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1.
Acta Med Port ; 32(6): 415-418, 2019 Jun 28.
Artigo em Português | MEDLINE | ID: mdl-31292020

RESUMO

In the Portuguese National Health Service, little attention has been paid to oral health care. The almost nonexistence of a dentistry network raises concern about accessibility to services, and justifies the need to call on a predominantly private provision of services. The coexistence between the public and private settings is not always easy, especially when services need to interact and actively collaborate in order to find answers to the patient's problems. Dental implant procedures and the need to perform a previous maxillofacial computerized tomography to study the bone bed where osseointegrated dental implants are placed are a common situation. The current governmental regulation, blinded to the clinical context, may limit the accessibility to the tests. Based on this scenario, we discuss the possible options from an ethical point of view, framing the patient's and the physician's perspective and the relation between both. We conclude that the medical decision can't be disregarded from the clinical evaluation, in the intimacy of the medical consultation. This is an ethical duty that overrules the administrative and bureaucratic constraints. A good management of this apparent dichotomy may enhance better health and greater empowerment for the patient.


Assuntos
Tomada de Decisão Clínica/ética , Implantação Dentária Endo-Óssea Endodôntica/ética , Acesso aos Serviços de Saúde/ética , Cuidados Pré-Operatórios/ética , Tomografia Computadorizada por Raios X/ética , Medicina de Família e Comunidade/ética , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Papel do Médico , Portugal , Prescrições , Radiografia Dentária Digital/ética , Direito à Saúde/legislação & jurisprudência , Medicina Estatal
3.
Gac. méd. espirit ; 21(1)Ene-Abr 2019. Ilustraciones
Artigo em Espanhol | LILACS | ID: biblio-998469

RESUMO

El Programa del Médico y la Enfermera de la Familia cumple 35 años, ha sido una de las ideas más excelentes y oportunas relacionadas con la salud pública que haya pensado el comandante en jefe Fidel Castro en 1984. Surgió por la necesidad de acercar la atención médica a la comunidad y la familia, asimismo para lograr cambios en el estado de salud de la población; este programa es considerado la piedra angular del sistema nacional de salud pública (SNS), escalón superior de la atención primaria de salud (APS), el cual sustituye la atención sectorizada del policlínico de esa época


Assuntos
Humanos , Medicina de Família e Comunidade/ética , Saúde Pública/ética
5.
J Am Board Fam Med ; 31(2): 286-291, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29535247

RESUMO

BACKGROUND AND OBJECTIVE: To determine whether family medicine program directors (PDs) experienced moral distress due to obstacles to Hepatitis C virus (HCV) treatment, and to explore whether they found those obstacles to be unethical. DESIGN: An omnibus survey by the Council of Academic Family Medicine's Educational Research Alliance was administered to 452 and completed by 273 US-based PDs. The survey gauged attitudes and opinions regarding ethical dilemmas in patient access to HCV treatment. RESULTS: Most of the respondents were male. Sixty-four percent of respondents believed that treatment should be an option for all patients regardless of cost. Forty-one percent believed that it was unethical to deny treatment based on past or current substance use, and 38% believed treatment should be offered to patients who were substance abusers. Moral distress was reported by 61% (score >3) of participants when they were unable to offer treatment to patients due to the patient's failure to meet eligibility criteria. In addition, PDs reporting moderate-to-high levels of moral distress were also likely to report the following opinions: 1) treatment should be offered regardless of cost, 2) it is unethical to deny treatment based on past behavior, 3) substance abusers should be offered treatment, 4) it is unethical for medicine to be prohibitively expensive, and 5) Medicaid policy that limits treatment will worsen racial and ethnic disparities. CONCLUSIONS: Currently, important ethical dilemmas exist in the access and delivery of HCV therapy. Although a diversity of opinions is noted, a significant proportion of PDs are concerned about patients' inability to avail equitable care and experience distress. In some cases, this moral distress is in response to, and in conflict with, current guidelines.


Assuntos
Medicina de Família e Comunidade/ética , Acesso aos Serviços de Saúde/economia , Hepatite C/tratamento farmacológico , Princípios Morais , Diretores Médicos/psicologia , Antivirais/economia , Antivirais/uso terapêutico , Custos de Medicamentos/ética , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/normas , Feminino , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/normas , Hepatite C/economia , Hepatite C/etiologia , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/ética , Cobertura do Seguro/normas , Masculino , Medicaid/economia , Medicaid/normas , Estresse Ocupacional/psicologia , Diretores Médicos/ética , Diretores Médicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Transtornos Relacionados ao Uso de Substâncias/complicações , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
7.
Contraception ; 95(5): 470-476, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28131650

RESUMO

OBJECTIVE: The objective was to understand the motivations around and practices of abortion referral among women's health providers. METHODS: We analyzed the written comments from a survey of Nebraska physicians and advanced-practice clinicians in family medicine and obstetrics-gynecology about their referral practices and opinions for a woman seeking an abortion. We analyzed clinician's responses to open-ended questions on abortion referral thematically. RESULTS: Of the 496 completed surveys, 431 had comments available for analysis. We found four approaches to abortion referral: (a) facilitating a transfer of care, (b) providing the abortion clinic name or phone number, (c) no referral and (4) misleading referrals to clinicians or facilities that do not provide abortion care. Clinicians described many motivations for their manner of referral, including a fiduciary obligation to refer, empathy for the patient, respect for patient autonomy and the lack of need for referral. We found that abortion stigma impacts referral as clinicians explained that patients often desire additional privacy and clinicians themselves seek to avoid tension among their staff. Other clinicians would not provide an abortion referral, citing moral or religious objections or stating they did not know where to refer women seeking abortion. Some respondents would refer women to other providers for additional evaluation or counseling before an abortion, while others sought to dissuade the woman from obtaining an abortion. CONCLUSIONS: While practices and motivations varied, few clinicians facilitated referral for abortion beyond verbally naming a clinic if an abortion referral was made at all. IMPLICATIONS: Interprofessional leadership, enhanced clinician training and public policy that addresses conscientious refusal of abortion referral are needed to reduce abortion stigma and ensure that women can access safe care.


Assuntos
Aborto Induzido , Atitude do Pessoal de Saúde , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Aborto Induzido/ética , Aborto Induzido/psicologia , Aconselhamento , Medicina de Família e Comunidade/ética , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Ginecologia , Humanos , Status Moral , Obstetrícia , Padrões de Prática Médica/ética , Gravidez , Encaminhamento e Consulta/ética , Religião , Estigma Social , Inquéritos e Questionários
8.
Aten Primaria ; 49(4): 248-252, 2017 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-27614533

RESUMO

Family medicine has to continually reinvent itself around a core of values that constitutes its navigation system. But accurate data on its impact on the health of people will account for how far the values are actually being implemented. Thus, we can say that family medicine is a specialty based on values and as well as evidence based. The absence of a clarification system of values or its implementation threatens its very existence. Some of the values that are reviewed have shown great recognition and survival over time. Others are presented because they seem sufficiently significant. These are: people, comprehensiveness, trust relationship, patient-centred method, accessibility, continuity, family unity and the community, teamwork, sustainability of the health system, and continuous improvement.


Assuntos
Medicina de Família e Comunidade , Medicina de Família e Comunidade/ética
10.
J Am Board Fam Med ; 29 Suppl 1: S69-71, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27387169

RESUMO

A recurring conference theme was the essential place of social justice within family medicine, especially the need to focus on denominator populations, exalt the personal and caring qualities of doctoring, and address social determinants of health. Many expressed solidarity with "community," but it is not always easy to define community in our large and diverse nation. Exhortations for health advocacy were frequently voiced, but putting these into meaningful action agendas is a challenge. There was general agreement that medicine is in flux and that the many expressions of "commodity-centered consumerism" have altered organization and financing. The increasing demands by "consumers", who want low cost, instant availability, and shared decision-making, and yet change doctors when health plans alter coverage also differentially impact high-volume, low-margin specialties such as family medicine. Additional challenges were the electronic health record and calibrating an appropriate work/life balance. Five action steps are recommended: 1) speak out on the important social and moral issues; 2) be the experts on personal care; 3) make common cause with potential allies; 4) help institutions perceive the value of generalism; and 5) help find ways to enrich generalist disciplines to increase the joy of medicine and decrease the threat of burn out.


Assuntos
Medicina de Família e Comunidade/ética , Médicos de Família/ética , Atenção Primária à Saúde/ética , Justiça Social , Centros Médicos Acadêmicos , Defesa do Consumidor/tendências , Informática Aplicada à Saúde dos Consumidores/tendências , Registros Eletrônicos de Saúde , Medicina de Família e Comunidade/tendências , Humanos , Médicos de Família/tendências , Atenção Primária à Saúde/tendências , Determinantes Sociais da Saúde , Mídias Sociais , Estados Unidos
12.
Rev Esc Enferm USP ; 50 Spec: 89-95, 2016 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27384281

RESUMO

OBJECTIVE: Understanding the Moral Suffering experiences expressed in the daily life of the Family Health Strategy. METHOD: This is a case study with a qualitative approach, conducted between August and October 2014 in a municipality of Minas Gerais. The sample was represented by 28 professionals of family health teams. Data were collected through interviews with semi-structured questionnaires, observation, projective technique and submitted to thematic content analysis. RESULTS: The results indicate that routine issues of the health care system lead professionals to experience a challenging practice in dealing with daily situations that contradict their ethical precepts and can compromise the quality of work, becoming triggers of Moral Distress. CONCLUSIONS: Social vulnerabilities such as domestic violence, poor socioeconomic conditions and organizational weaknesses of the health system were the main triggers of Moral Distress. Therefore, it is necessary to amplify this reflection by workers of the Family Health Strategy, aiming to encourage the minimization of suffering experiences, considering their ethical values. OBJETIVO: Compreender as vivências de Sofrimento Moral expressas no cotidiano da Estratégia de Saúde da Família. MÉTODO: Trata-se de um estudo de caso com abordagem qualitativa, realizado entre os meses de agosto a outubro de 2014, cujo cenário foi um município de Minas Gerais. Participaram 28 profissionais das equipes de saúde da família. Os dados foram coletados por meio de entrevistas com roteiro semiestruturado, observação, técnica projetiva e, submetidos à análise de conteúdo temática. RESULTADOS: Os resultados apontaram que as questões rotineiras do serviço de saúde levam os profissionais a vivenciarem uma prática desafiadora ao lidarem diariamente com situações que contradizem seus preceitos éticos capazes de comprometer a qualidade do trabalho tornando-se disparadores de Sofrimento Moral. CONCLUSÃO: As vulnerabilidades sociais, como violência doméstica e condições socioeconômicas precárias, além das fragilidades organizacionais do Sistema de Saúde, foram os principais geradores de Sofrimento Moral. Assim, considera-se necessária a reflexão ampliada sobre a temática por parte dos trabalhadores da Estratégia de Saúde da Família, com intuito de propiciar a minimização de vivências de sofrimento e uma prática profissional em consonância com seus valores éticos.


Assuntos
Saúde da Família , Medicina de Família e Comunidade , Pessoal de Saúde/psicologia , Doenças Profissionais/etiologia , Estresse Psicológico/etiologia , Brasil , Cidades , Violência Doméstica/psicologia , Ética Médica , Medicina de Família e Comunidade/ética , Humanos , Princípios Morais , Doenças Profissionais/psicologia , Pesquisa Qualitativa , Fatores Socioeconômicos , Estresse Psicológico/psicologia
13.
BMC Res Notes ; 9: 339, 2016 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-27401163

RESUMO

BACKGROUND: It has been suggested that health literacy may impact the use of decision aids (DAs) among patients facing difficult decisions. Embedded in the pilot test of a questionnaire, this study aimed to measure the association between health literacy and pregnant women's intention to use a DA to decide about prenatal screening. We recruited a convenience sample of 45 pregnant women in three clinical sites (family practice teaching unit, birthing center and obstetrical ambulatory care clinic). We asked participating women to complete a self-administered questionnaire assessing their intention to use a DA to decide about prenatal screening and assessed their health literacy levels using one subjective and two objective scales. RESULTS: Two of the three scales discriminated between levels of health literacy (three numeracy questions and three health literacy questions). We found a positive correlation between pregnant women's intention to use a DA and subjective health literacy (Spearman coefficient, Rho 0.32, P = 0.04) but not objective health literacy (Spearman coefficient, Rho 0.07, P = 0.65). Hence subjective health literacy may affect the intention to use a DA among pregnant women facing a decision about prenatal screening. CONCLUSION: Special attention should be given to pregnant women with lower health literacy levels to increase their intention to use a DA and ensure that every pregnant women can give informed and value-based consent to prenatal screening.


Assuntos
Tomada de Decisões/ética , Síndrome de Down/psicologia , Alfabetização em Saúde/estatística & dados numéricos , Diagnóstico Pré-Natal/ética , Adulto , Instituições de Assistência Ambulatorial/ética , Técnicas de Apoio para a Decisão , Síndrome de Down/diagnóstico , Medicina de Família e Comunidade/ética , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Consentimento Livre e Esclarecido/psicologia , Intenção , Gravidez , Diagnóstico Pré-Natal/psicologia , Quebeque , Inquéritos e Questionários
15.
Fam Med ; 48(1): 44-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26950665

RESUMO

BACKGROUND AND OBJECTIVES: Physician interaction with pharmaceutical representatives results in less evidence-based prescribing and increased costs. Many organizations have called for strong conflict of interest policies in academic institutions. Implementing policy without educational interventions may not adequately address the influence of industry on physician prescribing patterns. The objective of this study is to assess the implementation and content of family medicine residency curricula on the physician-pharmaceutical industry relationship. METHODS: We surveyed US family medicine program directors using the Council of Academic Family Medicine Educational Research Alliance (CERA) platform. The presence of a formal curriculum on the physician-industry interaction and specific curricular elements (ethics of interaction, understanding detailing sessions and advertisements, use of unbiased pharmaceutical information) were the outcome measures of interest. RESULTS: Fifty-two percent (212 of 406) of program directors responded. Forty percent (95% confidence interval [CI]: 33%--46%) reported having a formal curriculum on physician-pharmaceutical industry interactions. The presence of a formal curriculum was more likely in residencies permitting interaction with industry (52% [48/92] versus 30% [36/120]) or with a university affiliation (43% [75/173] versus 19% [7/36]). The use of unbiased sources of information relating to pharmaceutical products and the ethics of the physician-pharmaceutical industry relationship were the most common curricular elements (59% and 55%, respectively). CONCLUSIONS: This study shows that less than half of US family medicine programs have a curriculum addressing physician-industry interactions. Further research on the efficacy of and barriers to curriculum creation and implementation is warranted.


Assuntos
Currículo , Indústria Farmacêutica/ética , Ética Médica/educação , Medicina de Família e Comunidade/educação , Internato e Residência , Relações Interprofissionais/ética , Medicina de Família e Comunidade/ética , Feminino , Humanos , Masculino , Política Organizacional , Padrões de Prática Médica/ética , Inquéritos e Questionários , Estados Unidos
19.
Aust Fam Physician ; 44(11): 846-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26590627

RESUMO

This is the fifth in a six-part series on general practice ethics. Cases from practice are used to trigger reflection on common ethical issues where the best course of action may not be immediately apparent. The case presented in the article is an illustrative compilation and not based on specific individuals.


Assuntos
Conflito de Interesses , Indústria Farmacêutica , Educação Médica Continuada/métodos , Ética Médica , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/ética , Humanos
20.
BMC Res Notes ; 8: 620, 2015 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-26514128

RESUMO

BACKGROUND: Family physicians (FPs) have a central role in the detection and management of child abuse. According to the literature, only 2-5% of initial reports of child abuse come from the medical profession. METHODS: The objective of this study was to assess levels of knowledge of risk factors for child abuse by Family Physicians (FPs) and the attention that the physicians pay to these risk factors. We conducted a mixed-method survey based on semi-structured interviews. 50 FPs practicing in the Somme County (northern France) were interviewed with closed and open questions. The FPs' level of knowledge of risk factors for child abuse and obstacles in the detection of child abuse were assessed. RESULTS: The FPs' level of knowledge of risk factors for child abuse was similar to that reported in the literature. However, FPs knew little about the significant role of prematurity. Likewise, the FP's training did not seem to influence their knowledge of risk factors. Fear of an incorrect diagnosis was the main obstacle to reporting a suspected case. The FPs considered that they were often alone in dealing with a difficult situation and considered that the judicial system and the social services were not sufficiently active. CONCLUSIONS: Few FPs had actually received specific training in the detection and management of child abuse but many stated their need for this type of training. FPs encounter many obstacles in the detection of child abuse, which sometimes make the FP reluctant to report a suspected or potential case. Medical education need to be improved in this field.


Assuntos
Atitude do Pessoal de Saúde , Maus-Tratos Infantis/diagnóstico , Medicina de Família e Comunidade , Médicos de Família/ética , Adulto , Criança , Maus-Tratos Infantis/prevenção & controle , Educação Médica Continuada , Medicina de Família e Comunidade/ética , Feminino , França , Humanos , Masculino , Médicos de Família/educação , Fatores de Risco , Inquéritos e Questionários , Recursos Humanos
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