We surveyed a cohort of 107 consecutive patients attending a community teaching hospital in February 2019, who were asked to define the desirable characteristics of a good/bad doctor. Additionally, a cohort of 115 physicians working at the same hospital was asked to define the desirable characteristics of a good/bad patient. Responses were subjected to content analysis. Simultaneously, an algorithm in Python was used to automatically categorize responses throughout text-mining. Results: The predominant patients' perspective alluded to desirable personal qualities more importantly than proficiency in knowledge and technical skills. Doctors would be satisfied if patients manifested positive personality characteristics, were prone to avoid decisional and personal conflicts, had a high adherence to treatment, and trusted the doctor. The text-mining algorithm was accurate to classify individuals' opinions. Conclusions: Ideally, fusing the skills of the scientist to the reflective capabilities of the medical humanist will fulfill the archetype of what patients consider to be a 'good' doctor. Doctors' preferences reveal a "paternalistic" style, and his/her opinions should be managed carefully to avoid stigmatizing certain patients' behaviors.

Antecedentes: Desde la perspectiva del paciente, un médico "ideal" podría definirse como aquel que tiene cualidades para las relaciones interpersonales, habilidades técnicas y buenas intenciones. Sin embargo, las opiniones de los médicos sobre lo que significa ser un "buen" paciente no se han investigado sistemáticamente. Objetivo: Explorar cómo los pacientes definen las características de un "buen" y "mal" médico, y cómo los médicos definen un "buen" y "mal" paciente. Material y Métodos: Encuestamos a una cohorte de 107 pacientes consecutivos que asistieron a un hospital comunitario en febrero de 2019, a quienes se les pidió que definieran las características deseables de un médico bueno/malo. Además, se pidió a una cohorte de 115 médicos que trabajaban en el mismo hospital que definieran las características deseables de un paciente bueno/malo. Las respuestas se sometieron a un análisis de contenido. Simultáneamente, se utilizó un algoritmo en Python para clasificar automáticamente las respuestas mediante minería de texto. Resultados: Los pacientes aludieron que las cualidades personales del médico eran más importantes que la competencia en conocimiento y las habilidades técnicas. Los médicos estarían satisfechos si los pacientes mostraran características positivas de personalidad, fueran propensos a evitar conflictos, tuvieran una alta adherencia al tratamiento y confiaran en el médico. El algoritmo de minería de texto clasificó las opiniones de los encuestados en forma precisa. Conclusiones: Idealmente, fusionar las habilidades del científico con las capacidades reflexivas del médico humanista cumplirá con el arquetipo de lo que los pacientes consideran un "buen" médico. Las preferencias de los médicos revelan un estilo "paternalista", y sus opiniones deben manejarse con cuidado para evitar estigmatizar los comportamientos de ciertos pacientes.

Phytoplasma and virus detection in commercial plantings of Vitis vinifera cv. Merlot exhibiting premature berry dehydration

A new and devastating physiological disorder of Vitis vinifera cv. Merlot was recently reported, known as premature berry dehydration (PBD), which is characterized by plant growth reduction, induction of general senescence and pedicel necrosis in the fruit, causing significant reductions in vineyard production. The causes of this disease remain unclear and previous reports suggest that it may be associated with phloem disruption and water provision. For this reason, any factor causing phloem disturbances could cause an important change in the berry water status. As some micro-organisms have been reported to disrupt phloem flow, we analyzed the occurrence of phytoplasma and viruses in commercial vineyards presenting PBD. In this study, a phytoplasma was detected by electron microscopy and nested PCR while virus infections were diagnosed by RT-PCR in samples collected during two growing seasons. The presence of phytoplasma only in samples from grape plants with PBD suggests that this pathogen may be one of the causal agents of this disorder. We suggest that the influence of other factors, such as virus infections, agronomic handling and environmental conditions also modulate berry dehydration. This is the first study at the microscopic and molecular levels that correlates phytoplasma presence with PBD.