Letter to the Editor
Primum non nocere: When hospital care is unnecessary or excessive
Primun non nocere: cuando el cuidado hospitalario no es necesario o es excesivo
Luis Corral Gudino
Servicio de Medicina Interna, Hospital Universitario Río Hortega, Universidad de Valladolid, Valladolid, Spain
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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:308" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "When hospital care can be improved" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "308" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuando el cuidado hospitalario es mejorable" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Angel Sánchez-Muñoz" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Luis Angel" "apellidos" => "Sánchez-Muñoz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320306710" "doi" => "10.1016/j.medcli.2020.07.044" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320306710?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621004472?idApp=UINPBA00004N" "url" => "/23870206/0000015700000006/v2_202201010922/S2387020621004472/v2_202201010922/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Primum non nocere: When hospital care is unnecessary or excessive" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "309" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Luis Corral Gudino" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Luis" "apellidos" => "Corral Gudino" "email" => array:1 [ 0 => "lcorral@saludcastillayleon.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Río Hortega, Universidad de Valladolid, Valladolid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Primun non nocere: cuando el cuidado hospitalario no es necesario o es excesivo" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The letter from Dr. Sánchez-Muñoz is an excellent complement to the editorial on the excesses of hospital care.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Whereas the editorial focused on the excesses in hospital care with the generalisation of low-value practices, Dr. Sánchez-Muñoz’s letter scrutinises the other side of the coin, all those practices that are not implemented in most of our centres despite proof that they improve the quality of care and the health outcomes of our patients. If, on the one part, there is an excess of limitations (diet, rest), prophylaxis or administration-route instrumentation, on the other there is a deficit when it comes to getting patients “moving”, ensuring their night's rest, or promoting more complete nutrition according to the individual’s characteristics.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are many factors that influence the overuse of certain care practices. I would like to highlight three areas<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>: a) the care structure, where ‘doing something’ is the only route, or where the fear of prosecution of alleged malpractice or the influence of the pharmaceutical industry is often excessive, b) training, which is insufficient, where continual updates for care professionals is lacking, and are always assigned second place after medical treatments or diagnosis updates. And also, the lack of existing evidence for some care practices should be highlighted, c) cultural pressure, as the perception still prevails that the more that is done, the better the result.</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are also many factors that influence the absence of implementing proactive practices to mobilise our patients, improve their rest, and ensure their nutrition. The factors that contribute to the insufficient use of these care tools include the structure of the services, the lack of professionals dedicated to these tasks, and the resistance to change.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">All these factors undoubtedly have a common need for a multidisciplinary and coordinated approach by the different health professionals who care for patients (auxiliaries, physiotherapists, nurses, doctors), but it seems that this is always placed on the ‘pending’ pile.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The times that we have been forced to live through with the COVID-19 pandemic have made the deficiencies of the care system even more evident. As an example, this reference evaluates the decrease in the end-of-life discussions between the patient and his/her healthcare professionals prior to and during the pandemic.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is the perfect opportunity to re-build ourselves by redirecting attention, not only to the treatment of the disease, but also to the best care, centred on the patient, including where possible the recovery of the patient’s quality of life.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Corral Gudino L. <span class="elsevierStyleItalic">Primum non nocere</span>: cuando el cuidado hospitalario no es necesario o es excesivo. Med Clin (Barc). 2021;157:309.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primum non nocere: when hospital care is unnecessary or excessive" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Corral-Gudino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2020" "volumen" => "155" "paginaInicial" => "123" "paginaFinal" => "125" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drivers of poor medical care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Saini" 1 => "S. Garcia-Armesto" 2 => "D. Klemperer" 3 => "V. Paris" 4 => "A.G. Elshaug" 5 => "S. Brownlee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(16)30947-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2017" "volumen" => "390" "paginaInicial" => "178" "paginaFinal" => "190" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28077235" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Levers for addressing medical underuse and overuse: achieving high-value health care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.G. Elshaug" 1 => "M.B. Rosenthal" 2 => "J.N. Lavis" 3 => "S. Brownlee" 4 => "H. Schmidt" 5 => "S. Nagpal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(16)32586-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2017" "volumen" => "390" "paginaInicial" => "191" "paginaFinal" => "202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28077228" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dying from Covid-19: Loneliness, end-of-life discussions and support for patients and their families in nursing homes and hospitals. A national register study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Peter" 1 => "B. Jonas" 2 => "M. Lisa" 3 => "L. 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