La mirada del cine al cáncer (I): arte, ciencia y conciencia / The look of the cinema to cancer (I): art, science and consciousness

El objetivo de este artículo es revisar la presencia de patologías oncológicas en el cine con el fin de identificar los principales trastornos de cáncer que han sido retratados en él. Del mismo modo, se intenta describir la praxis médica y la relación entre médico y paciente, así como las experiencias del paciente y la familia, la adaptación social y la intervención de otros profesionales de la salud alrededor de la enfermedad oncológica. Se revisan algunas de las películas más significativas sobre el cáncer en adultos. Se analiza una muestra representativa de 41 películas en las que el cáncer tiene distinta representatividad, clasificada como "puntual" (8 películas), "argumental" (22 películas) o "relevante" (11 películas) en la película. El cine puede ayudar a los profesionales de la salud que trabajan alrededor del cáncer, a los pacientes, a la familia y a la sociedad. En ocasiones, el cáncer que se muestra en las películas es diferente de la realidad: las películas prefieren los pacientes más jóvenes y de mayor clase social, así como los cánceres más fotogénicos. Los síntomas, las pruebas diagnósticas y los tratamientos tienden a reflejar la realidad, sobre todo en las películas argumentales producidas en las últimas décadas. Algunas de estas películas puede ser un recurso de primera mano para la formación de profesionales de la salud. El cine, una oportunidad para hablar con arte, ciencia y conciencia de la enfermedad oncológica y, sobre todo, de los pacientes con cáncer y su entorno. Una oportunidad para mejorar la relación profesional-paciente, para mejorar la humanización y para abrir el debate bioético (AU)

The aim of this article is to review the presence of oncological pathologies in the cinema with a view to identifying the main cancer disorders that have been portrayed in films. Likewise it also intends to describe the medical praxis that is employed, the relationship between physician and patient, how the experiences of the patient and the family are represented, the adaptation to social situations, and the intervention of other health care professionals related with cancer patients. Some of the most significant films about adulthood cancer are reviewed. A representative sample of 41 films was analyzed in which the cancer had a "prompt" (2 films), a "relevant" (22 films) or a "plot" character (11 films). Cinema has helped to shape certain ways of thinking about the health care professionals who work with patients, the importance of support from the family and the social role, among other things. The cancer showed by films is, sometimes, different from reality: movies prefer younger patients, higher social class and the most photogenic cancer's locations. The symptoms, diagnostic tests and treatments tend to reflect reality, especially in "plot" movies produced in the last decades. Some of those films may be a first hand resource for training health professionals. Cinema is an opportunity to talk with art, science and consciousness about oncological diseases; cinema is a tool to talk about cancer patients and their environment. Cinema is an opportunity to improve the relationship between health professionals and patients, to improve the humanization and to open the bioethical debate (AU)

[The need for bioethics training in the Community of Madrid]. / Necesidades de formación en bioética en la Comunidad de Madrid.

MAIN OBJECTIVE: to understand the significance and sense of bioethics for social work/health professionals; the secondary objective is to quantify the bioethics training given in IMSALUD primary care. DESIGN: Interviews with key reporters. Face-to-face interviews with people in charge of the training and research departments. SETTING: The 11 primary health care areas of IMSALUD. PARTICIPANTS AND/OR CONTEXTS: Key reporters (1 for each health area) chosen by heads of teaching: people working in the area with a specific weight or personal interest in bioethics. METHOD: 11 key reporters (1 for each health area); telephone contact and mailing of open-question questionnaire. RESULTS: Bioethics is implicit in daily activity, but unconsciously. General rejection due to its themes, which involve self-criticism. Ethical conflicts basically arising from the relationship of health workers with patients and the family, especially concerning information-giving, were pointed to. Themes considered very important were informed consent and confidentiality. Other ethical problems were allocation and distribution of limited resources, responsibility for taking up situations that worsen health care (lists too long, burnt-out companions, malpractice...). More training, both practical and theoretical, and more time to perform tasks were called for. CONCLUSIONS: The strategy to improve health professionals' ethical approach is to increase their Bioethics training. Very little bioethics training is provided for social work/health professionals by primary care management in the Community of Madrid.

Necesidades de formación en bioética en la Comunidad de Madrid / The need for bioethics training in the community of Madrid

Objetivo. El objetivo principal es comprender el significado y el sentido de la bioética para los profesionales sociosanitarios. El objetivo secundario es cuantificar la formación en bioética impartida en atención primaria del IMSALUD. Diseño. Entrevistas a informadores clave. Entrevistas personales con responsables de los departamentos de formación e investigación. Emplazamiento. Las 11 áreas sanitarias de atención primaria del IMSALUD. Participantes y/o contextos. Informadores clave (uno por cada área sanitaria) elegidos por los responsables de docencia: trabajadores del área con un peso específico o interés personal en la bioética. Método. Se estableció contacto telefónico y se envió un cuestionario de preguntas abiertas a los 11 informadores clave (uno por cada área sanitaria). Resultados. La bioética está implícita en la actividad diaria, pero de forma inconsciente. Se observa un rechazo en general por los temas que impliquen autocrítica. Se señalan conflictos éticos fundamentalmente derivados de la relación sanitario-enfermo y con la familia, sobre todo al dar información. Los temas considerados como muy importantes son el consentimiento informado y la confidencialidad. Otros problemas éticos son: la asignación y distribución de recursos limitados y la responsabilidad de denunciar situaciones que empeoran la calidad asistencial (cupos masificados, compañeros quemados, mala práctica, etc.). Se demanda mayor formación, tanto teórica como práctica, y más tiempo para desarrollar las tareas. Conclusiones. Como estrategia para mejorar el talante ético de los profesionales se apunta el aumento de su formación en bioética. La formación en bioética impartida desde las gerencias de atención primaria a los profesionales sociosanitarios en la Comunidad de Madrid es escasa

Objectives. Main objective: to understand the significance and sense of bioethics for social work/health professionals; the secondary objective is to quantify the bioethics training given in IMSALUD primary care. Design. Interviews with key reporters. Faceto- face interviews with people in charge of the training and research departments. Setting. The 11 primary health care areas of IMSALUD. Participants and/or contexts. Key reporters (1 for each health area) chosen by heads of teaching: people working in the area with a specific weight or personal interest in bioethics. Method. 11 key reporters (1 for each health area); telephone contact and mailing of openquestion questionnaire. Results. Bioethics is implicit in daily activity, but unconsciously. General rejection due to its themes, which involve self-criticism. Ethical conflicts basically arising from the relationship of health workers with patients and the family, especially concerning informationgiving, were pointed to. Themes considered very important were informed consent and confidentiality.Other ethical problems were allocation and distribution of limited resources, responsibility for taking up situations that worsen health care (lists too long, burnt-out companions, malpractice...). More training, both practical and theoretical, and more time to perform tasks were called for. Conclusions. The strategy to improve health professionals’ ethical approach is to increase their Bioethics training. Very little bioethics training is provided for social work/health professionals by primary care management in the Community of Madrid

[How much time does the physician dedicate to his patients? A study of contents of office visits and their length]. / Cuánto tiempo le dedica a sus pacientes? Estudio del contenido de las consultas médicas según su duración.

OBJECTIVE: To describe the content and length of General Medicine interviews at a health centre, analysing the problems dealt with and activities undertaken, in function of the time taken. DESIGN: A crossover study. SETTING: An urban health centre at Alcobendas (Madrid). PATIENTS AND OTHER PARTICIPANTS: The problems, activities and length of all the interviews (926) were recorded over a period of 10 days. MEASUREMENTS AND MAIN RESULTS: The average length of the interviews was 6.7 minutes (standard error SE = 0.13). More problems were dealt with, and more activities carried out, in the longer interviews. Problems of a psycho-social character and preventive activities were discussed in the long interviews. Significant differences were found in the length of interviews in function of the patient's age and between different professionals. CONCLUSION: To achieve integrated care which includes both preventive medicine and psycho-social problems, doctors must have more interview time, as these questions are not tackled in short interviews.