RESUMO
Estudo qualitativo com abordagem cartográfica que teve como objetivo compreender os efeitos que o vínculo e a responsabilização entre médicos de família e usuários produzem nos próprios médicos. Foram realizadas dez entrevistas abertas por meio de perguntas disparadoras com médicos de família e médicos residentes. A análise das entrevistas se deu sob o referencial da micropolítica e problematizou, com base nas experiências relatadas, a existência de um "território identitário médico", bem como as possibilidades de desconstituição desse território, sua desterritorialização no sentido de novas reterritorializações, a exemplo de afastar-se da onipotência/infalibilidade não para sofrer, mas para cuidar de si e do outro. Propõe-se que, nesse movimento de reconstrução do território identitário, tanto médico como usuário passem a transitar pela dimensão cuidadora do encontro, em que tecnologias leves podem ser operadas e novas possibilidades de configurações do cuidado acontecem. (AU)
Estudio cualitativo con abordaje cartográfico cuyo objetivo fue comprender los efectos que el vínculo y la toma de responsabilidad entre médicos de familia y usuarios producen en los propios médicos. Se realizaron diez entrevistas abiertas a partir de preguntas desencadenadoras con médicos de familia y médicos residentes. El análisis de las entrevistas se realizó con base en el referencial de la micropolítica y problematizó, a partir de las experiencias relatadas, la existencia de un "territorio de identidad médico", así como las posibilidades de desconstitución de este territorio, su desterritorialización en el sentido de nuevas reterritorializaciones, con el ejemplo de apartarse de la omnipotencia/infalibilidad no para sufrir, sino para cuidar de sí mismo y del otro. Se propone que, en ese movimiento de reconstrucción del territorio de identidad, tanto el médico como el usuario pasan a transitar por la dimensión cuidadora del encuentro, en donde tecnologías leves pueden operar y suceden nuevas posibilidades de configuraciones del cuidado. (AU)
The purpose of this qualitative research with a cartographic approach was to understand the effects that bonding and accountability between family physicians and users can produce on the physicians themselves. Ten open interviews were conducted based on triggering questions with family physicians and medical residents. The analysis of the interviews using the reference of the micropolitics was based on the experiences reported, and it was problematized the existence of a "medical identity territory", as well as the deconstruction of this territory, its "deterritorialization", leading to "reterritorializations", such as moving away from omnipotence / infallibility not to suffer, but to take care of oneself and others. It is proposed that in this movement, both physician and user start to move through the caregiving dimension of the encounter, where light technologies can be operated and new possibilities of configurations of care happens. (AU)
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Médicos de Família/psicologia , Assistência Centrada no Paciente , Medicina de Família e Comunidade , Apego ao Objeto , Entrevistas como Assunto , Continuidade da Assistência ao PacienteRESUMO
BACKGROUND AND OBJECTIVES: Despite the efforts of many organizations to increase the volume of rural health care providers, rural communities continue to experience a shortage of physicians. To address this shortage, more information is needed as to how specific factors contribute to family physicians' choice to purse rural full-spectrum practice. METHODS: Interviews with 21 key informants guided a grounded theory analysis around the question of "What factors contribute to the decision to, and maintenance of, practicing full-spectrum rural medicine?" RESULTS: Analysis revealed two categories of factors that influenced choice of scope and maintenance of scope across a career: contextual and developmental factors. Contextual factors included the national health care landscape, the local setting, and personal factors. The developmental factors pertained to the point in the physician's career, and include preprofessional envisioned scope, current scope, and ideal future scope of practice. CONCLUSIONS: Results describe how a rural physician's scope of practice generally narrows as her/his career progresses. The results elaborate on how the larger health care landscape, local community, and personal factors all intersect to inform a physician's decision to pursue and/or continue practice. Results of the study were consistent with preexisting literature, but provide additional depth and suggest a theoretical relationship among factors.
Assuntos
Escolha da Profissão , Medicina de Família e Comunidade , Teoria Fundamentada , Médicos de Família/psicologia , Serviços de Saúde Rural , Humanos , Entrevistas como Assunto , Área de Atuação Profissional , Estados UnidosRESUMO
BACKGROUND: The Brazilian undergraduate medical course is six years long. As in other countries, a medical residency is not obligatory to practice as a doctor. In this context, this paper aims to clarify what and when competencies in communication and professionalism should be addressed, shedding light on the role of university, residency and post-residency programmes. METHODS: Brazilian family physicians with diverse levels of medical training answered a questionnaire designed to seek a consensus on the competencies that should be taught (key competencies) and when students should achieve them during their medical training. The data were analysed using descriptive statistics and correlation tests. RESULTS: A total of seventy-four physicians participated; nearly all participants suggested that the students should achieve communication and professionalism competencies during undergraduate study (twenty out of thirty competencies - 66.7%) or during residency (seven out of thirty competencies - 23.33%). When competencies were analysed in domains, the results were that clinical communication skills and professionalism competencies should be achieved during undergraduate medical education, and interpersonal communication and leadership skills should be reached during postgraduate study. CONCLUSION: The authors propose that attainment of clinical communication skills and professionalism competencies should be required for undergraduate students. The foundation for Leadership and Interpersonal Abilities should be particularly formed at an undergraduate level and, furthermore, mastered by immersion in the future workplace and medical responsibilities in residency.
Assuntos
Comunicação , Educação de Graduação em Medicina , Médicos de Família/psicologia , Profissionalismo/educação , Adulto , Brasil , Competência Clínica , Feminino , Guias como Assunto , Humanos , Internato e Residência , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the effect of a participative educational intervention on the clinical competence of Mexican family physicians regarding the nutritional management of patients with diabetes mellitus Type 2. MATERIALS AND METHODS: Quasi-experimental study with a before-and-after control group. Convenience sample included 60 family physicians distributed in two social security primary health care units, randomly selected: 30 in the "A" unit and 30 in the "B" unit. Unit "A" was assigned randomly as control group, and "B" unit as intervention group. The intervention consisted of a theoretical-practical course-workshop that lasted six months where real cases were discussed and solved. Clinical competence was evaluated by means of an instrument designed ex professo, with a maximum theoretical value of 100 and 94% reliability according to the Kuder-Richardson test. Medians of clinical competence were compared among groups, before and after intervention, using the Mann-Whitney U test, while frequencies distribution of clinical competence level were analyzed with the Kolmogorov-Smirnov test (p≤0.05). RESULTS: Overall medians and intervals for unit "A" were 28 (9-45) pre-intervention and 34 (11-51) pos-intervention, with before-after difference p>0.05; for unit "B", values were 32 (12-50) pre-intervention, 61 (36-82) pos-intervention, and before-after difference p≤0.05. No significant differences were found among groups pre-intervention (p>0.05), although they were observed pos-intervention (p≤0.05). CONCLUSIONS: The educational intervention evaluated proved to improve, in a statistically significant way, the overall and by dimensions clinical competence level of Mexican family physicians for nutritional management of patients with diabetes mellitus type 2.
Assuntos
Competência Clínica , Diabetes Mellitus Tipo 2/dietoterapia , Dieta para Diabéticos , Educação Médica Continuada , Médicos de Família/psicologia , Atitude Frente a Saúde , Avaliação Educacional , Humanos , MéxicoRESUMO
La enfermedad situacional es una categoría nosográfica poco analizada en la bibliografía médica. En este artículo se abordan aspectos importantes relacionados con su valor clasificatorio y práctico, así como la importancia que reviste en el plan de formación del médico general integral, debido a las potencialidades de desarrollo en la comunidad. Además, se enfatiza en las posibilidades prácticas de aplicar los procedimientos psicoterapéuticos de apoyo, que son oportunos y facilitadores para evitar la sobresaturación de la demanda asistencial secundaria, resultante del envío o remisión
The situational disease is a nosographic category little analyzed in the medical literature. In this work important aspects related to its classificatory and practical value are approached, as well as the importance that it has in the training plan of the comprehensive general doctor, due to the development potentialities in the community. It is also emphasized on the practical possibilities of implementing the support psychotherapeutic procedures that are opportune and facilitators to avoid the overflood of secondary assistance demand, resulting from referral.
Assuntos
Humanos , Masculino , Feminino , Estresse Fisiológico , Esgotamento Profissional , Transtornos de Adaptação , Médicos de Atenção Primária/psicologia , Médicos de Família/psicologia , Clínicos GeraisRESUMO
AIMS: Few clinical coaching studies are both endorsed by real cases and focused on reducing suboptimal diabetes control. We evaluated the effectiveness of coaching on improving type 2 diabetes goals after 3 years of implementation in primary care. METHODS: A cross-sectional study with follow up was conducted during 2008-2011. Coaching consisted of guiding family doctors to improve their clinical abilities, and it was conducted by a medical doctor trained in skill building, experiential learning, and goal setting. Effectiveness was assessed by means of fasting plasma glucose and glycosylated hemoglobin outcomes. The main analysis consisted of 1×3 and 2×3 repeated measures ANOVAs. RESULTS: A significant coaching×time interaction was observed, indicating that the difference in glucose between primary care units with and without coaching increased over time (Wilks' lambda multivariate test, P<0.0001). Coaching increased 1.4 times (95%CI 1.3, 1.5) the possibility of reaching the fasting glucose goal after controlling for baseline values. There was also a significant improvement in glycosylated hemoglobin (Bonferroni-corrected p-value for pairwise comparisons, P<0.0001). CONCLUSIONS: A correctible and even preventable contributing component in diabetes care corresponds to physicians' performance. After 3 years of implementation, coaching was found to be worth the effort to improve type 2 diabetes control in primary care.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Tutoria/métodos , Médicos de Família , Médicos de Atenção Primária , Atenção Primária à Saúde , Idoso , Atitude do Pessoal de Saúde , Biomarcadores/sangue , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Distribuição de Qui-Quadrado , Competência Clínica , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Hemoglobinas Glicadas/metabolismo , Fidelidade a Diretrizes , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Médicos de Família/psicologia , Médicos de Atenção Primária/psicologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Resultado do TratamentoRESUMO
The author, a seasoned midcareer family physician, summarizes his personal practice philosophy as it relates to encounters with patients. By focusing on 3 aspects of care--process issues, people issues, and political issues--he explores the unique characteristics of his clinical decision-making process. He concludes by noting that it is through examination of the question "How do I think in the work I do?" that family physicians can best bring their signature presences to their encounters with patients and their families.
Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Filosofia Médica , Relações Médico-Paciente , Médicos de Família/psicologia , Técnicas de Apoio para a Decisão , Humanos , Relações Interprofissionais , Papel do Médico , Relações Profissional-FamíliaRESUMO
Many family physicians have written about how they influence, nurture, and empower people in their communities of practice. In this essay, the author writes of the personal joys that family medicine has brought him. An expression of his appreciation for his work as a family doctor, it touches on 6 themes that continue to rejuvenate his practice: love, faith, mystery, place, dance, and medicine. By examining the emotional and psychological dimensions of these themes, he offers a path by which other family physicians may be able to find sustenance and joy in their daily work.
Assuntos
Atitude do Pessoal de Saúde , Medicina de Família e Comunidade , Humanos , Papel do Médico , Médicos de Família/psicologiaRESUMO
OBJECTIVE: To determine the stance of providers in Jamaica regarding the suggested change in abortion law and proposal to train providers. METHODS: A face-to-face anonymous survey of 35 obstetrician-gynecologists (Obs) and 228 general practitioners (GPs) in Kingston was used to assess knowledge, opinions and practice. RESULTS: Demand for abortion was high: 94.7% of GPs and 100% of Obs had been asked to perform an abortion. Although 50.7% of GPs and 70.6% of Obs had performed abortions, 81.2% and 88.6%, respectively, had referred women to another provider. Training was more likely for Obs (65.7% versus 52.2%; P<0.001). Patient assessment was appropriate, but written guidelines, counseling, and social services referral were uncommon. More Obs knew the laws (62.9% versus 42.5%; P=0.052). Most participants did not agree to abortion under any circumstance, but only 25.3% had moral or religious objections, and only 9.4% refused to perform abortions because they were illegal. Most providers felt that abortions should be made more accessible, and almost all felt that abortions should be performed only by Obs. CONCLUSION: Demand for abortions is high in Jamaica, but many doctors refer clients to another provider. Patient assessment is good, but support services need improvement.
Assuntos
Aborto Induzido/legislação & jurisprudência , Atitude do Pessoal de Saúde , Aborto Induzido/educação , Aborto Induzido/estatística & dados numéricos , Adulto , Competência Clínica , Feminino , Ginecologia , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Obstetrícia , Médicos/psicologia , Médicos de Família/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To identify family, provider, and healthcare setting characteristics associated with African-American parents' perceptions of partnership with their child's primary care provider. STUDY DESIGN: Data were collected via a telephone survey of 425 African-American parents of 0- to 5-year-old children who had presented for a health visit 1 to 2 weeks earlier at participating pediatric primary care practices in Washington, DC. Parents' perceptions of the level of partnership building by their child's provider were assessed using the Street Provider Communication Style instrument. RESULTS: Multivariate logistic regression models indicated that, after adjusting for other family and provider/setting characteristics, parents seen in community health centers were more likely to report high partnership building compared with parents seen at private or hospital-based practices. Parents with at least a college education and those who described their child's provider's race as "other" were most likely to report moderate partnership building. CONCLUSIONS: Future studies should examine elements of care delivery at community health centers that may lead to better partnerships between parents and providers in private and hospital-based practice settings.