COMPANY / IV Patient Conference of the Spanish Society of Internal Medicine

Internists reflect at ICOMEM on how the doctor-patient relationship has changed and where it should go with an eye to humanism and techno-ethics

The incorporation of technology into routine clinical practice is causing “a transformation in the pattern of social relationships and also in the pattern of health care”

There is an urgent need to reorient the doctor-patient relationship from the point of view of techno-ethics, without forgetting the humanistic approach of person-centered medicine and avoiding clinical practice based only on data and evidence

Technology “should not displace the essence of the doctor-patient relationship based on communication, affection and shared decision-making.” Technological humanism should be advocated in medical practice

Emphasis was also placed on the fact that health professionals are “technically prepared” to face the end-of-life process, but that it is key that future doctors are trained to “give bad news or know how to communicate information about friendly and empathetic to shared decision-making with the patient”

Internists from the Spanish Society of Internal Medicine (SEMI) discussed how the doctor-patient relationship has changed, what it is and where it should go at the “IV SEMI Patient Conference: New Models in the 21st Century” held this past Wednesday at Illustrious Official College of Physicians of Madrid (ICOMEM) and jointly organized by SEMI and the Institute of Clinical Ethics Francisco Vallés.

During the meeting, the rights of patients, respect for their autonomy, techno-ethics and how technology has contributed to changing the relationship between doctor and patient, as well as the need to achieve human-centered and humanistic medicine, were discussed. In the current context in which we live, it became clear that technology is a “very useful” tool that is included in clinical practice so that diagnostic and therapeutic procedures are more precise, but “it should not replace the essence of the doctor – relationship with the patient, which is based on communication, emotionality and shared decision-making”.

The meeting was opened by Dr. Jesús Diez Manglano, President of SEMI, and by Dr. Arantazu Álvarez de Arcaya, SEMI Coordinator of Patient Relations and Coordinator of the Hospital Medicine Clinical Management Unit of Hospital Clínico San Carlos.

Dr. Díez Manglano reiterated at the opening that for the medical profession in general and for internal medicine specialists in particular, “the voice of the patient is and must be fundamental” and emphasized “the comprehensive and holistic vision that characterizes the work of the internist” . Also that “greater attention and commitment to the end-of-life process from the clinical field is urgently needed” and in this sense he recalled the consensus promoted by SEMI-SPMI on good practices in the end-of-life process.

In the words of Dr. Arantzazu Álvarez de Arcaya, SEMI’s coordinator of patient relations: “new technologies have changed the way we treat each other, and this is something we all need to learn to continue creating high-quality medicine , based on affectivity. The challenge is knowing how to integrate new technologies to promote humanistic medicine.”

The end-of-life process

During the day, they reflected on the end-of-life process, a stage where patients find themselves in a situation of “great vulnerability”, both physical, psychological and moral; “not forgetting family and close friends, also greatly affected by the situation from an emotional and vital point of view”.

“The doctor is very prepared to meet the end of life technically: how to interpret the tests, make a prognosis or sedation. However, he will need more training in communication skills as well as more ethical training to meet the end of life, a time when difficult decisions are shared with the patient, taking into account their socio-familial environment, with high emotional cost,” points out Dr. Álvarez de Arcaya, who emphasizes that “care at the end of life must be adequate medically, but also close, empathetic and compassionate. In short, man”.

Humanistic medicine beyond mere evidence and data

The importance of humanistic medicine was also emphasized and clinical practice focused solely on evidence and data should be avoided. “The clinical relationship must be reoriented to effective communication between two people. Technology is important and necessary, as is respect for patient autonomy. But the best thing is that someone guides the whole process with common sense and clinical reasoning, well, a good doctor . Otherwise, medicine will be reduced to just data and tests. It will be reduced to a consumer commodity, far from its true foundation: the best health care for patients.”

In this sense, Dr. Alvarez de Arcaya reiterates that “medicine is a combination of science and humanism. Doctors treat people, and if we want to make medicine people-centered, we need to know, in addition to the scientific aspects, those related to psycho-emotional factors and social complexity. This has been especially relevant in the last two years, during the period of the COVID-19 pandemic.”

Techno-ethics: How to make technology and humanistic medicine compatible?

From the various tables it became clear that technology has invaded our lives and changed our knowledge, behavior and way of communication. And in the environment we live in at the moment, close to technolatry, reflections arise on whether we should do all we can and how to apply ethics to technology (technoethics). Technologies solve social problems and at the same time cause the need to rethink the way we should act, redefine concepts and revise the principles on which we base our actions. “It’s about avoiding misuse of technology so that it doesn’t interfere with people’s well-being.”

In this sense, it was emphasized that “a good doctor must be able to integrate scientific knowledge with other non-technical skills that are essential for the development of what is called ‘medical well-being’, among which are communication skills and emotion management. Internists as specialists with a holistic vision, we have this ability to integrate all aspects of the person: physical, psycho-emotional and social, all of which are essential to be able to accompany our patients and their families throughout the disease process, for the rest of his life,” says Alvarez de Arcaya.

However, it was also reiterated at the conference that “these skills should be taught by medical faculties. Communication is fundamental to the physician’s work; for example, knowing how to communicate bad news is crucial in helping people minimize the emotional impact of illness; or to know how to communicate information in an appropriate and friendly way in order to make shared decisions and thus be able to face serious illnesses from all perspectives”.

Evolution of the doctor-patient relationship

The classic doctor-patient relationship was based on charity. That is, thinking about what doctors think is best for the patient, they decide for the patient himself. This created a type of relationship called paternalistic. In recent decades, the change has been radical, because the rights of patients and above all the respect for their autonomy have been introduced. This completely transformed the clinical relationship model. An information model (information model or template) is proposed in which the doctor and patient exchange information and the patient decides. However, this model has its drawbacks, as many patients want more than just information and advice from a doctor. A doctor’s recommendation as to what is best for him. This pattern or model is called deliberative. In the counseling relationship, doctor and patient exchange information, but also their opinions and evaluations of what is best.