[Medical practice within the primary health care context. characteristics and new trends]

The request for a high quality clinical practice is a permanent challenge. Many conclusions have been drawn concerning the medical care and the results variability and the drifts cost. Within this context the General Practitioner has to maintain and improve his performance. Aim: To asse the agreement of primary care physicians with new trends in the specialized literature: A survey via an auto-questionnaire comprising 20 items was addressed to 50 General Practitioners of the Public Health Sector, draw chosen, in order to provide their opinion, knowledge and know-how relative to certain aspects of their daily activity. The General Practitioners' estimation of the average time for a consultation is 10 minutes; the reasons of its prolongation are the poly-pathologies, the unexplained medical symptoms and the extreme aged patients. The preferred anamnesis strategy is followed by the global method; in the relationship General Practitioner - Patient the medical aspect is prevailing on the centred patient approach [psycho - socio-medical]. The majority of General Practitioners are behaving more as teachers and advisors than as technicians and tutors. The non - explained medical symptoms are merely corresponding to psychosomatic pathologies and hidden complaints. The sanitary information promotion consists, in priority, in the use of a standard classification and then in the electronic activity registration. Our study allowed us to confirm a certain clash between our General Practitioners' practice and the new trends in the specialized literature. The validity of these results remains though dependant of a survey to be done with the Patients

Perfil do administrador de clínica oftalmológica na Grande São Paulo / The profile of the ophthalmic clinic manager in São Paulo city and neighboring towns

OBJETIVO: Determinar o perfil do administrador de clínica oftalmológica na Grande São Paulo. MÉTODOS: Foram encaminhados questionários para clínicas oftalmológicas sorteadas aleatoriamente. Variáveis analisadas: sexo, idade, escolaridade, cursos de graduação e pós-graduação, participação na sociedade, carga horária efetiva, visão de carreira, e sistemática de remuneração e número de consultas/mês da clínica. RESULTADOS: Cinqüenta e cinco por cento eram homens, 60 por cento tinham de 30 a 59 anos, para 60 por cento era sua primeira experiência na área e 56 por cento administravam clínicas com mais de 1000 consultas/mês. Entre os que tinham formação universitária (70 por cento), 56 por cento concluíram curso de Administração de Empresas. Metade dos entrevistados tinham pós-graduação, sendo os cursos preferidos: Administração Hospitalar (40 por cento) e MBA (30 por cento). Somente 10 por cento eram sócios da clínica. Trabalham acima de 40 horas/semana 75 por cento dos profissionais. Atualmente 60 por cento não fazem curso na área e 56 por cento acham que o incentivo à carreira deve vir da clínica. Benefícios: 75 por cento dos profissionais têm planos de saúde e/ou carteira assinada. Remuneração: salário com participação no faturamento (48 por cento) e o salário fixo (42 por cento). CONCLUSÕES: Neste estudo, encontramos a profissão de administrador de clínicas estruturando-se com profissionais de ambos os sexos, formação em Administração de Empresas, alguns com pós-graduação na área, carga horária acima de 40 h semanais, acreditando que a clínica deve investir em seu aperfeiçoamento. Fazem-se necessários outros estudos que contribuam para melhor conhecimento deste profissional.

Nuevas tendencias en la regulación de la profesión médica en el contexto de la reforma del sector salud: el caso de México / New trends in the regulation of medical practice in Mexico: the context of the health care reform

The recent panorama of medical practice regulation in Mexico is exposed. The dynamics of regulation changes is observed in different areas, with particular intensity in the labor market. Changes seem to be moving towards the constitution of a new regulatory model. A full state regulation for the last 50 years, is being substituted by a model where private and professional corporations are increasing their influence through informal mechanisms of regulation. In the constitution of this new model, the presence of a wide variety of actors claiming regulatory authority is notorious. Three of these new actors are analyzed: The National Commission for Medical Arbitrage, managed care models of medical services, and Specialists Certification Councils. The changes that have occurred in the process of regulation and its future transformation have an intimate link with the reform of the Mexican health care system