Post Covid-19 Doctor-Patient Relationship Model. Creation of Social Connection Contexts With Physical Distancing

The coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 has produced a significant change in the way general medicine is conducted. This shift has been remarkably quick towards telecare. The form of the clinical interview has changed, and with it communication and the doctor-patient relationship; Before COVID-19, all communication techniques and doctor-patient relationship, which were considered tried and true to establish a good relationship with patients, involved physical proximity 2. Now in many European countries and in the United States face-to-face consultations have been reduced to 10-20%, with most contacts now being provided remotely using symptom checkers, electronic messaging, and phone or video consultations 3.

General Doctor's Consultation Work Begins before Entering the Patient and does not End when Patient Comes Out

The consultation is the activity of meeting and communication between an individual and the doctor for the knowledge and solution of a health problem. In today's busy world of general medicine, constant demands for the general practitioner (GP) arise: she or he should not only make a diagnosis not only should make a differential diagnosis during consultation, but must also establish a good relationship, explore patient ideas, concerns and expectations and negotiate a management plan, taking into account limited resources, the quality framework and results, having Information technology skills, plus, the need to promote health during any consultation. Normally the GP has only 10 minutes to achieve all that, as well as to manage your own emotions, agendas and uncertainty. In this way, novice doctors may find it difficult to move in this situation of complexity, and they can also observe a gap in the literature that really guides them in practice. Rigorous preparation is the key to success for many endeavours. Some tips to perform an efficient and safe consultation work in general medicine are suggested: 1) Focus on the next patient; 2) Preparing the consultation before entering the patient, memorizing the patient's previous history; 3) Establishing a connection with the patient; 4) Remembering the elements that must be in each consultation (the current reason, update other previous processes, chronic diseases and continued attention, "case finding", health promotion); 5) Striking a balance between empathy and assertiveness; 6) Putting in writing and contextualized the clinical record; and 7) Making reflection-safety questions, learning questions, and preparation questions for the next visit. Rigorous preparation is the key to success for the general practitioner in every consultation. Think about these topics of the consultation before doing it, and after it, prepare the next consultation of that patient. All these things are force multipliers.

Patient Safety and Clinical Risk Management for General Practice

General practitioners are the first contact between the person, the family and the community with the health system. The philosopher and epistemologist K. Popper (1902-1994) recommended the need to register errors, in order to know them, catalog them and therefore prevent them. J.Reason in 1963 introduced the systemic approach to the study of errors with the theory of latent errors. The knowledge of the causal factors, or which in any case contribute, of possible errors, as well as of the latent gaps in the system, is a fundamental prerequisite for the construction of paths aimed at improving the quality of assistance, structures and organizational aspects.

Care in Chronic Diseases and in "Frail" Patients in General Practice

The world of chronicity is an area in progressive growth that involves a considerable commitment of resources, requiring continuity of assistance for long periods of time and a strong integration of health services with social ones and those requiring residential and territorial services often not sufficiently designed and developed. The fundamental aim of the treatment of chronic systems is to keep as much as possible the patient at home and prevent or reduce the risk of institutionalization. GP could put their expertise to good use in the Complex of Primary Care Units and Territorial Functional Aggregations, reducing the costs of the health service.

Medical Concepts with Clinical-Epidemiological Implications that have to be Re-Assessed Since the Coronavirus Disease 2019 (Covid-19) Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is something new that baffles us. The dominant health model and the theory that supported it until before COVID-19 are refuted or invalidated by observing the current tragically situation, which also implies lasting changes in that new medical model. Consequently, once the urgency of the epidemic is over, the conceptual and organizational building of medical care can no longer be rebuilt in the same way. Based on the COVID-19 experience, it is necessary to rethink what kind of knowledge can emerge. Some of the concepts with clinical-epidemiological implications that have to be re-evaluated since the COVID-19 pandemic are: 1. Large epidemics or changes do not arise from an event similar to the "Big Bang", but rather they develop slowly and underground, so a surveillance system must be instituted; 2. Re-evaluate what we understand by "evidence-based medicine"; 3. Patient-centered care is inadequate and must be replaced by community-centered care; 4. Telecare and changes in the organization of consultations; 5. Hospitals and health centers are "biological bombs" that act as vectors of disease and must change their architecture, organization and use; 6. The end of the nursing home model; 7. Change of habits; and 8. Social media can democratize information and help communities organize.

Practical Methods to Improve Client Compliance in General Medicine

There is a gap between theoretical knowledge about strategies and the techniques or methods to apply in the practice of the consultation to improve compliance. Within the framework of these strategies, a number of techniques to be used in certain situations can be cited: 1) Assessing readiness to change, importance and confidence; 2) Instruments for decision support; 3) Technique of the "pros and cons"; 4) Auto-monitoring techniques; 5) Technique of "information exchange"; 6) Feedback technique; 7) Brainstorming; 8) The “typical day”; and 9) Practical reminder systems for taking medication. A certain technique is not a universal procedure, but it is usually refined by trial and error, based on past experiences, and their choice and design are the responsibility of the general practitioner.

Looking for the Best Journey: Real Methodology of Research in General Medicine

The research methods that the researcher uses are one of the most important parts of a study. But, classically, it is said that the initial question must be "What do I need to know and why?" Only after that, you can decide the method that best suits the particular purpose of the study is chosen. But, this article aims to put the "scientific method" in real life in general medicine and primary care, and so the “process of searching for the best research study” is like when we want to find the best time to buy airline tickets: we must look for cheap flights without a date or destination; without a predetermined and invariable research objective. “It's much easier to find deals on flights than hotels.” It is easier to have a research method available (accessible, useful, and possible) than to clearly specify an objective or research topic. There are times when the destination of our trips is based on a good offer of flights. Once we have the method / design, we can decide on the objective to achieve (more modest, grander, etc.). So, be flexible with your objective. When you see a good possibility of conducting a research study, for having the research methods do not let it escape because of the topic or research objective. In research, as in travelling, the adventure is very exciting.