ABSTRACT
Una entrevista clínica bien desarrollada permite orientar de forma adecuada el diagnóstico. Sin embargo, la psicología cognitiva muestra que las personas cometen errores cuando se encuentran con problemas complejos, tales como los que se enfrentan a la hora de hacer un diagnóstico, especialmente cuando disponen de poco tiempo o de recursos limitados. La principal causa de los fallos en el razonamiento clínico es el uso de «atajos cognitivos». Entre ellos, el cierre prematuro es un factor clave desencadenante de error diagnóstico. Los errores cognitivos son predecibles y, por tanto, es posible aprender estrategias para reducirlos o evitarlos. Conocer las características de los atajos cognitivos, e identificar los que se aplican de forma automática, es el primer paso hacia la prevención de errores o la minimización de sus consecuencias(AU)
A well-developed clinical interview makes it possible to adequately focus the diagnosis. However, cognitive psychology shows that mistakes are made when the persons face complex problems, such as those faced when making a diagnosis, especially if time or resources are limited. The main cause of failures in clinical reasoning is using cognitive shortcuts. Among them, premature closure is a key factor triggering a diagnostic error. Cognitive errors are predictable and thus, it is possible to learn strategies to reduce or avoid them. Knowing the main features of cognitive shortcuts and identifying those automatically used is the first step towards preventing errors or minimizing their consequences(AU)
Subject(s)
Humans , Male , Female , Diagnostic Errors/ethics , Diagnostic Errors/statistics & numerical data , Diagnostic Errors/trends , Physician-Patient Relations , Patient Safety/standards , Diagnostic Errors/legislation & jurisprudence , Diagnostic Errors/prevention & controlABSTRACT
A well-developed clinical interview makes it possible to adequately focus the diagnosis. However, cognitive psychology shows that mistakes are made when the persons face complex problems, such as those faced when making a diagnosis, especially if time or resources are limited. The main cause of failures in clinical reasoning is using "cognitive shortcuts". Among them, premature closure is a key factor triggering a diagnostic error. Cognitive errors are predictable and thus, it is possible to learn strategies to reduce or avoid them. Knowing the main features of cognitive shortcuts and identifying those automatically used is the first step towards preventing errors or minimizing their consequences.
Subject(s)
Cognition , Decision Making , Diagnostic Errors/psychology , Physician-Patient Relations , Diagnostic Errors/prevention & control , Humans , UncertaintyABSTRACT
El reconocimiento recíproco es un concepto, surgido del pensamiento filosófico, imprescindible para comprender las actitudes que fundamentan unas relaciones interpersonales pacíficas. Cuando no se da, se establecen relaciones en las que personas o colectivos humanos luchan por ser reconocidos. Excluir a los pacientes de la toma de decisiones concernientes a su salud es no respetar su autonomía y puede hacer que éstos se sientan tratados como objetos, con la consiguiente pérdida de confianza en el profesional. El paciente informado, es decir, con criterio propio y deseos de participar en lo que le concierne, está generando un colectivo de tendencia creciente. El reconocimiento recíproco aplicado a la relación clínica requiere, por una parte, la confianza del paciente en el profesional al que consulta y, por otra, la iniciativa profesional de compartir decisiones con el paciente. Los autores reflexionan sobre el concepto de reconocimiento recíproco, ejemplificando con situaciones posibles en la consulta(AU)
Reciprocal recognition is a philosophical concept that is essential to understand the attitudes that are basic for peaceful personal relationships. When it is not present, relationships in which people struggle for recognition are established. When the patients are excluded from the decision making regarding their health, their autonomy is not respected. This may make the patients feel like they are being treated as objects, with the consequent loss of trust in the doctor. An informed patient, that it, with their own criteria and desires to participate in what concerns them, is generating a group of growing tendencies. Reciprocal recognition applied to the physician-patient relationship need for one hand, the patient's trust in professional consulting and, secondly, the professional's initiative of sharing decisions with patients. The authors reflect on the concept of reciprocal recognition, with scenarios illustrating the consultation(AU)
Subject(s)
Humans , Male , Female , Decision Making/ethics , Decision Making/physiology , Interpersonal Relations , Referral and Consultation/ethics , Referral and Consultation/trends , Decision Support Techniques , Health Manager , TrustABSTRACT
"Reciprocal recognition" is a philosophical concept that is essential to understand the attitudes that are basic for peaceful personal relationships. When it is not present, relationships in which people struggle for recognition are established. When the patients are excluded from the decision making regarding their health, their autonomy is not respected. This may make the patients feel like they are being treated as objects, with the consequent loss of trust in the doctor. An informed patient, that it, with their own criteria and desires to participate in what concerns them, is generating a group of growing tendencies. Reciprocal recognition applied to the physician-patient relationship need for one hand, the patient's trust in professional consulting and, secondly, the professional's initiative of sharing decisions with patients. The authors reflect on the concept of reciprocal recognition, with scenarios illustrating the consultation.
Subject(s)
Decision Making , Patient Participation , Physician-Patient Relations , Cultural Competency , Humans , Informed Consent , Patient Education as Topic , Personal Autonomy , Social ValuesABSTRACT
No disponible
Subject(s)
Humans , International Classification of Diseases , Information Management , Primary Health Care , Information Systems , Family PracticeABSTRACT
No disponible
Subject(s)
Humans , Models, Statistical , Employment , Spain , Primary Health Care , Delivery of Health CareABSTRACT
OBJECTIVE: To evaluate the techniques of DPT vaccination in the nursing child. DESIGN: An observation study of a crossover type. Evaluation by means of an anonymous survey of those responsible for administering the vaccinations. Statistical analysis using the precise Fisher test. PARTICIPANTS: The thirteen official vaccination centres in Health Areas 11 and 12 in the Community of Valencia. MEASUREMENTS AND MAIN RESULTS: 12 centres (91%) answered the questionnaire. Four of them (41%) used different needles to aspirate the contents of the vial and give the injection to the nursing child. The DPT was always administered in the gluteal region. 33% used needles which were 16 mm long. Prophylactic paracetamol was used in two of the Centres as a matter of course. The Centre's size or length of time in use did not affect the techniques used. CONCLUSIONS: There is no uniformity in the technique of administering the DPT vaccine to the nursing child in the different Vaccination Centres of Areas 11 and 12 in the Community of Valencia. The techniques used for vaccinations often differ from those recommended by groups of experts.
Subject(s)
Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage , Vaccination/methods , Cross-Over Studies , Humans , Infant , Needles , Spain , Surveys and QuestionnairesABSTRACT
BACKGROUND: Objective. 1. To know the primary and secondary chief complaints. 2. To obtain health problems incidence and prevalence rates of the population attended. 3. To evaluate the usefulness of a selective morbidity registry, of certain complaints in order to elaborate assistance quality indicators. DESIGN: Descriptive cross-sectional study. Site: Health urban center (Nazaret, Valencia) for primary assistance. PARTICIPANTS: Randomized sample of patients attended during a year (n = 2898). Age, sex and case history number were recorded as well as whether the complaint was chief, secondary, new or known. RESULTS: Among all the problems recorded, the bureaucratic ones (prescriptions) accounted for 11.6% (IC95%: 4.3 +/- 12.8), working disability certificates due to health being 5.1% (IC95%: 4.3 +/- 5.9). Among the patients attended there was an incidence rate of 10(5) year patients in the acute respiratory infections of 12584.3, acute bronchitis was 2516.8 showing the highest prevalence those regarding administrative sources and attention of chronic pathologies. CONCLUSIONS: A morbidity record with the characteristics mentioned leads to the knowledge of the problems of the population attended and to assess some aspects of assistance quality (disease cases avoidable by vaccine, assistance administrative charge, health training activities during the consult ...), especially when these sampling are performed periodically.
Subject(s)
Health Services Administration , Quality of Health Care , Registries , Evaluation Studies as Topic , Female , Health Services/statistics & numerical data , Humans , Male , Morbidity , SpainABSTRACT
OBJECTIVES: To find out the satisfaction's level of the Nazaret (Valencia) Health Center's users; To detect the deficiencies in the areas under study; To find out whether or not there are differences with previous studies in primary care. DESIGN: Transversal study, results evaluation with no equivalent control group. SETTING: (site). Primary health care. Neighborhood of Valencia with 6749 people. With a regressive Sundbarg index, and the 42.6% of the population that are older than nine years are illiterate or with incomplete primary education, the income level index by neighborhood in 1986 is -5.6 (range: 13.4; -8.1). TARGET POPULATION: all the Nazaret Health Center users. The inclusion criteria were: 1. Eighteen years old (or older) users. 2. That had contacted previously for whatever reason (administrative or sanitary) with the health center at least in one occasion during the prior 6 months. The random sample was selected for a 5% maximum error, a 95.5% confidence level, and a p < or = 30% for the negative answers from the scale, its size was 323 patients, with a 20% increase for forecasted no cooperation/no answers (n = 388). INTERVENTION AND RESULTS: The average age of the interviewed was 42 years. The total adding score was 98.1 (theoretical range: 27-135). The score by areas (theoretical range 9-45) was: personal quality area 35.5 professional competence 32.4 and the relationship cost-comfort 30.5. A total (overall) satisfaction item had an average of 7.2 on a 1 to 10 scale, with P10 = 5, P50 = 7, P90 = 10. The analysis of variance shows that satisfaction increases with age, with the attachment to the same doctor, with feminine sex, with unemployment and, with low educational level, being more critic the young people and the people with educational level (not significative difference). CONCLUSION: We consider that users have a good degree of satisfaction, that the ratio cost-comfort should be improved, there is a significative improvement compared with previous studies done with the former primary health care model.
