key: cord-322052-zsbisk3b
authors: Bohórquez-Rivero, José; García-Ballestas, Ezequiel; Moscote-Salazar, Luis Rafael
title: Letter to the Editor: Humanization of Neurosurgery: Incorporation of a New Concept in Times of COVID-19
date: 2020-08-24
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.06.142
sha: 
doc_id: 322052
cord_uid: zsbisk3b

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Letter to the Editor: Humanization of Neurosurgery: Incorporation of a New Concept in Times of COVID-19 LETTER:

T he practice of medicine has changed nowadays. The increasingly and progressive fragmentation of medical practice, increases in administrative processes, and decrease in physicianpatient communication have immersed physicians in an environment of insensitivity and indifference with regard to the human being. Professionals prefer not to have a patient of their own, but rather to strictly comply with a part of the diagnosis or treatment as specialists, without getting involved or committing to a relationship with the human patient. 1,2 Thus, the patient has been divided into 2 parts: the carrier of the disease (who receives more attention) and the individual (who represents little interest to science). In other words, the perception of a patient as an individual has been set aside. For example, a neurosurgeon sees a brain tumor, and it would be clear to the neurosurgeon that it would have to be removed, but he or she does not think about the person (the individual carrying the tumor), their perception of the disease, their goals, their dreams, their purpose in life, and so forth. This attitude on the part of physicians can produce despair and provoke an emotional crisis in patients. It is a problem that needs a deep restructuring, where a change in ethical values and the establishment of new humanist connections are needed. 3 In particular, the concept of humanizing includes the relationship with the other, sharing a community and empathetic, kindly contact. Humanization in health care is characterized by a set of practices aimed at better care of the person. 1, 2 In this order of ideas, a physician with humanization approaches his or her patient from an integral perspective of the human and scientific knowledge. 2 The process of humanizing medical practice contributes to improving the physician-patient relationship, improving patient safety, and avoiding medical errors. 1 Each historical period has had events to humanize medicine. 4 Neurosurgeons are currently working in difficult circumstances caused by the 2019 novel coronavirus disease (COVID-19) pandemic. Challenges neurosurgeons are facing include, among others, the advent of new technologies, an increasingly impersonal physician-patient relationship, loss of interest in the emotional aspects of the patient, differences in public versus private care, loss of autonomy to make decisions about patients, loss of interest in performing an adequate physical examination, and hospitals becoming increasingly less humanized. As a result, in daily neurosurgical practice and during the process of training new neurosurgeons, humanistic principles receive little attention, and scientific and technical aspects dominate. 3 This situation has led to the incorporation of a new concept during the COVID-19 pandemic: the humanization of neurosurgery. The neurosurgeon has immediate contact with the physical material that constitutes an individual (the brain), and brain manipulation demands well-intentioned actions with beneficial objectives. However, in addition to the fact that such surgical manipulation implies the possibility of a cure, it also includes the possibility of changing the personal characteristics of an individual. 3 Therefore, knowledge and technical skills must be accompanied or surpassed by attitudes of compassion and empathy. 5 The work of a neurosurgeon during this pandemic must be based on 3 fundamental principles, humanism, clinical, and technical, which are closely related. These require a high level of professionalism from specialists and neurosurgery teachers. The greater the professionalism, the more effective humanism will be. It is believed that prioritization of human values and moral norms at each stage of education, capacitation, and neurosurgical practice can prevent the dehumanization of neurosurgery. 3 Therefore, the humanization of the neurosurgeon must begin from the first years of residency, medical school, and even high school, as the development of the ability to communicate and interact with patients and their family members requires time and preparation. 3, 5 Other measures must be implemented in these times to avoid dehumanization and encourage humanization in neurosurgery. Art and literature are powerful sources for humanization and to inspire a sense of wonder and justice in a physician (e.g., studying fine arts, reading sci-fi, listening to music). 3 Similarly, maintaining the quality of hospital treatment and additional rehabilitation therapy to achieve the optimal level of adaptation to daily life and work as well as the treatment of behavioral and emotional disorders caused by a disease is a social duty of the neurosurgeon. Moreover, neurosurgical centers should advocate for the design of models of humanization, including an environment for neurosurgeons, patients, and families that allows informal physician-patient contacts not related to the disease (e.g., conversations on current topics, humanistic use of patient consciousness, and spheres of subconsciousness). 4 Based on the foundation of the Project for the Humanization of Intensive Care Units (Proyecto HU-CI), in Madrid, Spain, 6 we consider that some aspects of this excellent approach can be incorporated into neurosurgical practice. Optimal communication must occur in interactions of neurosurgeons and the medical team with patients and their families. 6 The physician should understand the emotional state of the patient's relatives and try to help, using all available tools. 3 Medical practice should be perceived as human; thus human science and the patient cannot be reduced to diseases. 3, 4 The first priority is promoting the patient's well-being, and the second priority is the preservation of the physical and mental status of the neurosurgeon in accompanying the patient to the end of postoperative and palliative care. The implementation of humanization programs must be mandatory in all neurosurgical services.

Neurosurgery residents must develop humanization skills. The neurosurgery associations of each country should institutionalize the humanization of our specialty. Humanization is necessary in these difficult times. We extrapolate to the current COVID-19 era a statement expressed by Likhterman: "[The] neurosurgeon must not only be Homo Sapiens, but also Homo Moralis. 

Humanization: a conceptual and attitudinal problem

The humanization of medicine

Ethics and factors of humanization of modern neurosurgery

The role of humanities and arts in medical education with special reference to neurosurgery

Care ¼ organisation þ physical labour þ emotional labour

Humanizing intensive care: toward a human-centered care ICU model

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.https://doi.org/10.1016/j.wneu.2020.06.142.