“You have to teach the psychosocial part of the patient”

The motto of Spanish Society of Internal Medicine (SEMI) is “the global vision of the sick”. For Arántzazu Álvarez de Arcaya, your patient relations coordinator, there is nothing better defining the internist than that global and integrative vision.

The medical society organizes its third patient conference focused on attention to the disability and the gender vision, two issues that go beyond treating a disease and require that vision. To broaden this perception, the event also includes a speech on the care of Turkana women, a Kenyan people, at the hands of Carmen Hernandez-Perez, medical director of the Cirugía en Turkana organization.

What news await us in this third edition of the conference for SEMI patients?

This is the third day we have with patients. From SEMI we are clear that we have to transform our model and for this we have to incorporate the patients’ perspective and experience. As a result of that firm belief, we started organizing the first day 3 years ago.

We raised them on the basis of the issues we felt were most relevant at the time and the path we wanted to follow. The first year we talked about shared decision making, ways to better train patients, how to incorporate ethics into decision making … The second day we focused on patient safety in shared decision making and aging.

This year we have chosen two themes that seemed important to us from before and in the context we lived through are more relevant: disability and gender inequalities. Disability does not necessarily mean talking about illness, is a group that must be given a voice. Our health model is focused on acute pathologies with characteristic profiles, and the patient has changed in recent years, with chronicity and advanced age, which usually lead to disability. There are elderly people who do not have a disease in themselves but have a disability.

As for gender, pathologies are not treated in the same way. There are many studies from a professional point of view, but there are also patient-led studies that address this problem.

Are these two realities that are not very visible in the daily life of the doctor, of which little account has been taken?

If something has highlighted the situation we have experienced in this country in relation to the pandemic, it is that we must transform our health model, because it is aimed at acute patients, with specific pathologies, who cure them and solve the problem. But there is a group that does not obey this, and it is the one linked to chronicity, aging, vulnerable people … Among them are people with disabilities.

There is news that has recently come out about these groups in relation to the pandemic that gives food for thought, and it is something that needs to be put on the table. When we say we want to transform the model, what do we mean? That we want an updated health model to address, in a complete, integrative and personalized way, the needs of all people: with acute processes, with disabilities, with vulnerabilities … and takes into account other inequalities in relation to gender. There are diseases that have a different presentation in women than in men.

What challenges do these two questions pose in medicine?

We all talk about creating a comprehensive, inclusive, and personalized care model. These are the challenges. For what, you have to start by knowing what they need, they have to verbalize it to you, and there is no better way than to incorporate their perspective and experience, to be able to tailor care processes to what people need.

We have chosen disability and gender this year because the differences in this sense are becoming more and more relevant.

Is the Internal Medicine practitioner better trained than others for this approach?

If we are known for something as internists, it is precisely because we have that global and global vision. We are general practitioners, we have that global vision of one person. We do not dissect into parts: we incorporate the clinical, social, psycho-emotional part …

It is very important to know the biopsychosocial impact of the disease on people, or of vulnerability or disability, and of course also that of gender. That For internists it is very easy because our education and training has been like this, but these ideas need to be reinforced. All this must be taught by the faculties, so that all doctors have that vision.

Is training on gender and disability necessary in the MIR, not just that of the Interior?

All this must start from the faculties. There they teach us about diseases, how to treat and cure them. We learn the pathophysiology, pathogenesis, etc. But there is all that psychosocial part, which accompanies the biological part, which is relevant or more than the biological part.

High-value medicine is achieved by doing this, incorporating all of this but from their point of view, not what we think they need.

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