Measuring medical students' empathy using direct verbal expressions.

PURPOSE: Empathy is an important trait in physicians and a key element in the physician-patient relationship. Accordingly, one of the goals in medical education is developing empathy in students. We attempted to practically assess medical students' empathy through their direct verbal expressions. METHODS: The medical students' empathy was measured using the modified Pencil-and-Paper Empathy Rating Test by Winefield and Chur-Hansen (2001). The students took 15 minutes or so to complete the scale, and it was then scored by one of two trained evaluators (0 to 4 points for each item, for a total score of 40). The subjects were 605 medical students, and the data were analyzed using descriptive analysis, independent t-test, and one-way analysis of variance in SPSS version 21.0. RESULTS: The students' empathy scores were low (mean, 12.13; standard deviation, 2.55); their most common responses (78.6%) registered as non-empathetic. Differences in empathy were observed by gender (female students>male students; t=-5.068, p<0.001), school system (medical school>medical college; t=-1.935, p=0.053), and academic level (pre-medical 1 year < other years; t=-4.050, p<0.001). CONCLUSION: Our findings lead us to the significant conclusion that there is the need for empathy enhancement training programs with practical content.

[Philo of Alexandria and his views on health and sickness]. / Gesundheit und Krankheit bei Philo von Alexandrien.

Philo of Alexandria, Torah scholar and philosopher of religion, (c. 20 BC to 50 BCE) is the first Middle Platonic philosopher whom we know through his own works. His thinking was determined by the two antitheses of God and world, and virtue and vice. The Logos (divine reason) mediates between the transcendent God and the earthly world. His thoughts on health and illness and on the possibilities and limitations of medicine are testimony to his comprehensive philosophical education as well as to his belief in God as ruler of the world and of human life. He saw human health as the reward for self-control for which one was best prepared by the classical education programme. Self-control and physical exercise were therefore, in his view, possible guarantors of health, and a coach potentially more important than a physician. Illnesses, if they result from the loss of self-control, may point to the necessity for penitence. Philo therefore saw virtuousness as the safest precondition for a healthy and cheerful life. That the life forces increase during youth and diminish in old age is part of destiny. Similarly, illness can be brought about by strokes of fate. If illness occurred in this or any other way, medicine was there to help and its success or failure depended on divine providence. Like Jesus Sirach, the Jewish scholar who taught around a hundred years earlier, Philo did not think it sinful to use medical help if one was ill, seeing that God himself had made natural remedies available. He compared the importance of physicians for their patients to that other professionals have in people's lives. Philo did not provide a compendium on the work of the physician, but he gave indications, on nutrition for instance, or on the use of laxatives and fragrances, or that complaints can be necessary stages of recovery. Philo also asked himself whether physicians were always obliged to tell patients the truth. The only case of illness he described in sufficient detail was one of leprosy, which he diagnosed in accordance with Leviticus 13:2. Philo saw physicians as helpers of God, who was the Lord of life and who would therefore decide on the fate of the healthy and sick. Faith in God, Philo thought, was vital if one was to cope with life's ups and downs. Only the wicked had to fear death, however, while the souls of the righteous returned to heaven after death.

Lepra. Impacto psicosocial / Leprosy. Psychosocial impact

Las enfermedades infecciosas se han convertido en un importante problema de salud, y reto para científicos, médicos e investigadores. En la actualidad son cientos de miles de personas que padecen de Lepra. El estigma y las discapacidades producidas los convierten en inhabilitados sociales. La aparición de la Bioética como nuevo paradigma del pensamiento médico, con sus principios de beneficencia, no maleficencia, autonomía y justicia, ha conmocionado al mundo de las ciencias médicas. Se realiza un análisis filosófico de un dilema bioético importante en nuestro medio: la ética médica y la Enfermedad de Hansen (Lepra), el humanismo como base de la relación médico paciente y la reflexión acerca del impacto psicosocial y económico de la Lepra. Se realizan algunas reflexiones que debe tener en cuenta el médico y enfermera de familia, así como el resto del Equipo Básico de Salud y los trabajadores de la Atención Primaria, con el paciente de Lepra. Se concluye que la relación médico-paciente en enfermos de Lepra requiere un humanismo vivo y desde el punto de vista (AU)

Infectious illnesses are an important health problem and a challenge for scientists, doctors and investigators. At the present time there are hundreds of thousands of people suffering from leprosy. The stigma and the inabilities produced makes them socially disabled. The appearance of Bioethics as a new paradigm of medical thought, with its charity principles, non balefulness, autonomy and justice, has revolutionised the world of the medical sciences. A philosophical analysis of an important dilemma ofbioethics in our environment is performed: the medical ethics and Hansen’s illness (leprosy), humanism as the base of the patient- doctor relationship and the reflection in the impact psychosocial and economic impact of leprosy. Some reflections that doctors and nurses, as well as the rest of the Basic Health Team and Primary Attention workers should bear in mind when dealing with leprosy patients are offered. The conclusion is that the doctor-patient relationship when dealing with leprosy requires active humanism and, psychosocially, it is necessary to conquer the taboo and the discrimination that leprosy sparks off in the community (AU)

Electronic medical records in dermatology: practical implications.

BACKGROUND: Electronic medical records (EMRs) can be of great use in dermatological data recording. Unfortunately, not many studies have been carried out in this specific area. AIMS: We attempt to evaluate the use of an EMR system in dermatology, comparing it with a conventional paper-based system. METHODS: Two hundred patient records of patients attending the dermatology outpatient department were studied over a 3-month period. Half the reports were entered in the conventional paper-based format while the other half was entered in an EMR system. The time taken for each consultation was recorded and the same was carried out for the first subsequent follow-up visit. RESULTS: The average time taken for the completion of the EMR-based consultation for new cases was 19.15 min (range, 10-30 min; standard deviation, 6.47). The paper-based consultation had an average time of 15.70 min (range, 5-25 min; standard deviation, 6.78). The P-value (T-test was used) was 0.002, which was significant. The average time taken for consultations and entering progress notes in the follow-up cases was slightly less than 10 min (9.7) for EMR while it was slightly more than 10 min (10.3) for the paper format. The difference was not statistically significant. The doctors involved also mentioned what they felt were the advantages and disadvantages of the system along with suggestions for improvement. CONCLUSION: The use of an EMR system in dermatology (or for that matter in any specialty) may overawe most users at the beginning, but once a comfort level is established, EMR is likely to outscore conventional paper recording systems. More time-motion-case studies are required to ascertain the optimal usage of EMR systems.

Improving adherence to antiretroviral therapy.

Antiretroviral therapy (ART) has transformed HIV infection into a treatable, chronic condition. However, the need to continue treatment for decades rather than years, calls for a long-term perspective of ART. Adherence to the regimen is essential for successful treatment and sustained viral control. Studies have indicated that at least 95% adherence to ART regimens is optimal. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression. The various factors affecting success of ART are social aspects like motivation to begin therapy, ability to adhere to therapy, lifestyle pattern, financial support, family support, pros and cons of starting therapy and pharmacological aspects like tolerability of the regimen, availability of the drugs. Also, the regimen's pill burden, dosing frequency, food requirements, convenience, toxicity and drug interaction profile compared with other regimens are to be considered before starting ART. The lack of trust between clinician and patient, active drug and alcohol use, active mental illness (e.g. depression), lack of patient education and inability of patients to identify their medications, lack of reliable access to primary medical care or medication are considered to be predictors of inadequate adherence. Interventions at various levels, viz. patient level, medication level, healthcare level and community level, boost adherence and overall outcome of ART.

Identificando barreiras para aderência ao tratamento de hanseníase / Obstacles to compliance with treatment for Hansen's disease

Visa a identificar alguns fatores associados à näo-aderência ao tratamento poliquimioterápico da hanseníase. O trabalho utiliza o referencial teórico das representaçöes sociais como base de sustentaçäo metodológica da investigaçäo. Foram entrevistados dois grupos de pacientes ambulatoriais em tratamento poliquimioterápico: "aderentes" e "näo-aderentes" ao tratamento, provenientes de dois serviços de saúde distintos. Nas entrevistas, foi observada a presença de uma representaçäo, comum entre os discursos, empregada como metáfora para explicar o tratamento: a figura de uma batalha em que o bacilo é retratado como uma ameaça, o doente como vítima, o medicamento como a principal arma de combate e os profissionais da saúde como os heróis ou santos. Foi observado também que o medicamento é representado por ambos os sujeitos como sendo algo ora benéfico ora maléfico ao bem-estar do paciente. Além disso, a relaçäo médico-paciente parece representar um ponto importante, pois nota-se que a confiança depositada na capacidade do médico para solucionar o problema divide sujeitos "aderentes" dos "näo-aderentes" entrevistados.

The demystification of leprosy: a multifactorial problem.

Abolishment of misbeliefs and misconceptions, unfounded fear and prejudice are factors as important in leprosy control as prevention, early detection and therapy. Concrete measures of demystification are proposed. Identify and divulge the absolute truth about leprosy. Calling leprosy "Hansen's disease" did not result in demystification. Patients know that the two terms are identical. Treating them as human beings attracts more patients to the healers than the Hansenologian ritual. Contrary to statements, no major advances are being made in the field of bacteriology, immunology, molecular biology, mode of transmission and epidemiology of leprosy. Not a single new drug has been discovered in 26 years. Vaccination is a dubious venture. The question arises as to whether the right priorities are promoted in leprosy research. Cultivation of the leprosy bacillus is the sine qua non of any further progress. This field of research is a lost and totally neglected priority. Consequently we have no pharmacological model for badly needed of ultrapotent antileprosy drugs. Syphilis is now cured with a single dose of penicillin. A drug as potent against leprosy should not be a mission impossible if an appropriate pharmacological model--the in vitro culture--is available. The multifactorial problem of demystification is a difficult but not an impossible task. Less sensationalism, more real progress in research, selecting the right priorities, achieving the "ultimate drug", shelter, food, shoes, soap and broom for every human on this planet constitute the road to demystification.