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Francesc Borrell-Carrió

Publications and source records attributed to Francesc Borrell-Carrió.

4 recordsLinked to original sources
PubMed2006

[Clinical error and adverse events: Primary care doctors perception].

OBJECTIVE: To evaluate how primary care physicians perceive and face clinical errors (CE) and/or adverse events (AE). DESIGN: Cross-sectional study (personal mail survey). SETTING. Primary care physicians from "Ambit Costa de Ponent." PARTICIPANTS: All doctors with tenure from this area (717). MAIN MEASUREMENTS: Standardized questionnaire with error and adverse event frequencies. We compared answers considering age, gender, family medicine residency, "deniers" (never make a mistake), "perceptive" (admitting a mistake in the last year), "hyper-perceptive" (28 or more errors/adverse events a year), "internal locus of control" (admitting personal reasons in errors), and "hypersecure" (>7 points out of 10 in clinical security on Likert scale). RESULTS: Two hundred thirty eight physicians (33.2%) with an average age of 42.6 (95% CI, 41.6-43.6) replied. The 28% were "deniers" (95% CI, 22.34-34.26), 67% "perceptive" (95% CI, 60.79-73.23), 7.4% "hyperperceptive" (95% CI, 4.41-11.44), 6% had "internal locus of control" (95% CI, 3.34-9.91), and 23.4% were "hypersecure" (95% CI, 18.14-29.22). Every doctor had on average 10.6 adverse events yearly, mainly drug side-effects (37%) (95% CI, 35.36-39.15), and diagnostic delay in oncology scenarios (33%) (95% CI, 31.16-34.85). The most common reaction to an error was to try and contact the patient (80%) (95% CI, 73.24-85.73) and to communicate the case to the team (41.4%) (95% CI, 33.97-49.22). CONCLUSIONS: AE and CE were recognized as frequent, but a third of doctors affirmed they never made a mistake. Young male physicians, unlike senior ones, communicate mistakes to the team. "Internal locus of control" and "hyperperceptive" professionals tended to have stronger emotional reactions after committing errors. Physicians felt less secure with ophthalmology and ENT problems; and older doctors added to these dermatology and palliative care.

Adult↗
PubMedDate not supplied

The biopsychosocial model 25 years later: principles, practice, and scientific inquiry.

The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient's subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care. In this article, we defend the biopsychosocial model as a necessary contribution to the scientific clinical method, while suggesting 3 clarifications: (1) the relationship between mental and physical aspects of health is complex--subjective experience depends on but is not reducible to laws of physiology; (2) models of circular causality must be tempered by linear approximations when considering treatment options; and (3) promoting a more participatory clinician-patient relationship is in keeping with current Western cultural tendencies, but may not be universally accepted. We propose a biopsychosocial-oriented clinical practice whose pillars include (1) self-awareness; (2) active cultivation of trust; (3) an emotional style characterized by empathic curiosity; (4) self-calibration as a way to reduce bias; (5) educating the emotions to assist with diagnosis and forming therapeutic relationships; (6) using informed intuition; and (7) communicating clinical evidence to foster dialogue, not just the mechanical application of protocol. In conclusion, the value of the biopsychosocial model has not been in the discovery of new scientific laws, as the term "new paradigm" would suggest, but rather in guiding parsimonious application of medical knowledge to the needs of each patient.

Delivery of Health Care↗
PubMedDate not supplied

Preventing errors in clinical practice: a call for self-awareness.

While ascribing medical errors primarily to systems factors can free clinicians from individual blame, there are elements of medical errors that can and should be attributed to individual factors. These factors are related less commonly to lack of knowledge and skill than to the inability to apply the clinician's abilities to situations under certain circumstances. In concert with efforts to improve health care systems, refining physicians' emotional and cognitive capacities might also prevent many errors. In general, physicians have the sensation of making a mistake because of the interference of emotional elements. We propose a so-called rational-emotive model that emphasizes 2 factors in error causation: (1) difficulty in reframing the first hypothesis that goes to the physician's mind in an automatic way, and (2) premature closure of the clinical act to avoid confronting inconsistencies, low-level decision rules, and emotions. We propose a teaching strategy based on developing the physician's insight and self-awareness to detect the inappropriate use of low-level decision rules, as well as detecting the factors that limit a physician's capacity to tolerate the tension of uncertainty and ambiguity. Emotional self-awareness and self-regulation of attention can be consciously cultivated as habits to help physicians function better in clinical situations.

Awareness↗