Dr. Daniel Gaitán Román is in charge of the cardiological assessment of patients before kidney, pancreas, and liver transplantation at the Carlos Haya Hospital in Málaga (Spain). He completed his training in cardiac imaging at the Vall de Hebrón Hospital in Barcelona, University of A Coruña, and Clínico Hospital in Madrid. He has several master’s degrees, has given 200 presentations in meetings, and has written chapters of books and published in journals with impact factor. Along with that, he also teaches. He recognizes that Practicum Script has changed his perspective on managing some conditions.
Madrid, December 18, 2018. For some, simulation has a certain negative connotation. What advantages do you see in it?
Simulation is an interactive learning method that allows specifying a relationship between the abstract (clinical practice guidelines) and the reality (real patient), enabling us to recall concepts, relearn things that were previously studied, and interact with other colleagues and teaching staff. This allows you to incorporate into your medical practice new tests and ways to approach diseases according to evidence-based medicine, always with an eye to consensuses and discussing different ways to deal with medical problems.
What has this course particularly brought to you?
It has been an enjoyable course that has reminded me of concepts of physiopathology, clinical management, and complementary tests. In some situations, it has even changed my perspective on the management of some conditions, by corroborating changes in medicine based on evidence and bringing awareness of pros and cons of tests that I often do not request, which in certain situations can provide valuable information.
What if I ask for an example that catalyzed this learning?
Yes, a case with renal artery atherosclerotic disease, which reminded me of the usefulness of radionuclide renal scan, MRI, and CT.
Is it better to memorize or to reason?
In medicine, memorization is fundamental: you need the knowledge to be able to think about illnesses, but without reasoning, you are exposed to malpractice. You must use the foundation of a previous memory and reason about the best way to handle each case, at each moment, with each patient, and at each situation.
To what extent is it helpful to have environments with controlled simulation and to be able to rely on previous cases, as lawyers do in terms of jurisprudence?
They guide you a lot towards the objective of fulfilling your goal. I would even have a glossary of possible tests, in which by writing 3 letters, the system would offer a suggestion; this would prevent problems with local denominations at different sites. Being able to have management data in a similar case is very beneficial and helpful in consolidating knowledge.
Beyond the statistical mass, how do we treat the individual?
The most important thing is to consider the human dimension. In the heyday of humanistic medicine, we deal with people with specific individual characteristics and social, economic, and family situations that are not taken into account in protocols, guidelines, and recommendations. Unfortunately, in the current state, this way of dealing is greatly mediated by the economy in regard to the sustainability of the healthcare system in public medicine and the possibilities of the patient in private care. We sometimes lose touch with the essence of medicine: a physician must practice to help a patient recover or improve his health or to offer him the highest possible quality of life depending on the situation.