El profesor docente y la ética institucional / The educational teacher and the institutional ethics

Organizations develop codes of ethics to give orientations to their members on how to recognize, understand and handle ethical dilemmas in their daily work. In year 2005 a group of faculty members of the Universidad de Chile Faculty of Medicine started an institutional ethics project, acknowledging that all institutional decisions have moral contents. The purpose of this project is to promote an ethical environment in the institution. The first step was to establish a diagnosis by means of the organization of focal groups that collected the perceptions of students, faculty members and non-academic personnel. With a diagnosis in hand, a preliminary document was prepared, the “Universidad de Chile Faculty of Medicine declaration of principles and values”. Members of all groups that participated in the diagnostic phase had the opportunity to discuss this preliminary document and check if their agreement with its contents. Given the relevance of the ethical aspects of the learning and teaching process for the positive modeling of students from all health-related professions, special emphasis is given to its discussion.

La noción de capacidad de la persona para tomar decisiones, en la práctica médica y legal / The notion of decision making capacity in medical and legal practice

Background: The relationship between patients and health professionals emphasizes deliberation and joint decision making, that derives in the informed consent. Aim: To evaluate decision making of patients in health care and to identify the notion of capacity for decision making, according to lawyers and physicians. Material and methods: A semi-structured interview about procedures to assess decision making capacity was applied to 27 selected physicians and lawyers, considering their experience in this area. A qualitative analysis of answers was performed. Results: Several differences were observed between physicians and lawyers, probably originated in their respective disciplines as well as the context of their professional practice. For physicians the notion of capacity is associated to comprehension of the information, it is not absolute, and it must consider the intellectual maturity of the teenager and the autonomy of the elderly. This evaluation is frequently performed in the clinical interview and standardized protocols do not exist. For lawyers, capacity is established by age and is associated to rights and obligations, as determined by law. When it is assessed by experts, including physicians, it becomes evidence. These professionals assume that experts will use standardized assessment instruments. Capacity has significance in the legal system. Conclusions: Since there are substantial consequences when a person is deemed incompetent, it is necessary to distinguish between health capacity and legal capacity, and to ¡ink the informed consent with the fundamental rights of citizens, such as taking decisions about our own health.

El cambio de la práctica médica: desafíos psicosociales para la profesión / The change in medical practice: psycho-social challenges for the profession

This article analyzes important changes in medical practice, focusing in those most deeply perceived by a group of physicians from the Metropolitan Region of Santiago, included in a joint research conducted by the Departments of Psychiatry and Mental Health (East) of the Medical Faculty at the University of Chile and Public Health of the Catholic University of Santiago, during 2003. These are the perceived changes in the relationship between doctors and patients; increased limits in professional autonomy and the fragmentation of medical practice. Reflecting transformations in social relationships in general, they have added new stress and frustrations, as well as new opportunities and rewards to the medical profession. The perceptions identified are commented within the structural determinants of medical practice. These issues call for a refreshing discussion on the values supporting medical professionalism and the concept of profession in itself, in view of the challenges posed by the current social and cultural changes (Rev Méd Chile 2004; 132: 768-72).

El efecto del cambio social en la familia y en el desarrollo de los adolescentes / The effect of the social change in the family and in the development of the adolescents

Este trabajo ha analizado algunos importantes cambios sociales que están relacionados con la familia. Además se ha descrito de qué forma estos cambios afectan el desarrollo de los hijos adolescentes, cuáles son las consecuencias para su conducta social. Para estos propósitos se han revisado los aportes de seleccionadas investigaciones recientes realizadas en Chile, Estados Unidos y algunos países europeos. Desde un punto de vista ecológico de la familia y del desarrollo humano, que postula la estrecha vinculación de estos procesos con los acontecimientos del contexto, se hace evidente que para las familias de estrato socioeconómico bajo, los condicionantes más decisivos son los impuestos por la pobreza y sus consecuencias. En el caso de las familias de estratos más altos los principales cambios han sido de tipo demográfico: una reducción en su tamaño promedio, el cambio en el rol de la mujer y madre, el aumento de las separaciones matrimoniales. En el caso de las familias pobres, la importancia de las carencias tamiza la influencia de este tipo de variables de orden demográfico sobre el desarrollo de los hijos adolescentes y de todas las edades. No está demostrado, en suma, que la familia reducida esté más desprotegida que una con mayor número de integrantes, en similares condiciones de pobreza. Evidencias documentadas por estudios como los descritos, permiten fundamentar la cuidadosa planificación y desarrollo de intervenciones de tipo preventivo específico, dirigido, por ejemplo, a adolescentes hijos de familias con problemas, con padres alcohólicos, separados o con antecedentes de psicopatología. También señalan sólidamente la necesidad de políticas de protección a la familia, desde los sectores público y privado para promover su desarrollo sano

Aplicación de un instrumento para calificar el funcionamiento familiar en la atención de adolescentes / A family function test in primary care attention of adolescents

Numerosos estudios en poblaciones de diferentes edades apoyan el uso de la prueba de Smilkstein (Apgar familiar) como un instrumento útil y confiable que mide satisfacción del sujeto con cinco componentes del funcionamiento familiar. En la práctica clínica de atención de adolescentes es necesario explorar sus problemas psicosociales conociendo el ámbito emocional que lo rodea y particularmente a la familia como parte del orígen y/o apoyo a la problemática de este grupo etario. Este trabajo aplica el instrumento en 469 adolescentes validándolo para esta etapa del ciclo vital. Siendo confiable, útil y válido se recomienda como método de rastreo para identificar adolescentes que perciban sus familiares como funcionalmente alterados