The recommended patient syndrome
The recommended patient syndrome[1]
Rev Med Chil. 2012 Oct;140(10):1365-6. doi: 10.4067/S0034-98872012001000022.
[The recommended patient syndrome].
[Article in Spanish][2]
Young P, Finn BC, O'Farrell ML, Ceballos ME, Bruetman JE.
1Servicio de Clínica Médica, Hospital Británico de Buenos Aires, República Argentina. 2Servicio de Clínica Médica, Cooperativa Médica, Concepción del Uruguay, Entre Ríos.
PMID: 23559300 DOI: 10.4067/S0034-98872012001000022
ترجمة للإنجليزية English translation
من جوجل للترجمة
In 2002, the group of Sanz Rubiales published an article recalling a picture called "Recommended Syndrome", which occurs when it is intended to carry out a more careful and personalized care, in people of greater reputation or who have been recommended by reasons of social position, fame, kinship, etc. In these cases, unusual and unforeseen complications appear, many of them difficult to explain1. The term is widely used in Spain, its origin unknown. Its incidence is uncertain but possibly more common than one believes.1'2.
Among its causes are the request for special attention from patients, the misuse of resources, the poor quality of data recording, a fragmentation of the clinical history, lack of leadership in health personnel, over-education. diagnoses, omission of usual studies and inadequate treatment.
Patients refuse to be included in the "routine" of usual practice. The patient's own characteristics, with the interest and care they cause, make the events that in other patients would be assumed as "normal" (delays, forgetfulness, loss, communication problems) in this case to be enlarged, as a " magnifying effect ", and feel more relevant.
Regarding the use of resources, these patients are taken out of the usual place and time (in the corridor, in the guard, etc.), without availability of usual resources and without registration in the clinical history. Citations for consultations and complementary studies are carried out verbally, with what remains to the memory and good will of the patients. It leaves the usual routine, which can lead to omit important steps for diagnostic guidance and treatment. If hospitalization is needed, a room of greater comfort is sought, but not according to the complexity of the patient.
Regarding medical action, an explicit direction in clinical behavior is missing. An ultimate responsible party is not identified. Added to this is a greater feeling of being observed, "examined" by the patient and other colleagues. They intervene, they think, they collaborate and, on more than one occasion, they direct the treatment several doctors simultaneously. Some for obligation, others for family relations or prestige, some by request of the patient or family and a good number for the mere desire to collaborate. The pathology is broken down and different specialists handle each of these problems. Often there is no adequate communication, a reference person is missing and, with it, a common orientation. The lines of action are varied and even contradictory, because they are marked to the rhythm of the doctors' inspiration, outside the usual protocols. This is often something that criticizes the saying: "A doctor, cure, two, doubt, three, certain death." The attention is left in the hands of more prestigious and senior physicians. It is known that in some renowned professionals, their clinical knowledge or prestige is due to the time devoted to research work (clinical and / or basic), teaching and training. Acquire more valid "corridor consultations" in which another doctor, without the need to commit, thinks about a clinical case that arises. However, these comments can provide a biased view, since the person who pronounces them does not know the patient and does not assume direct responsibilities. Other doctors who should collaborate in the diagnosis and / or treatment, limit their participation to avoid being wrong and be judged by colleagues. The doctor with kinship to the patient unconsciously assumes, both on his part and on the part of the rest of the health personnel, the role of reference doctor and it is him who explains the attitudes and who is asked to make decisions .
Regarding diagnostic studies, there is a lack of information about personal history and physical examination, sometimes even on basic data (allergies, regular medication, etc.). The complementary studies requested may not be the most indicated. Two tendencies can be found: on the one hand, that of avoiding aggressive studies, with the intention of not bothering the patient; on the other hand, tend to blood diagnostic tests that are not justified. The reiteration of studies facilitates that false positives are found and that, according to these results, new treatments are established.
Multiple therapeutic options are used, sometimes without a clear line, with the intention of covering all the patient's problems. The use of novel and sophisticated techniques is interpreted as a sample of excellence, in these techniques they have less experience and may not yet have demonstrated a relevant benefit. When these treatments produce unexpected results, a new problem appears, which is the lack of experience in these complications. In case of doubt, it tends to be treated before "waiting and seeing". The indication of medical or surgical treatments is adapted to the principle of "more is better", which defends more aggressive attitudes.
1186/5000
To prevent the appearance of the "recommended syndrome", a complete medical history and physical examination must be performed from the first day (this exploration should not be ignored due to false modesty or out of respect). To archive in the story a copy of all the complementary studies and the comments about the clinical evolution. Respect the order of schedules and citations. Identify who is the doctor who directs or supervises the treatment, who is the point of reference (for the patient, for the family and for the rest of the doctors), that unifies and applies a common criterion. Maintain the same criteria of prudence in the face of diagnostic studies and treatments that are used with other patients. Request the opinion of specialists not related to the case, so that they give an unconditional assessment of the results of certain diagnostic tests.
The best prevention of this syndrome is the study, which allows to have solid clinical knowledge, and try to maintain habitual lines of conduct, the "healthy routine", not departing from the phrase "order exceeds brilliance", which helps to move forward the clinical work of each day.
Referencias
1. Sanz Rubiales A, del Valle Rivero ML, Flores Pérez LA, Hernansanz de la Calle S, García Recio C, López-Lara Martín F. Síndrome del paciente recomendado. An Med Interna (Madrid) 2002; 19: 430-3. [ Links ]
2. Hernández Rodríguez MD, Gea Fernández P, Medina Vargas L, Melgar García AC, Sánchez Pinilla M. Hipertensión arterial dentro del síndrome del recomendado. Hipertensión 2002; 19: 327-8. [ Links ]
