Torn between two lovers - on being a psychologist in a university medical centre.

Background: Psychology as applied to health and illness has a relatively short history. Nevertheless, that history shows a rapid development of the theoretical models that guide the field over the past 60 years. Core theoretical approaches are concisely reviewed, in the context of Kaplan's paper 'Behavior as the central outcome in health care' (1990), which is used as a model to examine the extent to which these approaches embrace Kaplan's notions. Advances: Empirical studies from the health psychology domain are used, which demonstrate the gains in terms of quality of life and behavioural outcomes in patients with (chronic) somatic diseases. Over a period of some 60 years, theoretical models and core concepts in psychology as applied to health and illness have evolved from psychosomatic views to neuropsychology, quality of life, patient education, self-management, illness perceptions, patient-reported outcome measures (PROMs), shared decision-making (SDM) and health humanities (HH). The more recent models (SDM, HH) appear to align to a considerable degree with adopting 'behavior as the central outcome an outcome in health care'; shared decision-making and health humanities focus on encouraging patients to make sense of and give meaning to their illness in order to attain optimal psychosocial adjustment. Conclusions: In addition to 'behavior as the central outcome in health care', a new definition of the concept of health (i.e. 'the ability to adapt and to self-manage' - Huber et al., 2011) seems to favour patients, healthcare providers, society, and health psychology. Incorporating this concept into medical care may be viewed as a challenge for health psychologists - and as a source of continual struggle with strong biomedical forces.

Analysis and enlightenment of the current situation of medical psychology undergraduate education in China and foreign countries / 西安交通大学学报(医学版)

With the economic development of China and transformation of medical model, people pay more attention to their spiritual world and psychological health, and medical psychology has become a major in urgent need of construction. Foreign medical/clinical psychology education was established earlier and has become relatively mature, thus making its experience valuable for reference. This paper compares and analyzes the current situation of undergraduate medical psychology education, and puts forward optimization strategies from the aspects of college planning, curriculum training scheme and teachers’ teaching philosophy, hoping to provide some ideas for the construction of undergraduate medical psychology education in China.

Pediatric Avoidant-Restrictive Food Intake Disorder and gastrointestinal-related Somatic Symptom Disorders: Overlap in clinical presentation.

Certain presentations of Avoidant/Restrictive Food Intake Disorder (ARFID) and Somatic Symptom and Related Disorders (SSRDs) have conceptual overlap, namely, distress and impairment related to a physical symptom. This study compared characteristics of pediatric patients diagnosed with ARFID to those with gastrointestinal (GI)-related SSRD. A 5-year retrospective chart review at a tertiary care pediatric hospital comparing assessment data of patients with a diagnosis of ARFID (n = 62; 69% girls, Mage = 14.08 years) or a GI-related SSRD (n = 37; 68% girls, Mage = 14.25 years). Patients diagnosed with ARFID had a significantly lower percentage of median BMI than those with GI-related SSRD. Patients diagnosed with ARFID were most often assessed in the Eating Disorders Program, whereas patients diagnosed with an SSRD were most often assessed by Consultation-Liaison Psychiatry. Groups did not differ on demographics, psychiatric diagnoses, illness duration, or pre-assessment services/medications. GI symptoms were common across groups. Patients diagnosed with an SSRD had more co-occurring medical diagnoses. A subset (16%) of patients reported symptoms consistent with both diagnoses. Overlap is observed in the clinical presentation of pediatric patients diagnosed with ARFID or GI-related SSRD. Some group differences emerged, including anthropometric measurements and co-occurring medical conditions. Findings may inform diagnostic classification and treatment approach.

Curriculum teaching design of Military Medical Psychology in medical universities / 中华医学教育探索杂志

This study comprehensively analyzes the course of Military Medical Psychology from 7 aspects including the nature and status, teaching objectives, teaching principles, teaching concepts, classroom teaching, practical teaching and lecturing principles, and finally summarizes the characteristics of the course and points out its shortcomings and prospects. The study found that the Military Medical Psychology is an important interdisciplinary course between medical psychology and military science; the teaching objectives include two categories, the overall goals and classified ones; the teaching principle emphasizes the forces of developing practice ability of service orientation; the teaching concept includes combining the theory with practice, focusing on the students, informatization and lectures; the mode of classroom teaching should be cases-introduction, theory-interpretation and case-analysis; the practical teaching should strengthen teaching skills, emphasize connection, stimulate interest and improve the health; lecturing principles emphasize the focus of content. This study has preliminarily completed the teaching design of the course of Military Medical Psychology, which is conducive to the smooth implementation of this course and the cultivation of professional talents of military medical universities.

Da medicina psicossomática à psicologia médica: a trajetória teórica e institucional de Julio de Mello Filho / From psychosomatic medicine to medical psychology: the theoretical and institutional trajectory of Julio de Mello Filho

Resumo Os estudos sobre as causalidades das patologias e da relação médico/paciente a partir de formulações psicanalíticas receberam duas denominações no Brasil: medicina psicossomática e psicologia médica. O médico e psicanalista Julio de Mello Filho assumiu o protagonismo dessa proposta a partir da doença incapacitante do psiquiatra e psicanalista Danillo Perestrello. A estruturação da concepção teórica do movimento psicossomático e as estratégias institucionais utilizadas para a consolidação desse campo disciplinar no cenário brasileiro são o objeto deste estudo. Por meio de um referencial epistemológico e histórico, conclui-se que a proposta inicial de transformação do modelo médico hegemônico perde força e observa-se um deslocamento da psicologia médica como um campo da psicologia da saúde.

Abstract Studies on the causality of pathologies and the doctor/patient relationship based on psychoanalytic formulations received two denominations in Brazil: psychosomatic medicine and medical psychology. The physician and psychoanalyst Julio de Mello Filho took a leading role in this movement after the psychiatrist and psychoanalyst Danillo Perestrello was incapacitated by illness. This study investigates how the theoretical concepts of the psychosomatic movement were structured and the institutional strategies used to establish this discipline in Brazil. From an epistemological and historical point of view, the initial notion of transforming the hegemonic medical model was seen to lose force, followed by a shift in medical psychology as a field of health psychology.

Entrevista a un profesional sanitario: estudio piloto de una actividad de contacto asistencial temprano en el grado en Medicina durante la pandemia por COVID-19 / Interviewing a health care professional: pilot study of an early care contact activity in the Medical degree during the COVID-19 pandemic

Introducción: El Espacio Europeo de Educación Superior fomenta el diseño y la aplicación de metodologías docentes innovadoras, que en las ciencias de la salud pueden contribuir al conocimiento y el contacto temprano con la práctica asistencial, y a la humanización de la medicina. El objetivo es presentar las características y los resultados obtenidos en la actividad grupal ‘Entrevista a un profesional sanitario’. Sujetos y métodos: La actividad se ha desarrollado en la asignatura de Psicología, de segundo curso del grado en Medicina, durante el curso académico 2019-2020 (n = 164 estudiantes; 29,3% hombres; edad media = 19,7 años). La pandemia por COVID-19 requirió su adaptación a la docencia no presencial. De los 33 profesionales sanitarios colaboradores, 29 contestaron al cuestionario de satisfacción en línea (65,5% hombres; edad media = 49,2 años). Resultados: Se constituyeron 33 grupos de estudiantes y la media (desviación estándar) de la calificación fue 8,8 (0,65) sobre 10 puntos. Los estudiantes presentaron una amplia variedad de cuestiones relacionadas con la humanización de la medicina. Las entrevistas se realizaron fundamentalmente por videoconferencia (58,6%). Los profesionales sanitarios que contestaron al cuestionario fueron preferentemente titulados en Medicina (89,7%) y especialistas en medicina familiar y comunitaria (27,6%). Presentaron una elevada satisfacción tanto en la organización de la actividad como en su valoración -media sobre 5 puntos (desviación estándar), 4,5 (0,5) y 4,7 (0,3), respectivamente-. Conclusión:‘Entrevista a un profesional sanitario’ es una actividad grupal que facilita el contacto asistencial temprano y el papel activo de los estudiantes, ha sido muy bien valorada por los profesionales sanitarios participantes y puede adaptarse a la docencia no presencial.(AU)

Introduction: The European Higher Education Area encourages the design and application of innovative teaching methods. Regarding Health Sciences, they can contribute to the early knowledge and contact with healthcare practice and to the humanization of medicine. The aim is to present the characteristics and results obtained in the group activity: ‘Interview a healthcare professional’. Subjects and methods: The activity has been applied in the subject of Psychology (second year of the Degree in Medicine) during the academic year 2019-20 (n = 164 students, 29.3% men, mean age = 19.7). The COVID-19 pandemic has required its adaptation to distance education. Of the 33 collaborating health professionals, 29 answered the online satisfaction questionnaire (65.5% men, mean age = 49.2 years). Results: Thirty-three groups of students were constituted, the mean (standard deviation) rating was 8.80 (0.65) out of 10 points. Students presented a wide variety of issues related to the humanization of medicine. Most of the interviews were conducted by videoconference (58.6%). The health professionals who answered the questionnaire were mostly graduates in Medicine (89.7%) and specialists in Family and Community Medicine (27.6%). They presented high satisfaction in both the organization and assessment of the activity -mean score out of 5 (SD), 4.5 (0.5) and 4.7 (0.3) respectively-.Conclusion: ‘Interview a healthcare professional’ is a group activity that facilitates early contact with healthcare practice and the active role of students, it has been highly valued by the participating healthcare professionals and can be adapted to the non-face-to-face teaching modality.(AU)

Improving the physician-patient relationship utilizing psychodynamic psychology: a primer for health professionals.

BACKGROUND: The quality of the physician-patient relationship is associated with improved healthcare outcomes and patients' complaints due to dissatisfaction. Factors that influence the quality of the physician-patient relationship include verbal communication, nonverbal communication, and clinical empathy. These factors have been studied from diverse theoretical approaches hindering their integration into a theoretical framework applicable in clinical practice and accessible for lay clinicians. OBJECTIVE: The aim of this paper is to put forward a psychodynamic framework that includes the factors associated with a better quality of the physician-patient relationship and is applicable in clinical practice and accessible for lay clinicians. THEORETICAL DISCUSSION: Basic concepts necessary to comprehend transference and countertransference phenomena were outlined. Then, based on the concepts of transference and countertransference, a psychodynamic framework to understand and manage the physician-patient relationship was put forward. CONCLUSION: This is the first paper that presents a psychodynamic framework applicable in clinical practice and accessible to lay clinicians for understanding and managing the physician-patient relationship. Additionally, this work could serve as introductory material to Balint groups.

Conspiracy theories as a natural part of pandemics.

Effectiveness of the policy measures against the COVID-19 pandemic is reduced by spread of conspiracy theories. Moreover, conspiracy theories induce opposition to vaccines. The text shows that increased occurrence of conspiracy theories is a typical public reaction to a disaster and describes some of the mechanisms contributing to susceptibility to conspiracy explanations on the individual as well as societal level.

O movimento da medicina psicossomática no Brasil: a trajetória teórica e institucional de Danilo Perestrello / Danilo Perestrello and the psychosomatic medicine movement in Brazil: from theory to institutional acceptance

Resumo Na década de 1950, surgia o movimento da medicina psicossomática no Brasil, tendo como protagonista o psiquiatra e psicanalista Danilo Perestrello. A configuração dessa proposta e a análise das estratégias construídas para a formação desse campo disciplinar são o objeto deste estudo. Desde o início, esse movimento foi marcado por um projeto teórico-institucional de refundação da medicina sobre bases psicanalíticas e de institucionalização. Em sua trajetória, Perestrello publicou artigos e livros que tinham como intuito formar um novo estilo de pensamento entre os médicos, bem como a ocupação de instituições estratégicas. Seu afastamento profissional, devido a uma grave doença em 1976, representou um fator desagregador do movimento psicossomático no contexto brasileiro.

Abstract In the 1950s, the psychosomatic medicine movement emerged in Brazil, led by psychiatrist and psychoanalyst Danilo Perestrello. This article analyzes the strategies developed to configure this proposal and establish this field of study. From the beginning, this movement was characterized by a plan to reformulate medicine based on psychoanalytic theory and obtain favorable reception in institutions. During his career, Perestrello published articles and books with the intention of establishing a new way of thinking among physicians and worked at strategic institutions. His withdrawal from professional work due to a serious illness in 1976 was a factor contributing to the fragmentation of the psychosomatic movement in Brazil.

Medical student burnout: Impact of the gap year in burnout prevention.

OBJECTIVE: Burnout is a common response to stress and is pervasive among medical students. An increasing proportion of students are taking "gap years" following undergraduate education and before matriculation to medical school. This study evaluates rates of and risk factors for burnout, with a particular focus on students who took gap years. METHODS: Burnout was measured utilizing the abbreviated Maslach Burnout Inventory. The primary independent variable was whether a student took one or more gap years prior to medical school matriculation. Other variables included age, gender, year in medical school, choice in specialty, and status in a combined baccalaureate-M.D. PROGRAM: Bivariate and multivariate regression was performed to elucidate relationships between student-level variables and burnout. RESULTS: A total of 31.4% of respondents were found to be experiencing high levels of burnout. In multivariate analysis, gap years were independently associated with lower levels of burnout (p = 0.041). Further, burnout decreased in a stepwise fashion with students who took 0 (p = 0.350), 1 (p = 0.192), and 2+ (p = 0.048) gap years. CONCLUSIONS: Students taking gap years exhibited significantly lower levels of burnout than those who did not. Efforts should be made in pre-medical and medical school curricula to better support students in their paths to medical school.

Caring for Health Professionals in the COVID-19 Pandemic Emergency: Toward an "Epidemic of Empathy" in Healthcare.

Psychological research into healthcare opened the door to understanding people's emotional reactions when experiencing events perceived as life-threatening. This is the case of the current outbreak of the novel Coronavirus disease (COVID-19) that has recently been declared "a public health emergency of international concern (PHEIC)" by the World Health Organization (WHO). The response to an influenza pandemic might generate remarkable stress and emotional turmoil to healthcare providers who work during the outbreak. Prior experience with disasters, pandemics, and major traumatic events indicates that enhanced support to healthcare professionals enabling them to become aware of their own emotions and effectively share their perspective and lived experience with patients can help them in remaining efficient and focused during these stressful events. This outbreak marks a vital moment where healthcare systems can endorse an "epidemic of empathy" aimed at bringing science and humanism together to benefit patients and consolidate citizens' trust in healthcare providers during this and future healthcare crisis. Perhaps, the greatest opportunity for managing people fears during health emergencies-like the COVID-19 one-lies, in the short term, in restoring our connections with each other. Today, we are all called to rebuild a sense of community and the ties that bind us together as human beings.

[Why Pharmacists Need Education in the Humanities: A Medical Professional Educator's Viewpoint].

Over the past few decades, pharmacists' work has changed from product-centered tasks to patient-centered care. In response to such social changes and needs, the pharmacy education course was also extended from 4 to 6 years, and the importance of the humanities in the curriculum (e.g., medical psychology, medical ethics, and communication) is now recognized. The Model Core Curriculum for Pharmacy Education, 2013 version, described 10 professional competencies for pharmacists (professionalism, patient-oriented attitude, communication skills, interprofessional team care, basic sciences, medication therapy management, community health and medical care, research, lifelong learning, and education and training) and stated that the humanities are a foundation of pharmaceutical education. However, a report by the Pharmaceutical Society of Japan (2014) expressed concern that clinical practice was not connected with knowledge of the humanities. It is educationally meaningful when pharmacists who studied the humanities can then offer the best medical care to patients. In order to utilize knowledge of the humanities in the clinical setting, educators need to provide opportunities for active learning. Furthermore, the humanities are useful to help pharmacists acquire meta-cognition.

Psychobiological Changes during National Futsal Team Training Camps and Their Relationship with Training Load.

The aim of this study was two-fold: (1) to analyze the within-week variations of heart rate, session-rated of perceived exertion (sRPE), total distance, distance in 8.0-11.99 km/h-1, recovery distance in 12.0-17.99 km/h-1, distance in >18.0 km/h-1, maximum speed, number of sprints, heart rate variability, delayed onset muscle soreness (DOMS), and fatigue during training camps of a national futsal team; and (2) to analyze the relationships between load and the well-being. Twenty-eight men from the Chinese Taipei U-20 national futsal team were analyzed. Comparisons of training days revealed that the total distance was significantly smaller on day 1 (d = -1.22) and day 6 (d = -1.95) than on day 3. The sRPE values were significantly lower on day 1 than days 4 (d = -1.53), 5 (d = -2.07), and 6 (d = -2.59). The relationships between training load and recovery parameters revealed moderate correlations between the DOMS and the sRPE recorded one (r = -0.321) and two days before training (r = -0.289). It is possible conclude that first day imposed a smaller external load and internal load, and that the internal load had a greater dependent relationship with reported DOMS and fatigue during the training camps.

Understanding bereavement experiences of mothers facing the loss of newborn infants / Experiências de luto das mães frente à perda do filho neonato

Abstract Objective: to understand mothers' bereavement experiences regarding the loss of their newborn child in the Neonatal Intensive Care Unit of a Brazilian university hospital. Methods: the study was designed by the clinical-qualitative method to understand the meaning of the emerging relationships of health scenarios. Sample consisted of six mothers. The sufficiency of the sample was verified through the saturation of the data. The data collection instrument was a semistructured interview with script of open questions, the collected material was recorded and transcribed in full. Thematic analysis was performed by two independent authors. Results: feelings and perceptions of the grieving process gave rise to three categories: 1. Guilt and fantasy of bereavement related to the death and grief for their children; 2. Relationships and ambiguities - the relationship between internal concerns and perception of external relations; 3. Fear, disbelief, abandonment and loneliness - questions about perception of the external environment. Conclusions: mothers' bereavement experience is mainly permeated by loneliness and abandonment related to feelings of guilt for not being able to keep their children alive. The difficult and definitive separation in the postpartum period, caused by death, brings fantasies of reunion with their child. Women show the need to realize grief, especially by recognizing their baby's identity.

Resumo Objetivo: compreender experiências de luto das mães frente à perda do filho neonato na Unidade de Terapia Intensiva Neonatal de um hospital universitário brasileiro. Métodos: o estudo foi desenhado pelo método clínico-qualitativo que propõe a compreensão do sentido das relações emergentes nos cenários de saúde. A amostra foi composta por seis mães e sua suficiência foi verificada através da saturação de dados. O instrumento de coleta de dados foi uma entrevista semiestruturada com roteiro de questões abertas, o material coletado foi gravadoe transcrito na íntegra. A análise temática foi realizada por dois autores independentes. Resultados: os sentimentos e as percepções do processo de luto deram origem a três categorias: 1. Culpa e fantasia das mulheres enlutadas relacionadas com a morte e luto por seus filhos; 2. Relacionamentos e ambiguidades - a relação entre preocupações internas e a percepção de relações externas; 3. Medo, descrença, abandono e solidão - questões sobre a percepção do ambiente externo. Conclusões: a experiência de luto das mães é permeada sobretudo, por solidão e abandono relacionados com sentimento de culpa por não poder manter o filho vivo. A separação no período de puerpério, provocada pela morte, é difícil, definitiva e traz fantasias de reencontro com o filho. As mulheres mostram a necessidade de concretizar o luto especialmente através do reconhecimento da identidade de seu bebê.

Pediatric medical psychology.

Paediatric medical psychology is a specialised field within clinical health psychology focussed on the behavioural, developmental, and psychological needs of children, adolescents, and families in healthcare contexts. Paediatric medical psychologists address a myriad of problems by employing evidence-based evaluations and interventions in order to support the well-being of paediatric patients and their families. In this paper, we provide an overview of paediatric medical psychology including the education and training required to be a paediatric psychologist followed by common problems addressed by paediatric psychology, the settings paediatric psychologists work in, and the services they provide. Discussion concludes with future application of integrating paediatric psychology throughout the continuum of care to optimise adjustment and health of paediatric patients.

[Psychological care in the intensive care unit : Task areas, responsibilities, requirements, and infrastructure]. / Psychologische Versorgung auf der Intensivstation : Tätigkeitsbereiche, Aufgaben, Anforderungen und Ausstattung.

The relatively high rates of mental stress among critically ill patients and their relatives implies the necessity of conceptually and financially embedded psychological care in intensive care units (ICUs). Professional associations also recommend the involvement of psychological professionals and screening of mental symptoms in critically ill patients. Intensive care medicine psychologists and psychotherapists take this as an opportunity to describe the content and goals of psychological care. Task areas are care for patients and relatives as well as staff support. Goals of psychological support in the ICU are detection of mental symptoms in patients and their treatment, psychological first aid for relatives in crisis situations, and support of the staff in terms of communication with patients and relatives as well as regarding development and maintenance of an adaptive coping style for dealing with emotionally challenging situations. Psychological care in the ICU is offered by psychologists, psychotherapists, or physicians with a psychotherapeutic qualification. The psychologist is integrated into the ICU team and has a proactive, resource-oriented, and supportive orientation. Psychological support can be an enrichment and a relief, both in the interdisciplinary treatment of patients as well as in the care of relatives, and also represent a resource for the team.

As emoções do médico e as implicações para a prática clínica / Doctors emotions and their implications for clinical practice / Las emociones del médico y las implicaciones en la práctica clínica / Les émotions du médecin et les implications pour la pratique clinique

Resumo O objetivo deste artigo foi investigar as emoções do médico e as implicações para a prática clínica. Utilizou-se o método misto, avaliando, na fase quantitativa, trinta médicos com atuação em consultório. Para a fase qualitativa, foram escolhidos quatro médicos para o estudo de caso. Os resultados mostraram que médicos mais velhos, com mais tempo de formação, que ficam mais tempo em consulta com o paciente sentiram-se mais impactados diante dos estímulos emocionais; e os que trabalham mais horas semanais no consultório perceberam os estímulos de forma menos prazerosa. Esses dados foram confirmados pelos agrupamentos dos quatro clusters. Efetuou-se a análise de caso com um representante de cada cluster. Os resultados revelaram que as emoções podem influenciar atitudes e percepções do médico na relação com o paciente.

Abstract This article investigated doctors' emotions and the implications for clinical practice. The mixed method was used to quantitatively evaluate thirty doctors with practice in the office. For qualitative analysis, we chose four doctors for the Case Study. The results showed that older doctors with more time after graduation and more time in consultation with the patient felt more impacted by emotional stimuli than other doctors; and that doctors who work more hours per week in the office perceived the stimuli in a more negatively than other doctors. These data were confirmed by groups of four clusters. It was conducted by a case study with a representative of each cluster. The results revealed that emotions could influence doctors' attitudes and perceptions regarding the patient.

Resumen El objetivo de este artículo fue investigar las emociones del médico y las implicaciones en la práctica clínica. Este estudio utilizó el método mixto y evaluó, en la fase cuantitativa, treinta médicos con actuación en consultorio. Para la fase cualitativa, se eligieron cuatro médicos para el estudio de caso. Los resultados mostraron que los médicos más viejos, con más tiempo de formación y que se quedan más tiempo en consulta con el paciente se sintieron más impactados ante los estímulos emocionales que los otros médicos; y los médicos que trabajan más horas semanales en el consultorio percibieron los estímulos de forma menos agradable. Estos datos fueron confirmados por las agrupaciones de los cuatro clusters. Se realizó el análisis de caso con un representante de cada cluster. Los resultados revelaron que las emociones pueden influir en las actitudes y percepciones del médico en la relación con el paciente.

Résumé Le but de cet article était d'étudier les émotions du médecin et les implications pour la pratique clinique. Cette étude a utilisé la méthode mixte et a évalué, dans la phase quantitative, trente médecins avec la pratique au bureau. Pour la phase qualitative, quatre médecins ont été choisis pour l'étude de cas. Les résultats ont montré que les médecins plus âgés, avec plusieurs années de formation et qui passent plus de temps en consultation avec le patient, se sentaient plus touchés par les stimuli émotionnels que les autres ; les médecins qui travaillent de longues heures au bureau ont remarqué les stimuli moins agréablement que les autres. Ces données ont été confirmées par les groupements des quatre grappes. L'analyse de cas a pris un représentant de chaque grappe. Les résultats ont montré que les émotions peuvent influencer les attitudes et les perceptions du médecin par rapport au patient.

Respostas Emocionais de Médicos aos Estímulos Afetivos do International Affective Picture System (IAPS) / Emotional Responses of Doctors to the Affective Stimuli from the International Affective Picture System (IAPS)

RESUMO As emoções dos médicos têm um papel importante na relação com o paciente, pois podem interferir em suas atitudes, percepções e nos processos de julgamento e decisão. O objetivo desta pesquisa foi analisar a resposta emocional dos médicos aos estímulos do International Affective Picture System (IAPS). Este estudo utilizou o método quantitativo e avaliou 30 médicos, homens e mulheres de diversas especialidades, que dedicassem parte (ou a totalidade) de seu tempo ao atendimento clínico no consultório, que tivessem no mínimo dois anos de experiência após a conclusão da residência médica e que atuassem em medicina convencional (clínica médica). Os instrumentos utilizados na análise foram: o questionário sociodemográfico, para análise das variáveis; o IAPS, composto por imagens afetivas capazes de induzir estados emocionais; e o Self-Assessment Manikin (SAM), para classificação das respostas emocionais por meio de duas escalas: prazer e alerta. Os resultados mostraram que, quanto à percepção emocional, não houve diferença entre os resultados da amostra e da população geral, mas houve diferença na relação com as variáveis sociodemográficas - idade, tempo de formado, tempo médio de atendimento (consulta) e horas semanais dedicadas ao trabalho no consultório -, concluindo-se que médicos mais velhos, com mais tempo de formados e que ficam mais tempo em consulta com o paciente se sentiram mais impactados diante dos estímulos emocionais do que os médicos mais jovens, com menos tempo de formados e que ficam menos com o paciente em consulta. Os resultados também mostraram que os médicos que dedicam mais horas semanais ao trabalho no consultório perceberam os estímulos de forma menos prazerosa que os médicos que trabalham menos tempo no consultório e que dividem seu tempo com outras atividades. São necessárias novas pesquisas e estudos para o aprofundamento do tema das emoções e de sua influência na prática médica, considerando amostras maiores, em contextos distintos e novas variáveis.

ABSTRACT The emotions of doctors play an important role in their relationship with the patient as they can interfere with their attitudes, perceptions and in judgment and decision processes. The objective of the research was to analyze the emotional response of doctors to the stimuli of the International Affective Picture System (IAPS). This study used a quantitative method and evaluated 30 male and female doctors of various specialties, who dedicated all or some of their working hours to clinical care, had at least two years of experience after conclusion of medical residency and worked in conventional medicine (medical clinic). The instruments used for the analysis were: sociodemographic questionnaire to analyze the variables; the IAPS, composed of affective images capable of inducing emotional states and the Self-Assessment Manikin (SAM) to classify responses through two scales: pleasure and arousal. The results showed that in relation to emotional perception there was no difference between the sample results and the general population, but differences were found in the relation to sociodemographic variables: age, time since graduation, average consultation time and weekly hours devoted to work in the consulting room, concluding that older doctors, with more time since graduation and more time in consultation with the patient, felt more impacted by the emotional stimuli than younger doctors with less training time and less time with the patient in consultation. The results also showed that doctors who work more hours per week in the consulting room perceived the stimuli in a less pleasant way than doctors who spend less time in the consulting room and share their time with other activities. Further research and studies are needed to deepen the theme of emotions and their influence on medical practice, considering larger samples in different contexts and new variables.

The Four-Cluster Spectrum of Mind-Body Interrelationships: An Integrative Model.

Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and mental health professionals (MHPs) find it difficult to treat patients with psycho-somatic disorders. This situation is particularly troublesome due to the high prevalence of these conditions. Although progress has been made over the last few decades in understanding mechanisms underlying the mind-body relationship, disparities remain between research and its clinical implementation. One possible reason for this is the lack of a comprehensive, agreed-upon model that incorporates a biopsychosocial framework and is rooted in an understanding of the various psychobiological pathways. Such a model would enable better communication between physicians and MHPs, allowing them to provide coordinated, stratified treatment. In this paper, four archetypal case studies, together with standard care options are presented to illustrate the current state of affairs. A four-tiered conceptual model of mind-body interrelationships based on pathophysiological and psychopathological mechanisms is suggested to help optimize the treatment of somatic complaints. This Four-Cluster model consists of: (1) Organic Conditions: Structural, or degenerative processes that can affect mood and psychological responses but are not clearly exacerbated by stress. (2) Stress Exacerbated Diseases: Biological disorders with a distinct pathophysiology, such as inflammatory or autoimmune diseases, whose progression is clearly exacerbated by stress. (3) Functional Somatic Syndromes: Conditions wherein heightened sensitivity to stimuli together with hyper-reactivity of the autonomic system form a "vicious cycle" of mutually enhancing learning processes. These processes involve biological mechanisms, such as central sensitization and psychological mechanisms such as catastrophization and selective attention. (4) Conversion Disorder: Physical manifestations of psychological distress, expressed somatically. Symptoms are solely an expression of problems in patients' psychic functioning and are not caused by biological pathology. Finally, suggested management of the aforementioned case studies is presented through the lens of the Four-Cluster model and a proposed integration of our model with existing theories is discussed. As it is rooted in an understanding of psychobiological pathways of illness, the proposed model enables a new way to discern which form of mind-body interaction is manifesting in different diseases and proposes a way to coordinate treatment plans accordingly, to enhance the accuracy and efficacy of care.

O discurso médico sobre as emoções vivenciadas na interação com o paciente: contribuições para a prática clínica / Medical discourse on the emotions experienced in the interaction with patients: contributions to clinical practice / El discurso médico sobre las emociones vividas en la interacción con el paciente: contribuciones para la práctica clínica

O estudo das emoções na prática clínica expõe sua influência na relação médico-paciente. Este artigo apresenta os resultados de uma pesquisa qualitativa cujo objetivo foi explorar o discurso dos médicos sobre as próprias emoções no atendimento a pacientes. Das entrevistas com oito médicos foram extraídos os seguintes temas de análise: função apostólica e o entendimento da emoção; defesas e estratégias perante as emoções; e a companhia de investimento mútuo: frustração e consequências. Os médicos demonstraram pouca percepção da influência das emoções sobre a própria atuação, apesar de terem relatado situações nas quais foram afetados por elas. Revelaram sofrimento em razão da dificuldade de elaborar conteúdos emocionais, usando distanciamento afetivo como um mecanismo de defesa. Conclui-se que a gestão emocional por parte do médico maximiza recursos na interação com o paciente, lançando novas perspectivas para a atuação médica.(AU)

The study of emotions in clinical practice shows its influence on the physician-patient relationship. This article presents the results of a qualitative study with the objective to explore the discourse of physicians on their own emotions in the delivery of care to patients. Interviews with eight physicians gave rise to the analysis themes: apostolic function and understanding of emotions; defenses and strategies in face of emotions; and the company of mutual investment: frustration and consequences. The physicians demonstrated a poor perception of the influence of emotions on their performance, despite having reported situations in which they were affected by them. They also revealed suffering due to the difficulty in elaborating emotional contents, using affective distancing as a defense mechanism. In conclusion, emotional management on the part of physicians maximizes resources in the interaction with patients, casting new perspectives for their medical performance.(AU)

El estudio de las emociones en la práctica clínica expone su influencia en la relación médico-paciente. Este artículo presenta los resultados de una investigación cualitativa, cuyo objetivo fue explorar el discurso de los médicos sobre las propias emociones en la atención a pacientes. De las entrevistas con ocho médicos se extrajeron los temas de análisis: función apostólica y el entendimiento de la emoción, defensas y estrategias antes las emociones y la compañía de inversión mutua: frustración y consecuencias. Los médicos demostraron poca percepción de la influencia de las emociones sobre la propia actuación, a pesar de haber relatado situaciones en las que fueron afectados por ellas. Revelaron sufrimiento debido a la dificultad de elaborar contenidos emocionales, usando el distanciamiento afectivo como un mecanismo de defensa. Se concluyó que la gestión emocional por parte del médico maximiza recursos en la interacción con el paciente, lanzando nuevas perspectivas para la actuación médica.(AU)