Clinical Management and Common Sense

22 In order to respond to the new challenges of medical care, it may be necessary to change the organization of health care services. It would undoubtedly be easier to commence from simple, agile, and flexible structures. However, this is not the case of Spanish hospitals which, although they have attained a scientific stature comparable to that of other countries, have a complex, rigid, and self-serving vertical organization. At present, many groups of the medical professionals are looking for new organizational formulas that will enable them to provide better care and feel more closely identified with their work. Indeed, it is significant that scientific journals provide page space for these topics. Why has the REVISTA ESPAÑOLA DE CARDIOLOGÍA decided to accept articles on clinical management? Perhaps we have become convinced that quality of care is something more than an appropriate diagnostic and therapeutic process. As Donabedian affirmed: «There are several definitions of quality, or variants of a single definition, and...each definition or variant is legitimate in terms of its appropriate concept». In any case, the definition goes beyond the technical treatment of disease and includes points like amount of care, cost, benefits and risks, interpersonal attention, accessibility, continuity and coordination, patient satisfaction, etc.1 The use of scientific journals as a forum for discussing professional concerns is not a novel phenomenon in other developed countries, and concern for the rise in health care costs (and, consequently, the social responsibility that any clinical decision involves) and the interest of physicians in playing a leading role in the management of scientific knowledge in daily practice are shared by us all. More than twenty years ago, we could read interesting debates on this topic in North American and British journals. An example is this strong ED I TO R I A L S