RESUMO
In surgery, the construction of knowledge is shaped in two scenarios: evidence-based medicine, and experiential learning. The former has become an essential pillar in this process. Based on this fact, clinical practice guidelines have been developed. However, their transient nature, constant renewal, and lack of individualization distance them from daily clinical activity. On the other hand, there is the construction of knowledge through vicarious and experiential learning. Its existence is linked to the beginning of medicine, and its importance is irrefutable. However, it is laden with the "truth effect", surgical dogma and singularism. When integrating the construction of knowledge in these scenarios, critical thinking skills are paramount and necessary to guide the surgeon in the decision-making process within the context of surgical dynamism. This article explores this situation and its impact.
RESUMO
Abstract The development of venous thromboembolism (VTE) in surgical patients is a serious public health problem since it increases morbidity and mortality rates, as well as the costs associated with in-hospital care for this population. Notwithstanding the above, and although their effectiveness has been demonstrated, prophylactic measures are not properly used in these patients in Colombia. A possible cause of this situation is the poor adherence of health professionals to clinical practice guidelines (CPG) addressing the prevention of VTE. In this regard, several methodological approaches to achieve an adequate implementation of thromboprophylaxis by transforming physicians' behaviors have been described. However, to accomplish this, it is necessary to comprehensively consider the multifactorial barriers and sociological conditions that underlie this problem. Better adherence to VTE prophylaxis CPGs is known to lead to better clinical practice. Therefore, the aim of this paper is to carry out a reflective analysis of the causes and possible solutions to the low adherence of Colombian health professionals to these guidelines.
Resumen El desarrollo del tromboembolismo venoso (TEV) en pacientes quirúrgicos representa un serio problema de salud pública, pues aumenta las tasas de morbimortalidad y los costos asociados con la atención intrahos-pitalaria de esta población. No obstante lo anterior, y a pesar de que su efectividad ha sido demostrada, en Colombia las medidas profilácticas no son utilizadas de forma adecuada en estos pacientes. Una posible causa de esta situación es la pobre adherencia de los profesionales de la salud a las guías de práctica clínica (GPC) para la prevención del TEV. En este sentido, se han descrito varias aproximaciones metodológicas para lograr una adecuada implementación de la tromboprofilaxis al transformar los comportamientos de los médicos. Sin embargo, para lograr este propósito es necesario considerar de forma integral las barreras multifactoriales y las condiciones sociológicas que subyacen a este problema. Se sabe que una mejor adherencia a las GPC de profilaxis del TEV conduce a una mejor práctica clínica. Por lo tanto, el objetivo de este artículo fue realizar un análisis reflexivo de las causas y posibles soluciones de la baja adherencia de los profesionales de la salud en Colombia a dichas guías.