“The obstinacy” in the diagnosis.
We’ve all heard of “therapeutic obstinacy” and all, or nearly all the members of today’s society, we agree, when there is a justified suspicion that approaching death, not continue with the therapeutic efforts in the struggle for the patient’s life, beyond what is ethically recommended,
It took years but right now all, or almost all, we accept failure to follow that effort “beyond logic foreseeable end”.
The “therapeutic cruelty” have an economic and social cost. One reason for rejection is “not to prolong the agony” (of the sick and their families) and another is the absurd use of health resources as no real counterpart in terms of health. Deny the death as reality.
The therapeutic cruelty leads an economic cost and also a high cost of family suffering and exertion, in terms of social solidarity.
The” therapeutic cruelty” leads an economic cost and exertion “material and psychic” in terms of social solidarity.
This way of thinking ( and acting) is generally accepted in our society. Poor content concepts evanescent like ” Death worthy ” (apparent contradiction), have a clear meaning and accepted in the society . The idea is clear to anyone who reads it.
We have laid the principle of social acceptance of NO to the “therapeutic cruelty”.
How long we will continue with the denial of the existence of the “abuse of diagnostic tests “?
The plain fact is that it exists and is, in large part, motivated by the desire both of the citizen as by the need to maintain a “market” of health assistance it generates (it spends…) between 6.8 % to 21% of GDP in developed countries.
In the case of “cruelty” or “bitterness DIAGNOSIS” questions they are:
The diagnostic test than was ordered Is ethically justified in terms “objective” health benefit to the patient?
Gives us added value for diagnostic ? What degree of sensitivity and / or specificity has for reach an etiologic diagnosis, or patonogmónico, from the disease what have patient?
On a diagnosis of clinical suspicion if we request one test more What more evidence to medical treatment for the patient this gives us ?
In this case the questions are:
- The diagnostic test than was ordered Is ethically justified in terms “objective” health benefit to the patient?
- Gives us added value for diagnostic ? What degree of sensitivity and / or specificity has for reach an etiologic diagnosis, or patonogmónico, from the disease what have patient?
- On a diagnosis of clinical suspicion if we request one test more What evidence more gives us in medical treatment for this patient ?
- With these diagnostic tests: we the possibility of expanding our understanding of the evolution that will follow this patient?
This diagnostic test :
- gives us more details of disease ?
- What degree of sensitivity and / or specificity has for reach an etiologic or patognomonico?
- . is the “test diagnosis” what gives us more details of disease?
- We think is clinical study the patient “the point of view” initial for your correct diagnosis?
The request that another test Does it lead to a better choice of alternative treatment ? , Or we will continue with the same treatment because as that test gives us no real possibility to improve the treatment than leads the patient?
These, I think, are important reasons for “not to prolong the agony” (the sick and their families) and another is the absurd use of health resources with no real counterpart in terms of the diagnostic test that its realization is requested … Is clinical, and ethically, justified in terms of health benefit “objective” for the patient?
In the end, and at the present time, we must ask: Is it correct to feed false hopes of healing or improvement, both the patient and his family, if we asked for more test of diagnosis with no real evidence its specificity for medical treatment?
Economic resources in health care are limited Does the cost / benefit relationship is socially acceptable and ethically justifiable?
If we Increase, without analysis of specificity and sensitivity of the tests, our requests for Determinations to arrive at a clinical diagnosis and the added cost of testing, or Their repetition over time not absolutely Necessary for the diagnosis: Its cost is valid and socially acceptable ?