الملخص
Objective To explore the mechanism of multiple institutional logics on the doctor-patient relationship.Method By reviewing the theory of multiple institutional logic,a conceptual model of the mechanism of the impact of multiple institutional logic on doctor-patient relationships from the patient's perspective is proposed.A questionnaire survey is conducted on hospitalized patients in two tertiary public hospitals in Jiangsu Province to analyze the path of the impact of multiple institutional logic on doctor-patient relationships from the patient's perspective and validate the conceptual model.Results The conceptual model of the mechanism of the multiple institutional logic on the doc-tor-patient relationship was constructed,which verified that the multiple institutional logic had a significant impact on the doctor-patient relationship from the perspective of patients.The interaction of market logic and social logic af-fected the doctor-patient relationship to a certain extent.The focus of patients'attention played a mesomeric effect in the impact of multiple institutional logic on the doctor-patient relationship.The interaction between multiple institu-tional logic and patient information allocation ability has a significant impact on patient focus.Conclusion There are two paths to the impact of multiple institutional logic on the doctor-patient relationship:the first is the direct effect path of multiple institutional logic on the doctor-patient relationship.The second is the mesomeric effect path of pa-tients'focus,which is regulated by patients'individual information allocation ability.Based on the research findings,certain suggestions were proposed to provide theoretical reference and strategic recommendations for policy makers to formulate policies related to public hospitals.
الملخص
At present， there are many difficulties in the diagnosis and treatment of acute vestibular syndrome （AVS）. For example， complex and difficult identification of the cause of disease， uneven diagnosis and treatment levels of clinical doctors， weak humanistic care awareness， lack of communication skills， intrinsic affinity and other reasons， which make it difficult for AVS patients in the process of diagnosis and treatment， and cannot receive timely and effective treatment， resulting in an exacerbation of doctor-patient conflicts. Therefore， it is recommended to explore new paths of AVS diagnosis and treatment work using the humanistic care concept， respect each other between doctors and patients， build a team of medical staff with the value orientation of “humanistic care”， and promote the organic unity of theory and practice of “humanistic care”， with a view to better promoting the implementation of AVS diagnosis and treatment work， helping more patients rebuild confidence， enhancing quality of life， and improving the doctor-patient relationship.
الملخص
The medical education perspective of the Johns Hopkins model mainly includes the integration of clinical， teaching， and scientific research， integrating medical humanities elements and conducting elite education with small class teaching， long learning， and high elimination rates. This model has made remarkable achievements in the practice of introducing it into the field of medical education several times， and also had many positive effects on the doctor-patient relationship in the first half of the 20th century. The contemporary doctor-patient relationship has generated new negative sides， mainly including reduced trust and compliance caused by the proliferation of medical information， increased aggression in patients due to information asymmetry between doctors and patients， and conflicts arising from difficulties in doctors-patient shared decision-making. These can be mitigated by taking action through drawing on the medical education perspective of the Johns Hopkins model and transforming it into a more in line with contemporary situations， as well as taking the cultivation of medical talents as the starting point， so as to promote the improvement of doctor-patient relationship.
الملخص
This paper analyzed the legal issues existing on the medical side in 20 medical damage cases in obstetrics from January 2020 to June 2022 in China Judgment Documents Network， and hoped to explore the paths that the medical side can use for reference in building a harmonious doctor-patient relationship in the legal context. Firstly， medical institutions should establish rescue evaluation systems and early warning mechanisms for critical pregnancy and maternal， so as to ensure the health and safety of life of pregnant women and newborns， as well as prevent the occurrence of adverse obstetric events. Secondly， strengthening the cultivation of the humanistic quality among obstetric medical practitioners is the basis of the harmonious obstetrical doctor-patient relationship. Thirdly， the training and learning of relevant laws and regulations such as the Civil Code of the People’s Republic of China and the Physician Law of the People’s Republic of China should be strengthened. Fourthly， the patients’ informed consent should be respected， the process and procedures of fulfilling informed consent should be standardized by the systems， and the forms for fulfilling informed consent should be further explored. Fifthly， the medical risk-sharing mechanism should be explored and this paper suggested that postpartum women purchase obstetric accident insurance to reasonably share medical risks. Sixthly， medical social workers should be introduced， doctor-patient communication should be strengthened， and the obstetric risk awareness of the whole society should be enhanced.
الملخص
De Xin Ji Medical Case， in a narrative and discussion manner， emerged the doctors’attention to the temporal aspect of life， the shaping of personality， the promotion of plot and the intersubjectivity and ethics of treatment， as well as displayed rich storytelling characteristics. Based on the perspective of doctors， the author Xie Xinghuan conducted multiple-dimensional narrative reflections from perspectives of the relationship between doctors and patients and society， patient compliance， as well as self-medical behavior， which presented the doctor’s introspection and deep understanding of human nature. By depicting the interactive details between the characters， the medical case showed the relationship between doctors and patients， doctors and other doctors， and doctors and disciples， which not only contained the core connotation of narrative medicine， but also highlighted the unique cultural attributes of traditional Chinese medicine diagnosis and treatment.
الملخص
One of the crux of the problem of doctor-patient relationship is the uneven division of rights and obligations between doctors and patients. Among them, it is significantly essential to emphasize the patient’s obligation as a weak point. The reasons cover many aspects. On the one hand, it is of great significance to standardize patient obligations: the definition of patients’ obligations is better health protection for patients; the emphasis on patients’ obligations is the moral support for doctors’ responsibilities; the fulfillment of patients’ obligations promotes the win-win interests of doctors and patients. On the other hand, the current situation of standardizing patients’ obligations is not optimistic: the provisions of patients’ obligations in existing laws and regulations are not ideal; the current ethical discussion on patient obligations also needs to be deepened. Therefore, in order to standardize patients’ obligations, build harmonious doctor-patient relationship and build a community of doctor-patient, this paper put forward specific suggestions from three aspects: improving laws and regulations, standardizing the management of medical institutions and enhancing patients’ literacy.
الملخص
China’s foreign aid medical work is an important part of development of friendly relations with foreign countries and an important way to build a human health community. African countries generally have backward economic and social development, poor medical and health conditions and different languages and cultures, which makes the development of foreign aid medical work special and challenging. Foreign aid doctors and local patients share common feelings, mutual respect, equality, mutual trust and sincere cooperation, and building a community of destiny with the common goal of defeating diseases is an essential content to promote the health of the people of the recipient countries and realize the community of human health. Taking the work practice of the eighth batch of China (Shaanxi) medical team assisting Malawi as an example, this paper expounded the specific practice of building a community of doctor-patient in foreign aid medical work and discussed its significance, to provide theoretical and practical basis for the smooth development of foreign aid medical work in the future.
الملخص
The intervention and prevention of perioperative hypothermia is not only reflected in the technical level, but also reveals the important role of humanistic care in the whole intervention work. If perioperative patients have hypothermia, it is likely to cause a series of complications such as postoperative shivering, which seriously threatens the life safety of patients. Prevention and intervention was based on a comprehensive understanding of the causes and hazards of hypothermia, especially the impact on the lives of the elderly. Effective supervision was implemented in the whole process of operation, such as dynamic monitoring of vital signs including body temperature, followed by room temperature regulation, body temperature protection and preoperative and postoperative psychological nursing. At this time, the sense of responsibility, good humanistic care of medical staff are of positive significance to effectively prevent and reduce the probability of perioperative hypothermia and accelerate the postoperative rehabilitation of patients.
الملخص
The COVID -19 epidemic not only brings heavy burden to the society, but also makes the originally tense doctor-patient relationship closely connected from another aspect, which objectively becomes a new opportunity to improve the doctor-patient relationship. By comparing and analyzing the current situation of the doctor-patient relationship before and after the COVID -19 epidemic, this paper discussed the causes of tension between doctors and patients, and proposed corresponding solutions, so as to promote the continuation and development of highly harmonious doctor-patient relationship during the COVID -19 epidemic prevention and control period in the future.
الملخص
Ethical sensitivity is a behavioral concept emerging in recent years, which has attracted high attention from all sectors of society. Ethical sensitivity not only affects the clinical decision-making, doctor-patient relationship and medical quality of medical staff, but also provides the possibility to identify, predict and solve ethical problems in clinical. Combined with previous studies, this paper analyzed the current situation of ethical sensitivity of medical personnel in China, and took pediatric medical staff as an example to analyze the factors affecting the ethical sensitivity of medical staff from clinical practice and related theories, including age, working years, occupational categories, education level, work environment, empathy ability, etc. At the same time, this paper analyzed the causes of the ethical sensitivity of medical staff from the perspective of clinical practice and related systems, and put forward corresponding countermeasures, so as to improve the ethical sensitivity of medical staff and help to build a harmonious doctor-patient relationship.
الملخص
In the Nicomachean Ethics, Aristotle expounded his thoughts on health by analogy. Through summarizing Aristotle’s main thoughts on health, which including clarifying that the purpose of medicine is health, thinking that only moderation can create, promote and maintain health, emphasizing active-passive doctor-patient relationship, and generally respecting medical discipline and healthy life, this paper founded that his thoughts on health have obvious limitations. The limitations included: ignored the purpose of medicine also included group health; the "moderation" theory lacked accuracy and scientificity; weakened the patient’s right to speak in the doctor-patient relationship and did not give a clear guide to "how to live a healthy life". And then explored the enlightenment of Aristotle’s health thoughts to the development of contemporary society.
الملخص
Medical Artificial Intelligence (AI) makes the traditional doctor-patient relationship present a new pattern, but also highlights many ethical problems: inability to protect the rights and interests of patients, weakening the main responsibility of medical personnel, weakening the practical ability of medical personnel, and challenging the main status of medical personnel, etc.. It is necessary to improve relevant laws, regulations and regulatory system, adhere to the main status of medical personnel, improve the public awareness and acceptance of medical AI, and strengthen the construction of ethical system of AI, so as to deal with the ethical anomie caused by intelligent medical treatment and promote the harmonious development of doctor-patient relationship. It is expected that through the combination of AI and professional ethics principles, AI will be brought into daily clinical practice responsibly, to provide patients with better medical services.
الملخص
In Qing Dynasty, doctor-patient relationship in the imperial court had distinct characteristics because of the particularity of the objects of diagnosis and treatment. Diaries of famous doctors has become an important research material from a unique perspective. Ji En Lu and Bei Xing Ri Ji contain many research materials on doctor-patient relationship in Qing Palace. By systematically sorting out the contents of the royal doctor-patient relationship in the two diaries, and analyzing them in detail from the three dimensions of doctors, patients and diagnosis and treatment situations, it can be known that patients’ strong performance will interfere with the diagnosis and treatment process to a great extent, and doctors’ low status makes it difficult for them to cope with the complicated diagnosis and treatment environment and affects the curative effect. Learn from the past and the present, further provide reference for the current patient strong special doctor-patient relationship.
الملخص
Colorectal cancer(CRC)is one of the common malignant tumors,and its incidence rate and mortality rate in China are rising.As a high-incidence malignant tumor,in the process of screening,diagnosis,and treatment,CRC not only has universal ethical issues similar to other diseases,but also has its unique ethical problems,including the accessibility of CRC screening and medical insurance reimbursement,privacy exposure and the materialization of doctor-patient relationship during consultation and physical examination,the balance between"killing"and"nurturing"of cancer cells in excessive diagnosis and treatment,as well as the physiological and psychological issues of patients caused by enterostomy.This paper summarized and analyzed the special ethical issues in the diagnosis and treatment of CRC,and proposed corresponding countermeasures and suggestions.
الملخص
Introducción: La comunicación por parte del logofonoaudiólogo con el paciente afásico y su familia garantiza el bienestar biopsicosocial de estos y favorece una adecuada relación médico-paciente. Objetivo: Evaluar una propuesta de estrategia para el fomento del principio de beneficencia entre el logofonoaudiólogo, el paciente afásico y su familia en el Policlínico Universitario Dr. René Vallejo Ortiz, ciudad de Manzanillo, Granma, Cuba. Método: Fue aplicada la técnica de Iadov o criterio de usuario que permitió evaluar la propuesta. Para ello se encuestaron 15 logofonoaudiólogos de la provincia de Granma, Cuba, se escogieron de manera intencional 10, cuyas cualidades cumplían los requisitos exigidos para ser considerados usuarios. Se utilizaron diferentes métodos, técnicas y procedimientos para procesar y analizar los datos recogidos. La escala valorativa Likert facilitó la interpretación cualitativa de los datos recogidos. Resultados: Desde el criterio individual el 60 % de los usuarios consideró la propuesta bastante adecuada; la valoración más baja fue de adecuada (20 %). El cálculo de la valoración grupal, el índice obtenido (0,5 %) le confirió confiabilidad a la propuesta para ser implementada. Conclusiones: Los usuarios consideran que la propuesta de estrategia cumple con los requisitos para la aplicación. No obstante, existen algunos elementos que pudieran dificultar la ejecución de la misma: la incorrecta preparación científico-metodológica de los facilitadores, el uso inadecuado de los métodos y técnicas educativas, así como la negativa de aquellos logofonoaudiólogos que no concienticen la necesidad de alcanzar modos de actuación acorde a los principios y valores profesionales.
Introduction: Communication by the speech-language pathologist with the aphasic patient and his family guarantees their biopsychosocial well-being and promotes an adequate doctor-patient relationship. Objective: To evaluate a proposed strategy to promote the principle of beneficence between the speech-language pathologist, the aphasic patient and their family at the Policlínico Universitario Dr. René Vallejo Ortiz, Manzanillo city, Granma province, Cuba. Method: The Iadov technique or user criteria was applied that allowed the proposal to be evaluated. For this, 15 speech-language pathologists from the province of Granma, were surveyed; 10 were intentionally chosen, whose qualities met the requirements to be considered users. Different methods, techniques and procedures were used to process and analyze the data collected. The Likert rating scale facilitated the qualitative interpretation of the data collected. Results: From individual criteria, 60% of users considered the proposal quite appropriate; the lowest rating was adequate (20%). The calculation of the group assessment, the index obtained (0.5%) conferred reliability to the proposal to be implemented. Conclusions: Users consider that the strategy proposal meets the requirements for the application. However, there are some elements that could make its execution difficult: the incorrect scientific-methodological preparation of the facilitators, the inappropriate use of educational methods and techniques, as well as the refusal of those speech-language pathologists who do not raise awareness of the need to achieve methods. of action in accordance with professional principles and values.
Introdução: A comunicação do fonoaudiólogo com o paciente afásico e sua família garante o seu bem-estar biopsicossocial e promove uma adequada relação médico-paciente. Objetivo: Avaliar uma proposta de estratégia para promover o princípio da beneficência entre o fonoaudiólogo, o paciente afásico e sua familia na Policlínico Universitario Dr. René Vallejo Ortiz, cidade de Manzanillo, Granma, Cuba. Método: Foi aplicada a técnica de Iadov ou critérios de usuário que permitiram avaliar a proposta. Para isso, foram entrevistados 15 fonoaudiólogos da província de Granma, foram escolhidos 10 intencionalmente, cujas qualidades atendiam aos requisitos para serem considerados usuários. Diferentes métodos, técnicas e procedimentos foram utilizados para processar e analisar os dados coletados. A escala de classificação Likert facilitou a interpretação qualitativa dos dados coletados. Resultados: A partir de critérios individuais, 60% dos usuários consideraram a proposta bastante adequada; a classificação mais baixa foi adequada (20%). No cálculo da avaliação do grupo, o índice obtido (0,5%) conferiu confiabilidade à proposta a ser implementada. Conclusões: Os usuários consideram que a proposta de estratégia atende aos requisitos para aplicação. Porém, existem alguns elementos que podem dificultar sua execução: o incorreto preparo científico-metodológico dos facilitadores, o uso inadequado de métodos e técnicas educativas, bem como a recusa dos fonoaudiólogos que não conscientizam sobre o necessidade de alcançar métodos de ação de acordo com princípios e valores profissionais.
الملخص
This article recounts a poignant interaction between the author and a mother of a child with cerebral palsy. The mother's remarkable strength and optimism in the face of adversity deeply moved the author, leading to a tearful moment which prompted a comforting response from the mother. The ongoing debate regarding whether doctors are allowed to display emotions in their professional lives centers around the challenge of balancing professionalism with the emotional impact of providing healthcare to patients. While doctors are expected to uphold professionalism and make sound decisions in their work environment, simultaneous expression of emotions, empathy, and vulnerabilities becomes inevitable.
الملخص
Resumen Las innovadoras tecnologías del metaverso y el chat GPT4 (basado en inteligencia artificial) están presentes en el discurso cotidiano de la sociedad; recientemente se han introducido en la práctica médica y están provocando importantes cambios. En cuanto al metaverso ("después del universo"), diversas escuelas y facultades de medicina del mundo comienzan a utilizarlo como una estrategia innovadora dirigida a la enseñanza de materias como anatomía, histología, oftalmología y simulación en mundos paralelos (virtuales) para el aprendizaje y supervisión de cirugías, así como para otras aplicaciones en educación médica y en la relación médico-paciente. Si bien debe tomarse en cuenta como un área de oportunidad para la transformación de la medicina, es importante considerar las diversas limitaciones y riesgos del metaverso en la práctica médica, la formación de estudiantes y la relación del médico con los problemas de salud a los que se enfrenta en su práctica.
Abstract Innovative technologies such as the metaverse and chat GPT-4 (based on artificial intelligence) are present in the daily discourse of society; recently, they have been introduced into medical practice and are bringing about important changes. In the case of the metaverse ("beyond the universe"), various medical schools and departments around the world are beginning to use it as an innovative strategy for teaching subjects such as anatomy, histology, ophthalmology, and simulation in parallel (virtual) worlds for learning and supervision of surgeries, as well as for other applications in medical education and in the doctor-patient relationship. Although it should be regarded as an area of opportunity for the transformation of medicine, it is important to consider the various limitations and risks of the metaverse in medical practice, student training, and physicians' relationship with the health problems they have to deal with in their practice.
الملخص
La forma como el clínico percibe al paciente y sus conocimientos sobre el consentimiento informado (CI) se reflejan en prácticas de respeto hacia el paciente, con relación a su autonomía y privacidad, desde un marco ético, deontológico y legal. El objetivo fue analizar las percepciones y prácticas de cirujanos en relación con el respeto de la autonomía del paciente durante el proceso de toma del CI en un hospital de la ciudad de Santo Domingo de los Tsáchilas, Ecuador. Metodología Cualitativa. La muestra fue por saturación, aplicando una entrevista semiestructurada. Los datos se analizaron por medio del programa Atlas Ti 8.0®, utilizando rastreo de categorías estructuradas. La mayoría de los médicos asume el consentimiento como un documento legal y obligatorio, por el miedo a procesos sancionatorios. Además, suele delegar su responsabilidad a otros profesionales, desconociendo componentes estructurales y éticos de la toma del consentimiento informado. Concluimos que la falta de conocimiento sobre CI lleva a percepciones y, por ende, a prácticas que vulneran la autonomía y la confidencialidad, además del respeto de recibir la información por parte del clínico que realiza la intervención.
The way in which the clinician perceives the patient and his knowledge about informed consent (IC) are reflected in practices of respect for the patient, in relation to their autonomy and privacy from an ethical, deontological and legal framework. Objective. Analyze the perceptions and practices by surgeons in relation to the respect of the autonomy of the patient during the process of taking the IC in a hospital in the city of de Santo Domingo de los Tsáchilas / Ecuador. Methodology. Cualitattivo. The sample was by saturation applying a semi-structured interview. The data were analyzed using the Atlas Ti 8.0 ® program using structured category tracking. Result. Most doctors take consent as a legal and mandatory document, for fear of sanctioning processes. In addition, they usually delegate their responsibility to other professionals ignoring structural and ethical components of taking informed consent. Conclusion. It is evident that the lack of knowledge about IQ leads to perceptions, and therefore, to practices that violate autonomy and confidentiality, in addition to the respect of receiving information from the clinician who performed the intervention.
A forma como o médico percebe o paciente e seus conhecimentos sobre o consentimento informado (IC) se refletem nas práticas de respeito ao paciente, em relação à sua autonomia e privacidade a partir de um arcabouço ético, deontológico e jurídico. Objetivo. Analise as percepções e práticas dos cirurgiões em relação ao respeito à autonomia do paciente durante o processo de tomada do IC em um hospital na cidade de Santo Domingo de los Tsáchilas/Equador. Metodologia. Qualitativo. A amostra foi por saturação aplicando uma entrevista semiestruturada. Os dados foram analisados utilizandose o programa Atlas Ti 8.0 ® utilizando rastreamento estruturado de categorias. Resultado. A maioria dos médicos toma o consentimento como documento legal e obrigatório, por medo de sancionar processos. Além disso, eles geralmente delegem sua responsabilidade a outros profissionais ignorando componentes estruturais e éticos de obter consentimento informado. Conclusão. É evidente que a falta de conhecimento sobre o QI leva a percepções e, portanto, a práticas que violam autonomia e confidencialidade, além do respeito ao recebimento de informações do médico que realizou a intervenção.
الموضوعات
Humans , Male , Female , Ecuadorالملخص
Resumen Introducción: Una buena relación médico-paciente es crucial para la práctica médica. Un elemento fundamen tal de la misma es la empatía del médico tratante, y esta puede ser cuantificada mediante una escala validada llamada Escala de Empatía de Jefferson. Métodos: En este estudio buscamos correlacionar los valores de empatía de los médicos del servicio con los resultados de las encuestas de satisfacción del pa ciente ambulatorio, medido mediante una herramienta llamada HCAPS. Resultados: Encontramos que los pacientes percibían un mayor trato respetuoso y que se les explicaba mejor sus opciones de tratamiento por parte de los médicos con mayores niveles de empatía. No hubo diferencias en los niveles de empatía de los médicos según su edad, sexo, o tiempo desde la obtención del título de especialista. Discusión: Los resultados validan a la empatía como una habilidad clave dentro de la relación médico-paciente.
Abstract Introduction: A good doctor-patient relationship is crucial to medical practice. A fundamental element of it is the empathy of the treating physician, and it can be quantified by means of a validated scale called the Jefferson Empathy Scale. Methods: In this study we sought to correlate the empathy values of our physicians with the results of outpatient satisfaction surveys, measured using a tool called HCAPS. Results: We found that patients perceived greater respectful treatment and had their treatment options better explained to them by physicians with higher lev els of empathy. There were no differences in physicians' empathy levels according to their age, gender, or time since qualifying as a specialist. Discussion: These results validate empathy as a key skill in the doctor-patient relationship.
الملخص
Introducción: El artículo reflexiona sobre la naturaleza multidimensional y compleja de la ética y su relación con las ciencias médicas. Objetivo: Reflexionar sobre la atención a pacientes en estadio terminal desde el punto de vista de la ética médica para una atención médica integral en el primer nivel de atención. Métodos: estudio cualitativo; se emplearon análisis documental, sistematización, análisis y síntesis de publicaciones sobre la temática estudiada como métodos teóricos, para ello se valoran los criterios de autores y resultados que se expresan en artículos publicados. Se realizaron búsquedas, tanto en bases de datos estudiadas como en las plataformas de productos del Nacional Council for Biotechnology Information de la Nacional Library of Medicine of United States of America; y de Elsevier, esta última productora de Embase y Scopus, a través del motor de búsqueda Google Académico, en español e inglés, y sin límite de tiempo. Se emplearon los términos: ética médica, deontología médica, relación médico-paciente, paciente terminal y cuidados paliativos. Se excluyeron aquellos artículos que no habían sido revisados por pares o no mostraban el texto completo. Se revisó la información suministrada por cada fuente y se sintetizó. Conclusiones: En Cuba, la bioética avanza en la medida que lo permite la estrategia de Atención Primaria de Salud, con un Programa del Médico y Enfermera de la Familia resiliente y de valores humanos demostrados nacional e internacionalmente. Como reto se plantea estimular el debate entre saberes para generar cambios a favor de los pacientes, las familias, las comunidades y la sociedad(AU)
Introduction: The article reflects on the multidimensional and complex nature of ethics and its relationship to the medical sciences. Objective: To reflect on the care of terminally ill patients from the point of view of medical ethics for comprehensive medical care at the primary level of care. Methods: A qualitative study was carried out using documentary analysis, systematization, analysis and synthesis of publications on the subject studied as theoretical methods. For this purpose, the criteria of authors and results expressed in published articles were evaluated. Searches were carried out in Spanish and English through Google Scholar, and without time limit, both in the databases studied and in the product platforms of the National Council for Biotechnology Information of the National Library of Medicine of the United States of America and Elsevier. The terms: medical ethics, medical deontolog, physician-patient relationship, terminal patient and palliative care were used. Articles that were not peer-reviewed and those that did not show the full text were excluded. The information provided by each source was reviewed and synthesized. Conclusions: In Cuba, bioethics advances to the extent allowed by the Primary Health Care strategy, with a resilient Family Physician and Nurse Practitioner Program and human values demonstrated nationally and internationally. The challenge is to stimulate the debate between knowledge to generate changes in favor of patients, families, communities and society(AU)