Resident Physicians as Patients: Perceptions of Residents and Their Teaching Physicians.

OBJECTIVE: This study aims to broaden understanding into the process by which resident physicians deal with illness and to identify areas for improvement regarding healthcare of residents and teaching physicians training to support them adequately. METHODS: A qualitative study of ten semi-structured interviews with residents who had suffered a serious illness and a focus group of teaching physicians were conducted. Analysis of the interview transcripts was performed using the grounded theory approach, with information divided into five categories: Differences between residents as patients and general patients; confidentiality; feelings and attitudes; learning from illness; and impact on work and training. RESULTS: There are differences between residents and the general population: In the initial stage, diagnosis is made promptly with preferential treatment shown by colleagues. Subsequently, the lack of clear guidelines can lead to poor follow-up. They accept a loss of confidentiality in the process. One of the most serious concerns felt by residents is the impact of their illness on their training as specialists, meaning that teaching physicians are charged with the important role of guaranteeing the resident's proper recovery, return to work, and readaptation to the training program. Teaching physicians demand their own training be reinforced in these aspects. CONCLUSION: There is a need to assess the great diversity observed in training-related decisions made by teaching physicians when residents fall ill. Given the differences observed, more research is required to improve the care provided to sick residents and particularly the teaching physicians training to handle them.

El proceso de enfermar de los médicos y sus consecuencias en el profesionalismo / The process of physicians falling ill and consequences for their professionalism / O processo de adoecimento dos médicos e as suas consequências acerca do profissionalismo

Resumen: La idiosincrasia de la profesión médica, los rasgos de personalidad característicos del médico y la falta de formación específica para reconocer y tratar adecuadamente la propia vulnerabilidad, predisponen a este colectivo a padecer más patología mental y, probablemente, un deficiente tratamiento de otras enfermedades. La mayoría de los estudios realizados hasta el momento se centran en la patología mental y adictiva del médico, desde el punto de vista del riesgo para la mala praxis y la seguridad de sus pacientes. La revisión narrativa de la literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) ha mostrado que, en el entorno hispanoparlante, apenas disponemos de información actualizada sobre el médico como paciente, a pesar de ser un tema de indudable relevancia desde el punto de vista de la seguridad asistencial, del profesionalismo y del propio bienestar de los profesionales. La situación del médico que enferma es compleja y poco conocida, con conflicto de roles y con repercusiones en la ética profesional y la calidad asistencial.

Abstract: The idiosyncrasy of the medical profession, the characteristic personality traits of the physician and the lack of specific training to properly recognize and treat one's own vulnerability dispose this group to suffer more mental pathology and probably worse control of other medical diseases. Most of the studies promoted so far focus on the psychiatric and addictive concerns of the physician, from the point of view of the sick doctor as being at risk for malpractice and to guarantee the safety of their patients. The narrative review of scientific literature (MEDLINE, EMBASE and IME 1985-2016) has shown that we do not have in the Spanish-speaking environment updated information about the doctor as a patient, despite being a topic of incipient media repercussion and undoubtedly relevant from the point of view of patient safety, professionalism and medical ethics and as well as the welfare of professionals. The characteristic of a sick doctor are more complex than the rest of patients with a conflict of roles and repercussions on professional ethics and the quality of care.

Resumo: A idiossincrasia da profissão médica, as características de personalidade característica do médico e a falta de formação específica para reconhecer e, corretamente, tratar a própria vulnerabilidade, predispõem esse grupo a sofrer mais patologias mentais, e provavelmente tratamento deficiente de outras doenças. A maioria dos estudos realizados até agora tem como foco a patologia mental e o comportamento aditivo do médico, do ponto de vista do risco por negligência e segurança de seus pacientes. A revisão narrativa da literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) tem mostrado que no ambiente de idioma hispânico temos apenas informações atualizadas sobre o médico como paciente, apesar de ser uma questão de relevância inquestionável do ponto de vista da segurança assistencial, do profissionalismo e do próprio bem-estar dos profissionais. A situação do médico enfermo é complexa e pouco conhecida, com conflito de papéis e impacto sobre a ética profissional e a qualidade dos cuidados médicos. São necessários mais estudos, tanto quantitativos como qualitativos, que permitam compreender o processo do adoecimento dos médicos em cada um dos seus estágios profissionais (desde a graduação até a aposentadoria) para ser capaz de considerar estratégias para a melhoria na atenção da saúde desses profissionais.

Esquizofrenia en la prensa: ¿el estigma continúa? / Schizophrenia in the press: does social stigma continue?

Introducción: los medios de comunicación son la principal fuente de información sobre salud mental para la población, por lo que pueden ser determinantes en la estigmatización. El objetivo del estudio fue analizar la utilización del término «esquizofrenia» por los medios de comunicación escritos. Método: se realizó búsqueda de noticias publicadas a través de los buscadores digitales de seis periódicos, que incluyeran la palabra «esquizofrenia». Se separaron las noticias que hacían un uso metafórico del término. Las noticias referidas a la enfermedad se dividieron en cinco grupos según su contenido. Se analizaron con mayor profundidad las dedicadas a delitos. Resultados: se analizaron 497 noticias. 126 (25,4%) hacían un uso metafórico del término «esquizofrenia». De las 371 restantes, 143 (38,5%) trataban sobre delitos, 105 (28,3%) sobre divulgación científica, 40 (10,8%) nombraban a alguien con esquizofrenia, 37 (10%) hablaban sobre falta de recursos o estigma, y 46 (12,4%) sobre otros temas. En las noticias sobre delitos, la persona con esquizofrenia era víctima en 16,1% y causante del delito en 83,9% y se utilizaban con relativa frecuencia expresiones estigmatizantes. Conclusiones: persiste en la prensa una tendencia a mostrar de manera desproporcionada historias negativas sobre los pacientes con esquizofrenia. Además, es frecuente el uso de la palabra esquizofrenia de forma denigrante, contribuyendo al estigma existente alrededor del término (AU)

Introduction: mass media is a major source of information about mental health and its attitude can be a determinant for stigmatization. The objective of this study was to examine the use of the term «schizophrenia» in print media. Methods: A search of posted news including the word «schizophrenia» was done through digital finders of six Spanish newspapers. Articles where the term «schizophrenia» had a metaphoric use were separated. Articles referred to the disorder were divided in five groups according to their content. Articles related to criminal acts were analyzed more deeply. Results: 497 articles were examined. In 126 (25,4%) the use of «schizophrenia» was metaphoric. From the remaining (371), 143 (38,5%) were about criminal acts, 105 (28,3%) about science popularization, 40 (10,8%) mentioned people with schizophrenia, 37 (10%) were about lack of health resources and stigma, 46 (12,4%) about other issues. In news about criminal acts, people with schizophrenia were victims in 16,1% and offenders in 83,9%, and stigmatizing expressions were used with relative frequency. Conclusions: The press tends to show disproportionately negative stories about people who suffer from schizophrenia. Furthermore, the word «schizophrenia» is used in a denigrating manner quite often, contributing to stigma around the term (AU)