Dilemas clínicos en la constitución de la tercera causal de la interrupción voluntaria del embarazo / Clinical dilemmas derived from the need to certify rape for voluntary pregnancy interruption

Since 2017, women in Chile are allowed to interrupt voluntarily a pregnancy on three grounds: 1) When a woman's life is at risk due to the pregnancy, 2) When there are fetal anomalies incompatible with life, or 3) When pregnancy is result of rape. Women who qualify for any of these three pregnancy interruption requirements are entitled to a psychosocial accompaniment program to promote an integrative approach. In this article we will discuss the role of the psychosocial team in cases of rape resulting pregnancy. Specifically, the clinical and ethical dilemmas posed by the need to certify the rape in a general hospital such as difficulties in assessment of the story's plausibility, clinician's dual role and the limits to confidentiality, are discussed.

Licencia médica psiquiátrica: revisión de los efectos positivos y negativos del reposo / Psychiatric sick leave

There is no consensus amongst physicians, social security representatives and researchers about optimum sick leaves. This is an indication that should maximize positive outcomes and minimize potential side effects, both for the patient and society. The use of sick leaves during the last decade rose steadily, particularly in the psychiatric field. The most important causes of this increase are: changes in public policies, overuse of psychiatric diagnosis to cover up unmet social needs, and modifications to labour structure. It is analysed the impact that this situation has implied for physician patient relationship as well as for health budget. Even though sick leave diminishes presentism associated to a psychiatric disorder, published evidence about the effect of prolonged sick leave shows that damage overruns potential benefits: augmented morbidity and mortality, workplace phobia, economic loss, among others.