Francesc Borrell i Carrió is one of the most insightful and committed voices in our healthcare system. A family physician, educator, researcher, and expert in care ethics and communication, he has dedicated much of his career to reflecting on how to make medicine more humane, honest, and person-centered. Winner of the Segovia de Arana Prize and internationally recognized for his pedagogical work, Borrell has seamlessly combined clinical practice with a critical, humanistic outlook that connects medicine, values, and society.
On the occasion of Sant Jordi’s Day, Dr. Borrell collaborated with IDIAPJGol by recommending readings that link health with ethics, philosophy, and the human condition. In this interview, we review his career, the current challenges of primary care, the role of communication and research, and the lasting relevance of Dr. Jordi Gol i Gurina’s thought, who defined the family physician as the “physician of people.”
What led you to explore ethics, communication, and values in medicine?
People who reflect on their professional practice are, in fact, reflecting on their lives as a whole. One crucial aspect is metacognition—questioning what you do and how you feel. This attitude opens you to learning, improvement, and asking how you can do things better. It requires humility, self-demand, and courage, but also has an obsessive edge. I admit I can be quite obsessive in this regard, sometimes pushing myself beyond my limits and causing unnecessary stress.
I believe there’s a generational component. Young people today take better care of themselves than ours did. We still felt the hunger of the postwar era. I strongly believe in hunger as a communal and motivational force; our generation worked very hard in that spirit.
“People who reflect on their professional practice are actually reflecting on their lives as a whole.”
You mention the physical hunger of the postwar era—do you see a link to intellectual hunger? Was your generation more inclined to question professional practice and established norms?
Absolutely. We lived under a dictatorship proud of its ignorance, which pervaded every aspect of society. Nothing was questioned. A hierarchical system prevailed in which those in power always assumed they were right. Medicine was highly rhetorical: department heads in hospitals never admitted errors. Our generation began reading in English, consulting The New England Journal of Medicine and The Lancet. We applied a scientific mindset. Although evidence-based medicine was only formalized years later, its seeds were planted in those early clinical protocols.
You’ve thought extensively about clinical communication. How can this skill be developed?
Everything starts with trust— the professional’s greatest asset. If a patient doesn’t know you, you must build that trust: first impressions matter greatly. Patients want their physician to be an advocate for their health, uninterested in finances and focused solely on their well-being. From this foundation, professionals need communication tools grounded in clear values and skills: honesty, strong semiology, and the ability to see beyond a patient’s explicit request. Physicians must prioritize, listen to the patient and themselves, and construct the patient’s reality from both spoken words and perceived signals. It’s a highly complex cognitive process requiring deep knowledge and experience.
“Trust is the professional’s main capital.”
Communication in healthcare is challenging. Patients often arrive emotionally distressed, anxious, and uncertain. How can professionals manage this?
Three mental “toxics” undermine professionals. The first is judging patients as “good” or “bad”: patients must be understood without judgment. Reactive emotionality—blame—must be countered with proactive emotionality. The second toxic is the team: feeling undervalued or that you give more than you receive. Counteract this by recognizing that your contributions strengthen and unify the group. The third toxic is the institution: believing you’ll be a good physician only when the system treats you as you deserve. That’s a mistake: you must be the best professional you can be here and now, creating synergies, collaborating, and engaging in research groups and scientific societies.
Are future healthcare professionals being trained adequately in ethics, values, and communication?
Significant efforts have been made, and there’s been real improvement in recent years. Yet these remain the “optional” subjects in the curriculum, and many assume theoretical knowledge suffices. Practical demonstrations via simulations are needed to assess how well they handle difficult situations. Another challenge is ensuring that those most eager to learn are also the most supported. The key is converting communication habits into conscious, intelligent practices: mindfulness of tone, gestures, and spontaneous reactions. Often, we need others to point out our shortcomings, which can be painful but necessary.
“The key is turning your communication habits into intelligent, conscious practices.”
What is the current state of primary care, and specifically family medicine?
We’re in a period of very positive change. Artificial intelligence (AI) excels at specific problem-solving but not at generalist thinking—where professionals have a major opportunity. Physicians can focus on contextualizing AI-generated data within the patient’s community, family, and life story. They now have the chance to conduct the holistic reflection they previously lacked time for. I wish I were young again to practice family medicine with these tools.
But such reflection requires time, and consultations are always time-pressed.
Time management will always be a battle, starting with education. Physicians must learn to use their ten-minute clinical interviews effectively: you can gather a thorough history in that time if you know how. I recommend reading Laín Entralgo, who in the 1960s already identified the tensions of a public health system with limited resources and time. We need tools to adapt to these constraints.
“I wish I were young again to practice family medicine with emerging technologies.”
You knew Dr. Jordi Gol i Gurina well; we celebrated his centenary last year. Is his vision still relevant?
Absolutely. Many of his premises remain fully current. One is that the healthcare system penalizes good professionals, failing to reward the transfer of patients to those who perform best—leading to burnout. Another is viewing the family physician as the “physician of people,” a concept that complements the community dimension: in consultations we are the specialists in the whole person, including their social determinants. He also insisted you have the right to err but not to ignore your mistakes’ consequences, a cornerstone of the ethics of error. In healthcare, errors can stem from professional actions or sheer chance.
What role does primary-care research play in this process?
Research begins with discomfort and dissatisfaction. Consider clinical guidelines: they are created or revised because practitioners were unhappy with previous protocols and sought better solutions. To feel that discomfort, one must be educated in perplexity. Research is uncomfortable and becomes comfortable only when the pain of not improving exceeds the pain of investigating. That’s when research starts. Then come the benefits of publishing, CV building, and the obsession with impact factors driven by evaluators and funders—but that’s another story.
“Research is uncomfortable and only becomes comfortable when the discomfort of not improving outweighs that of investigating.”
For IDIAPJGol’s Sant Jordi campaign you recommended several books on health, values, and ethics. Which would you highlight?
I’m an avid reader, not so much for distraction as for learning. Of my recommendations, The Ape in Us by Frans de Waal is superb—it teaches and entertains. Ten (Possible) Reasons for the Sadness of Thought by George Steiner is brief but profound. Also Brief Treatise on Illusion by Julián Marías or The Art of Making Yourself Miserable by Paul Watzlawick… wonderful books that both delight and educate. For deeper ethics, I recommend Peter Singer’s Practical Ethics or Steven Pinker’s Rationality, which includes a chapter on Bayes’ theorem that justifies the entire work. Reading well—learning, understanding, memorizing—means underlining, taking margin notes, relating new ideas to what you know, and memorizing what’s useful for practice.
Further information
Iatros Bulletin (Open Access): summaries of the most significant contemporary thought and resources on disability and vulnerability. https://humedicas.com/
Folia Humanística (Open Access): in-depth reflections on current health topics. https://revista.proeditio.com/foliahumanistica
Francesc Borrell Space on Campus Letamendi (Open Access): articles and books by Dr. Borrell. https://campusvirtual.fundacionletamendi.com/
