Navegando por Palavras-chave "Physician-patient relations"
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- ItemAcesso aberto (Open Access)Comunicação de más notícias no centro de terapia intensiva: inquérito com médicos de hospitais de grande porte na cidade de são paulo(Universidade Federal de São Paulo (UNIFESP), 2018-09-14) Gibello, Juliana [UNIFESP]; Citero, Vanessa de Albuquerque [UNIFESP]; Parsons, Henrique Afonseca; http://lattes.cnpq.br/9798707175891242; http://lattes.cnpq.br/9593692806458673; Universidade Federal de São Paulo (UNIFESP)Caring for seriously ill patients and talking to family members about difficult situations and decisions is routine practice for physicians at Intensive Care Units (ICUs). Communicating bad news in this context is considered one of the most difficult tasks for physicians who may not have had sufficient training to develop such skills. Objective: The objective of this study was to evaluate the perception of ICU physicians about the process of communicating bad news for patients and their families, identifying the degree of selfreported comfort and confidence and what factors may facilitate or hinder such process. Methods: A survey was conducted through a selfadministered questionnaire with ICU physicians and residents of three tertiary hospitals in the city of São Paulo: Hospital Israelita Albert Einstein, Hospital São Paulo UNIFESP and Hospital Municipal Vila Santa Catarina (SBIAE). Results: The 103 ICU physicians who participated (response rate 72.5%) reported that they did not have training or courses to develop communication skills, although they affirm that it is a frequent practice. Conclusions: Facilitators of the process of communication of bad news were: emotional support from the family, patient and family trusting the doctor and patient’s wishes to participate in the decisions. Hindering factors identified were:: discussions on poor prognosis, lack of communication skills (considering that they had little training on the subject), lack of family members (or presence of numerous members) during hospitalization, , fears of the doctors themselves, the possible emotional reactions consequent to the communication, and conflicting and divergent information being communicated by several doctors at the same admission. Doctors also reported that discussing withdrawal from lifesustaining treatment is more difficult than talking about initiating them. Another point mentioned by the intensivists was to feel more comfortable when treatment decisions happen together with patient, family, and doctor, which shows a possible change in the paternalistic positioning learned in their formation to that of a shared decision making setup. In addition, they believe that Palliative Care at the Intensive Care Unit has an impact on their future as a physician.
- ItemSomente MetadadadosDe la douleur des malades a la souffrance de l'equipe: une tentative de comprehension dynamique du fonctionnement d'une unite de therapie intensive de traumatismes(Universidade Federal de São Paulo (UNIFESP), 1990) Nogueira-Martins, Luiz Antonio [UNIFESP]; Yazigi, Latife [UNIFESP]; Yazigi, Latife [UNIFESP]
- ItemAcesso aberto (Open Access)O ensino da comunicação na graduação em medicina: uma abordagem(Universidade Federal de São Paulo (UNIFESP), 2004) Rossi, Pedro Santo [UNIFESP]; Batista, Nildo Alves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)A partir da importância atribuída à comunicação na relação médico-paciente com fator de boa adesão ao tratamento, surgiu o interesse em saber quando e como s contempla o ensino/aprendizagem de comunicação nos cursos de graduação em medicina. As recomendações sobre o desenvolvimento da competência "comunicação" preconizadas nas novas Diretrizes Curriculares Nacionais acrescentam uma justificava a mais para a pesquisa. Delimitado o campo da pesquisa, revisada a literatura e optado pelo referencial metodológico da pesquisa qualitativa, foram entrevistados doze egressos de cursos de medicina que estavam iniciando residência em Clínica Médica e nove professores, coordenadores de ensino de cursos de graduação em medicina. A análise da entrevistas, feita sob o olhar fenomenológico, privilegia o vivido. Aparece uma grande diversidade de concepções sobre o que seja a comunicação, contudo das falas dos entrevistadores emergem categorias de análise que mostram, em essência, uma tendência para considerar a competência comunicação como uma habilidade instrumental para se conseguir tirar informações e se fazer entender no procedimento médico. A temporalidade (o quando) também apresenta uma gama de possibilidades, distribuída entre as matérias iniciais e as atividades finais do curso. A forma (o como) de ensino/aprendizagem se distribui entre disciplinas básicas e atividades práticas. Em essência, o aprendizado se revela como produto da vivência pessoal ao longo do curso e da experiência na prática junto ao paciente.
- ItemAcesso aberto (Open Access)Laboratório de comunicação: ampliando as habilidades do estudante de medicina para a prática da entrevista(UNESP, 2010-03-01) De Marco, Mario Alfredo [UNIFESP]; Vessoni, Ana Luiza [UNIFESP]; Capelo, Augusto [UNIFESP]; Dias, Cíntia Camargo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This paper presents an activity named communication laboratory, in which, through recording and discussing simulated interviews (interactive video feedback technique), the aim is to capacitate medical students with the communicational skills needed for performing medical tasks. This activity is included in the second year of the medical course, and is part of the medical psychology program. Careful and detailed observation of the recorded images has revealed this to be a very powerful instrument for detecting and developing the relational and communicational capacities. We are still at the phase of performing systematized evaluations that will allow us, in the future, to verify the efficacy of the activity and to measure the repercussion that it will have on the development of students in their medical practice activities.
- ItemAcesso aberto (Open Access)Medical residency: factors relating to difficulty in helping in the resident physician-patient relationship(Associação Paulista de Medicina - APM, 2011-01-06) De Marco, Mario Alfredo [UNIFESP]; Citero, Vanessa de Albuquerque [UNIFESP]; Nogueira-Martins, Maria Cezira Fantini; Yazigi, Latife [UNIFESP]; Wissow, Lawrence Sagin; Nogueira-Martins, Luiz Antonio [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Health Department of the State of São Paulo Health Institute; Johns Hopkins Bloomberg School of Public Health Department of Health Policy and ManagementCONTEXT AND OBJECTIVE: Previous studies have attempted to understand what leads physicians to label patients as 'difficult'. Understanding this process is particularly important for resident physicians, who are developing attitudes that may have long-term impact on their interactions with patients. The aim of this study was to distinguish between patients' self-rated emotional state (anxiety and depression) and residents' perceptions of that state as a predictor of patients being considered difficult. DESIGN AND SETTING: Cross-sectional survey conducted in the hospital of Universidade Federal de São Paulo (UNIFESP). METHODS: The residents completed a sociodemographic questionnaire and rated their patients using the Hospital Anxiety and Depression Scale (HADS) and Difficulty in Helping the Patient Questionnaire (DTH). The patients completed HADS independently and were rated using the Karnofsky Performance Status scale. RESULTS: On average, the residents rated the patients as presenting little difficulty. The residents' ratings of difficulty presented an association with their ratings for patient depression (r = 0.35, P = 0.03) and anxiety (r = 0.46, P = 0.02), but not with patients' self-ratings for depression and anxiety. Residents from distant cities were more likely to rate patients as difficult to help than were residents from the city of the hospital (mean score of 1.93 versus 1.07; P = 0.04). CONCLUSIONS: Understanding what leads residents to label patients as having depression and anxiety problems may be a productive approach towards reducing perceived difficulty. Residents from distant cities may be more likely to find their patients difficult
- ItemAcesso aberto (Open Access)O significado de saúde e doença para o aluno de medicina ao longo da graduação(Universidade Federal de São Paulo (UNIFESP), 2010-09-29) Lerman, Tatiana Gottlieb [UNIFESP]; Blay, Sergio Luis [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The concepts of medical students about health and illness in the early graduation depends on your knowledge and past experiences as well as the degree of contact with medical practice and the reality that surrounds this issue. The aim of this study was to understand the vision of health and illness that pervades the minds of future doctors and delineate the relationships established between the notion of health and illness, the school curriculum, personal experiences and trajectory of social and professional student throughout the course. It was conducted a qualitative study, using a psychosocial questionnaire and semi-structured interviews with students from first, third and sixth year 2008 the Federal University of São Paulo (UNIFESPEPM). The material was subjected to content analysis. The experiences and personal characteristics of each participant, as well curricular and extracurricular experiences, and the hidden curriculum influence both the vision they hold for health and disease as their career choice. We can note certain coldness in the doctor-patient relationship, and greater distrust of patients throughout the course. Students graduating demonstrate a need to protect the feelings aroused by the experiences during the medicine course. It is clear that students have the knowledge of global and human care patients. However, it seems that they know cognitively, but emotionally they could not put it into practice. This issue would be linked to fact that they are having difficulty contacting these aspects in themselves.