Comunicación terapéutica en Fibromialgia = Therapeutic communication in Fibromyalgia

Resumen: Introducción: El carácter invisible y la estigmatización que existe acerca de la fibromialgia (FM) crean dificultades en la relación entre profesionales sanitarios y pacientes, por lo tanto, es necesario conocer las necesidades de comunicación entre ambos. Objetivos: Identificar la necesidad de comunicación entre profesionales sanitarios y pacientes con FM, conocer el grado de satisfacción de las personas con FM con respecto a la atención comunicativa recibida y determinar recomendaciones primordiales para una comunicación terapéutica eficaz. Metodología: Revisión sistemática a través de bases de datos de Ciencias de la Salud y páginas webs de organismos oficiales durante Enero y Febrero de 2019. Se obtuvieron un total de 166 artículos, de los cuales fueron seleccionados finalmente 25. Resultados: La comunicación entre profesionales y pacientes con FM es deficiente. Los pacientes están insatisfechos con la atención recibida y reivindican una comunicación más abierta y empática. Conclusión: Es necesario mejorar la comunicación entre profesionales y pacientes con FM para ofrecer una atención de calidad y mejorar la relación terapéutica. El respeto, el apoyo emocional, la escucha activa, la comprensión y la empatía son claves para una comunicación eficaz.Palabras clave: Comunicación; Fibromialgia; Relación profesional-paciente; Relación médico-paciente; Satisfacción del paciente.Abstract: Introduction: The invisible character and stigmatization that exists about fibromyalgia (FM) create difficulties in the relationship between health professionals and patients, therefore, it is necessary to know the communication needs between both. Objectives: To identify the need for communication between health professionals and patients with FM, to know the degree of satisfaction of people with FM with respect to the communicative attention received and determine essential recommendations for effective therapeutic communication. Methodology: Systematic review through Health Sciences databases and websites of official organizations during January and February 2019. A total of 166 articles were obtained, of which 25 were finally selected. Results: Communication between professionals and patients with FM is deficient. Patients are dissatisfied with the attention received and reclaim a more open and empathetic communication. Conclusion: It is necessary to improve communication between professionals and patients with FM to provide a quality attention and improve the therapeutic relationship. Respect, emotional support, active listening, understanding and empathy are key to effective communication.Keywords: Communication; Fibromyalgia; Professional-patient relation; Physician-Patient relation; Patient satisfaction.

Doctor 2.0 and i-Patient: information technology in medicine and its influence on the physician-patient relation

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Il Parere del Comitato Nazionale per la Bioetica su rifiuto e rinuncia consapevole al trattamento sanitario

Il presente lavoro costituisce un’analisi e un commento del Parere del Comitato Nazionale per la Bioetica (CNB) dal titolo “Rifiuto e rinuncia consapevole al trattamento sanitario nella relazione paziente-medico”, approvato il 24 ottobre 2008. La prima parte del contributo descrive sinteticamente la struttura e il contenuto del documento, il cui oggetto, secondo le parole dello stesso CNB, è così individuato: “rifiuto o rinuncia consapevole, totale o parziale, a trattamenti sanitari non iniziati o già intrapresi manifestata da un paziente informato e pienamente capace di intendere e di volere, e rivolta al medico (o all’équipe medica), titolare di fondamentali obblighi giuridici e deontologici e sotto la cui responsabilità il trattamento è in atto”. Operata questa prima delimitazione, la successiva importante distinzione che viene effettuata è tra un paziente autonomamente in grado di sottrarsi alla terapia indesiderata e un paziente che si trova in condizioni di dipendenza tali da rendere necessario l’intervento di un altro soggetto (il medico) per realizzare l’interruzione della cura. L’ultima parte del Parere presenta le “Conclusioni” che sintetizzano le riflessioni svolte ed espongono i profili di convergenza all’interno del Comitato. Gli Autori del contributo procedono quindi ad un’analisi critica del Parere a partire da queste “Conclusioni”, concentrando in particolare l’attenzione sulla distinzione, già messa in risalto, tra autonomia e dipendenza. Viene così evidenziato, da una parte, in relazione alla prima situazione, l’autentico fondamento dell’agire medico, anche in rapporto al consenso informato; dall’altra parte, riguardo alla situazione di dipendenza, si riafferma il valore giuridico del bene “vita” ed il ruolo dell’operatore sanitario per la tutela di essa. ---------- The present work constitutes of analysis and comment on the Advice of the Council on Bioethics entitled: “Conscious refusal and renunciation to medical care in the physician-patient relation”, approved on October 24th, 2008. The first part of this work describes synthetically the structure and the contents of the Advice, the object of which, according to the words of the same CNB, is: “The conscious refusal and renunciation, totally or partially, of medical care not started or already started by an informed and capable patient and directed to a physician, holder of fundamental legal obligation and medical ethics under whose responsibility the medical care is already in progress”. After this first delimitation, the succeeding important distinctions that come into effect between a patient who autonomously refuses the undesired therapy and a patient who is found in a state of dependence which requires the intervention of another subject (the doctor) to realize the interruption of the cure. The last part of the work presents the conclusions which synthesize the reflections made and the areas of overlap inside the Committee. The Authors proceed therefore to a critical analysis of the document apart from the conclusion, concentrating particular attention on the distinction already made between autonomy and dependence. They furthermore, in relation to the first situation, emphasize the authentic foundation of the medical act as it relates to informed consent; from another part, regarding the situation of dependence, they reaffirm the importance of life and the role of the physician in preserving it.

Il Parere del Comitato Nazionale per la Bioetica su rifiuto e rinuncia consapevole al trattamento sanitario

Il presente lavoro costituisce un’analisi e un commento del Parere del Comitato Nazionale per la Bioetica (CNB) dal titolo “Rifiuto e rinuncia consapevole al trattamento sanitario nella relazione paziente-medico”, approvato il 24 ottobre 2008. La prima parte del contributo descrive sinteticamente la struttura e il contenuto del documento, il cui oggetto, secondo le parole dello stesso CNB, è così individuato: “rifiuto o rinuncia consapevole, totale o parziale, a trattamenti sanitari non iniziati o già intrapresi manifestata da un paziente informato e pienamente capace di intendere e di volere, e rivolta al medico (o all’équipe medica), titolare di fondamentali obblighi giuridici e deontologici e sotto la cui responsabilità il trattamento è in atto”. Operata questa prima delimitazione, la successiva importante distinzione che viene effettuata è tra un paziente autonomamente in grado di sottrarsi alla terapia indesiderata e un paziente che si trova in condizioni di dipendenza tali da rendere necessario l’intervento di un altro soggetto (il medico) per realizzare l’interruzione della cura. L’ultima parte del Parere presenta le “Conclusioni” che sintetizzano le riflessioni svolte ed espongono i profili di convergenza all’interno del Comitato. Gli Autori del contributo procedono quindi ad un’analisi critica del Parere a partire da queste “Conclusioni”, concentrando in particolare l’attenzione sulla distinzione, già messa in risalto, tra autonomia e dipendenza. Viene così evidenziato, da una parte, in relazione alla prima situazione, l’autentico fondamento dell’agire medico, anche in rapporto al consenso informato; dall’altra parte, riguardo alla situazione di dipendenza, si riafferma il valore giuridico del bene “vita” ed il ruolo dell’operatore sanitario per la tutela di essa. ---------- The present work constitutes of analysis and comment on the Advice of the Council on Bioethics entitled: “Conscious refusal and renunciation to medical care in the physician-patient relation”, approved on October 24th, 2008. The first part of this work describes synthetically the structure and the contents of the Advice, the object of which, according to the words of the same CNB, is: “The conscious refusal and renunciation, totally or partially, of medical care not started or already started by an informed and capable patient and directed to a physician, holder of fundamental legal obligation and medical ethics under whose responsibility the medical care is already in progress”. After this first delimitation, the succeeding important distinctions that come into effect between a patient who autonomously refuses the undesired therapy and a patient who is found in a state of dependence which requires the intervention of another subject (the doctor) to realize the interruption of the cure. The last part of the work presents the conclusions which synthesize the reflections made and the areas of overlap inside the Committee. The Authors proceed therefore to a critical analysis of the document apart from the conclusion, concentrating particular attention on the distinction already made between autonomy and dependence. They furthermore, in relation to the first situation, emphasize the authentic foundation of the medical act as it relates to informed consent; from another part, regarding the situation of dependence, they reaffirm the importance of life and the role of the physician in preserving it.

轉型社會中醫患關係的觀念格局

LANGUAGE NOTE | Document text in Chinese; abstract also in English.轉型社會條件下醫患之間常常充滿了道德困境和失序，但是對於醫患關係的意識狀態缺乏必要的刻畫和描述。本文試圖通過一個常見事例的解析，說明醫患關係在中國傳統文化背景下的特質，尤其是儒家文化的影響。另一方面，西學東漸以來，西方科學精神以及西方倫理制度對中國醫界觀念的作用和影響也有獨特的反映。那麼，其中的優劣互見最終要落實到循著本土的文化邏輯和價值觀衍生具有生機和活力的醫患關係的觀念格局。In describing the situation of physician-patient relationship in current China, some like to characterize it by adopting popular Western concepts, principles and theories. As a result, the concept of "patient rights" has been a cliché in such discussion. While this concept may be important to appeal to in laying out some relevant issues as well as working out proper solutions, it by no means constitutes an exhaustive intellectual and moral network of resources to deal with the Chinese situation regarding the physician-patient relation. Instead, the physician-patient relation in China has been shaped by the moral thought and practice of Confucian tradition in a long history, which continuously informs the interplays between Chinese physicians and patients in current transitional China. Instead of being led by any ideas of patient rights and individual contracts, Chinese physicians, families as well as patients themselves are closely engaged in a value system in which the Confucian virtues and relation models direct medical practice in general and the physician-patient relation in particular. Confucian values and cultural factors , such as "following your moral conscience", "looking for connections in solving difficulties" and "giving a face to a friend" , have been salient in reality. It is difficult to resolve any problems resulting from this practice by appealing to rights and contracts intertwined in Western individualistic culture. Chinese bioethicists, in order to provide feasible and ethical guidance to current Chinese practice, must carefully study the Confucian values and their operating mechanisms in biomedical reality. If they simply expect to sit and relax by introducing modern Western concepts and ideas such as "patient rights" and "contracts" , they will end up without offering any real assistance.DOWNLOAD HISTORY | This article has been downloaded 31 times in Digital Commons before migrating into this platform.

Bioethical aspects of ethnic prejudice

It is assumed that considerable ethnic distance is an empirical manifestation of the ethnonationalistic political pattern still dominant in contemporary Serbian society. The results of our research of ethnic distance on a non-representative sample of Medical School students (University in Belgrade) confirm this assumption. We discuss a specific sample -future medical professionals who are a priori expected to be free from all kind of prejudice, while the physician-patient relation implies a complete and unreserved engagement of the medical professional, disregarding patient?s race, nation, religion, sex/gender, age etc. Nevertheless, the findings indicate considerable distance among students toward certain ethnic, national and racial groups. The authors point to the importance of bioethics in the education of future medical doctors since, among other things, bioethics reflects various dimensions of specific interaction/communication in the physician-patient relation. Finally, the authors emphasize the significance of bioethics in critical reflexion of a priori and unquestionable authority of the "white coat".