El cambiante escenario de la práctica de la medicina y su impacto sobre la salud mental de los médicos: alarmantes señales para los cardiólogos / The changing scenario of the practice of medicine and its impact on the physicians mental health: alarming signs for cardiologists

The introduction of digital technology in Medicine has brought enormous diagnostic and therapeutic advances but also has impacted the practitioner's welfare and important aspects of practice such as patient-physician relations. It has been alarming the increasing reports of physicians and nurse's burnout and associated mental disturbances such as depression and suicidal ideation. Increasing administrative burden brought to the practitioners by the need to document by digital technology patients' encounters has reduced the time of patient-physician relation and substituted by a longer time spend by the provider interacting with a computer. This represents probably one of the major causes of frustration and burnout consequences among health providers, as reported by a recent National Academy of Medicine review, a Mayo Clinic Proceedings study published in 2019, several recent Medscapes physicians surveys and by a panel discussion in the 2018 European Congress of Cardiology among many other publications. Many factors are indeed at play in this complex scenario such as government, payers, hospital facilities rules and regulations, and the way to modify them to create a more provider friendly environment may be long and difficult. Nevertheless, a first step to be considered is to reduce the administrative burden of the providers to free more time for them with their patients The future role of using diagnostic and therapeutic algorithms, some of them already available, to develop platforms of patient management with a reduced or minimal medical provider force is still uncertain and likely subject to controversial value and ethical considerations.

Low prevalence of relevant findings in inappropriate echocardiograms and discordant perceptions between cardiologists and patients

Complementary examinations are "inadequate" whenever the likelihood of benefits from their indication is lower than the negative results. The low benefit is a result of poor performance in detecting relevant changes that lead to improved behavior. However, inadequate examinations are prevalent and little is known about patients' notions of the usefulness of such indications. The aim of this study was to describe relevant findings in inappropriate echocardiograms and to assess the level of agreement between patients and cardiologists regarding their usefulness. Adults without known cardiovascular disease who were referred for echocardiogram by inappropriate criteria according to the American College of Cardiology were selected. Relevant findings were defined by any change in the degree of moderate to severe, according to the American Society of Echocardiography. We tested the level of agreement between the patients who underwent echocardiographic examination and the physicians who requested the exam through a standard questionnaire. Five hundred patients were included, with average age of 52±17 years (47% males). Only 17 patients had any relevant changes (3.4%, 95%CI=2 to 5.4%). The most frequent alterations included valve changes in 8 and diastolic dysfunction grade II in 6 patients. Eighty-seven examinations were performed to determine the level of agreement between patients and cardiologists. For the question "Is this test really necessary?", 92% of patients responded positively, compared with 5% of cardiologists (Kappa negative 0.04; P=0.01). The frequency of relevant findings was low in inadequate echocardiograms and patients and cardiologists had a different perception regarding its usefulness.