Cuidados críticos: la comunicación como terapia imprescindible

Abstract

Good interpersonal communication improves and facilitates human relationships, granting effectiveness, but the practice of modern Medicine does not consider it as a priority. Critical Care Units are not an exception. Although care is taken efficiently against illness, the patients and their families are not always satisfied with communication between them and caregivers and, at the same time, this is usually identified as the most important and least accomplished factor in the quality of care, mainly in end-of-life processes. Furthermore, advances in life support allow patients with no expectative of recovery to keep on living. Consequently, some patients only die after a decision to forego life sustaining therapies. Decision making about these topics can be very difficult for clinicians. The consensus among different professionals is needed and the involvement of the patient’s family is crucial too. These decisions take place in a very high emotional climate, thus communication, respect and compassionate attitude are essential. The welfare pressure, the lack of training of clinicians in the managing of complex situations, fear, or even the perception of death as a failure of Medicine, can explain, among other reasons, the serious deficit in this field. Integrating the palliative medicine and the skills of communication among the competencies needed for critical medicine would allow to improve the attention to the critical patient who dies and also to help his/her family facing the difficult situation of accepting the reality that has been imposed to them.