"Cooperation between physicians and physios fosters trust you know": a qualitative study exploring patients' experience with first-contact physiotherapy for low back pain in French primary care.

BACKGROUND: Physiotherapists working in collaboration with family physicians in French multidisciplinary primary healthcare clinics are now able to manage acute low back pain patients as first-contact practitioners in advanced practice roles. This includes medical act delegation such as making a medical diagnosis and prescribing medication. The aim of this study is to explore patients' experience and perceptions when attending a first-contact physiotherapist (FCP) in an advanced practice collaborative primary care model for acute low back pain (LBP). METHODS: A qualitative study using semi-structured interviews was conducted. Patients that consulted a FCP for acute LBP care in new collaborative model were included. Interviews were transcribed verbatim and inductive thematic analysis was performed to generate themes related to patients' experience and perceptions. RESULTS: Ten patients were interviewed (3 women, 7 men; mean age 36.5 ± 9.63 years). All LBP participants experienced important level of pain and disability. Four overarching themes related to patients' experience with the new FCP model were formalized: 1) "Going to see a physiotherapist who specializes in painful movements, well that makes sense to me", 2) "Physiotherapist offered to give me exercises to do at home to relieve the back pain", 3) "I went there feeling confident", 4) "The physiotherapist can do more than just send you to see more appropriate people". Participants highlighted the need to receive timely and high-quality care and were receptive with being autonomously managed by a FCP. Overall, patients' experiences with FCP model of care were positive. Participants were highly confident in the FCP's ability to perform delegated medical tasks including making a medical diagnosis and prescribing oral medication such as analgesic drugs. Patients felt that a greater expansion of FCPs' scope of practice was needed to improve the model. CONCLUSION: Findings from this study can inform the implementation of FCP in countries where patients are not typically granted FCP by underlining that patients are favourable towards the advance practice model as such models support timely and high-quality care. Further research is needed to better determine the future advance practice physiotherapists' scope of practice in French primary and secondary care settings.

A History of Medical Liability: From Ancient Times to Today.

Medical liability is a term associated with medical procedures and acts that has been a topic of controversy and research since ancient times all over the world. In ancient times, it was usually explained based on theocratic conceptions and was directly related to the social position of the patient to whom the physician applied medicine, while the capacity of the physician implied specific qualities. The present review of ancient history and geography provides a detailed description of the issues concerning medical responsibility through the years in ancient Greece, the birthplace of Asclepius and Hippocrates, the fathers of medical science, and the medical oath of conscientious performance of physician duties. Furthermore, it discusses the issue of medical liability globally from ancient times till more recently. Finally, medical liability and the interaction of its various aspects in Greece in recent years is presented according to Greek legislation to provide a good review for the reader to acknowledge the changes in medical liability through the centuries.

Grâce au développement dérogatoire pendant le COVID-19, la télémédecine en France est mieux encadrée juridiquement et plus accessible / Gràcies al desenvolupament derogatori durant la COVID-19, la telemedicina a França està més ben regulada legalment i és més accessible / Gracias al desarrollo derogatorio durante la COVID-19, la telemedicina en Francia está mejor regulada legalmente y es más accesible / Thanks to the derogatory development during the COVID-19, telemedicine in France is better legally regulated and more accessible

La télémédecine existe depuis les années 1980 et met en relation um patient à distance avec un médecin ou un professionnel de la santé qui échange des données numériques grâce à des outils informatiques. L'Ordre des médecins considère que les nouvelles technologies facilitent l'accès aux soins et à l'expertise, même si cela va à l'encontre des principes éthiques fondamentaux. Elle se substitue à l'acte médical traditionnel, et il est nécessaire de s’interroger sur sa pertinence et sur l’intérêt de ses conditions d’application pour le patient. Pendant l'épidémie de COVID-19, les conditions de la télémédecine ont été assouplies et le système d'assurance maladie a facilité son remboursement de manière dérogatoire. Les professionnels de la santé, les établissements de soins et les patients ont pu apprécier les nouvelles possibilités offertes par la télémédecine et en reconnaître les limites. Cependant, la sécurité n'est pas la principale préoccupation des patients, qui utilisent largement les outils informatiques pour surfer sur Internet et considèrent la médecine à distance comme un exercice facilement accessible sans en connaître les limites. Ils ne font pas de distinction entre la télémédecine clinique sous contrôle médical et les services de santé en ligne proposés sur Internet, qui sont des offres commerciales de bien-être. Dans cette présentation, nous décrirons d'abord l'évolution de la télémédecine, mise en œuvre depuis longtemps en France sous diverses formes, puis le développement spectaculaire des téléconsultations lors de l’épidémie COVID-19, dont les conséquences bénéfiques permettent une meilleure accessibilité et un meilleur remboursement par la sécurité sociale.(AU)

La telemedicina existe desde los años 80 y pone en contacto a distancia a un paciente con un médico o profesional sanitario que intercambia datos digitales mediante herramientas informáticas. La Orden de Médicos considera que las nuevas tecnologías facilitan el acceso a los cuidados y a los conocimientos especializados, aunque vaya en contra de principios éticos fundamentales. Se trata de un sustituto del acto médico tradicional, y hay que cuestionarse su pertinencia y si las condiciones de aplicación aportan un beneficio al paciente. Durante la epidemia de COVID-19, las condiciones para la telemedicina se relajaron y el sistema de seguros sanitarios facilitó su reembolso de forma derogatoria. Los profesionales sanitarios, las instituciones sanitarias y los pacientes pudieron apreciar las nuevas posibilidades que ofrece la telemedicina y reconocer sus limitaciones. Sin embargo, la seguridad no es la principal preocupación de los pacientes, que hacen un amplio uso de las herramientas informáticas para navegar porInternet y consideran la medicina a distancia como un ejercicio de fácil acceso sin conocer sus límites. No distinguen entre telemedicina clínica bajo supervisión médica y servicios de salud electrónica ofrecidos por Internet, que son ofertas comerciales de bienestar. En esta presentación expondremos en primer lugar la evolución de la telemedicina, implantada desde hace tiempo en Francia bajo diversas formas, y a continuación el espectacular desarrollo de las teleconsultas durante la epidemia de COVID-19, cuyas beneficiosas consecuencias permiten una mejor accesibilidad y reembolso por parte de la seguridad social.(AU)

Telemedicine has existed sincethe 1980s and puts a patient in contact with a doctor or health professional at a distance who exchanges digital data using computer tools. The Ordre des Médecins considers that new technologies facilitate access to care and specialised expertise, even ifit goes against fundamental ethical principles. It is a substitute for the traditional medical act, and one must question its relevance and whether the conditions of implementation bring a benefit to the patient. During the COVID-19 epidemic, the conditions for telemedicine were relaxed and the health insurance system facilitated its reimbursement in a derogatory manner. Healthcare professionals, healthcare institutions and patients were able to appreciate the new possibilities offered by telemedicine and recognize its limitations. However, safety is not the main concern of patients, who make extensive use of IT tools to surf the Internet and consider remote medicine as an easily accessible exercise without knowing its limits. They do not distinguish between medically supervised clinical telemedicine and e-health services offered over the Internet, which are commercial wellness offerings. In this presentation, we will first describe the evolution of telemedicine, which has long been implemented in France in various forms, and then the spectacular development of teleconsultations during the COVID-19 epidemic, the beneficial consequences of which allow better accessibility and reimbursement by social security.(AU)

El acto de telemedicina: hacia un nuevo concepto de asistencia médico-personal / The Telemedicine act: A new concept of medical-personal assistance

Gracias a la equivalencia funcional entre acto médico y acto de telemedicina, la prestación sanitaria adistancia queda sujeta a las exigencias deontológicas, legales y profesionales previstas para toda actuación médica. Sin embargo, la calificación jurídica del acto de telemedicina como acto médico suscita el debate sobre si la prestación médica a distancia cumple con la exigencia de prestación personal y directa del acto médico. Este estudio, analiza esta cuestión y su resolución en diferentes sistemas jurídicos, como el francés, el español, el alemán y el austriaco. De este análisis comparativo, resultarán los elementos necesarios para reflexionar sobre la nueva configuración de la relación asistencial personal como presupuesto de la regulación del acto de telemedicina.(AU)

Gràcies a l'equivalència funcional entre acte mèdic i acte de telemedicina, la prestació sanitària a distància queda subjecta a les exigències deontològiques, legals i professionals previstes per a tota actuació mèdica. No obstant això, la qualificació jurídica de l'acte de telemedicina com a acte mèdic suscita el debat sobre si la prestació mèdica a distància compleix amb l'exigència de prestació personal i directa de l'acte mèdic. Aquest estudi, analitza aquesta qüestió i la seva resolució en diferents sistemes jurídics, com el francès, l'espanyol, l'alemany i l'austríac. D'aquesta anàlisi comparativa, resultaran els elements necessaris per a reflexionar sobre la nova configuració de la relació assistencial personal com a pressupost de la regulació de l'acte de telemedicina.(AU)

Thanks to the functional equivalence between medical act and telemedicine act, the healthcare service at a distance is subject to the deontological, legal and professional requirements established for any medical performance. However, the legal qualification of the act of telemedicine as a medical act raises the debate on whether the medical service at a distance meets the requirement of personal and direct benefit of the medicalact. This study analyzes this issue and its resolution in different legal systems such as French, Spanish, German and Austrian. From this comparative analysis, the necessary elements will result to reflect on the new configuration of the personal care relationship as a regulatory budget for the act of telemedicine.(AU)

[Patient's consent to the medical act]. / Le consentement à l'acte médical.

The right to consent has become over time a fundamental right in both French and international law. Even if it is not formalized, the patient's consent is now required for each medical act. Moreover, it is always revocable. This article proposes to outline the historical evolution of consent in French legal texts.

Desde el derecho médico al deber ético-deontológico de la personalización en la relación médico-paciente / From medical law to deontological ethical duty of personalization in the doctor-pacient relationship

Los deberes legales de información, obtención del consentimiento, confidencialidad y protección dela intimidad del paciente deben ser escrupulosamente cumplidos. Pero la Ética y Deontología médicas im-ponen en la relación médico-paciente un nivel superior de exigencia, el adaptar esos deberes al pacienteconcreto y a la situación concreta. Esto significa individualizar el acto médico y hacerlo absolutamentepersonal; la personalización en la relación médico-paciente hace de esta algo único y excelente, el objetivomoral de la profesión médica desde los preceptos hipocráticos hasta nuestros días.(AU)

Legal duties of information, obtaining consent, confidentiality and protection of patient’s privacy mustbe scrupulously fulfilled. However, Medical Ethics and Deontology impose a higher level of requirementon the doctor-patient relationship, namely, to adapt these duties to the specific patient and the specificsituation. This means individualizing the medical act and making it absolutely personal; personalization inthe doctor-patient relationship makes it unique and excellent, the moral objective of the medical profes-sion from the Hippocratic precepts to the present day.(AU)

O "Ato Médico" e as disputas jurisdicionais entre as profissões de saúde / The "Medical Act" and jurisdictional disputes between health professionals

Resumo O artigo analisou as implicações do Ato Médico na ordenação das relações entre as profissões de saúde e em aspectos relacionados ao controle do campo de conhecimento médico, à prática profissional e ao mercado de trabalho em saúde. Por meio de pesquisa qualitativa, investigou-se o Ato Médico mediante análise documental de material proveniente de 18 edições do Jornal Medicina do Conselho Federal de Medicina (CFM) (223 edições consultadas entre 1998 e 2018). Foram evidenciados interesses particulares no processo de negociação e de efetivação da Lei do Ato Médico, reconhecida como instrumento de controle profissional decorrente das transformações ocorridas no sistema de profissões da saúde e no mercado de trabalho em saúde. A regulamentação profissional dirigida ao exercício exclusivo de atos profissionais considerados atos médicos aparece como uma vantagem para a corporação médica. Ao pretender a exclusividade da prática médica em múltiplas abrangências, o Ato Médico termina por intensificar conflitos com profissões da saúde que compartilham seus atos profissionais. Foi concluído que o Ato Médico poderia ser também entendido enquanto resultado de um movimento pela valorização das bases liberais de atuação, objetivando a defesa da prática individual, da livre escolha, do custeio dos serviços pelo cliente e da prestação direta dos serviços.

Abstract The article analyzed the implications of the Medical Act in ordering the relations between health professions and in aspects related to the control of the field of medical knowledge, professional practice, and the health labor market. With qualitative research, the Medical Act was investigated by documentary analysis of material from 18 editions of the Jornal Medicina do CFM (223 editions consulted between 1998 and 2018). Particular interests were evidenced in the process of negotiation and enforcement of the Medical Act Law, recognized as an instrument of professional control resulting from the changes that occurred in the health professions system and in the health labor market. Professional regulation aimed at the exclusive exercise of professional acts considered to be medical acts appears as an advantage for the medical corporation. In seeking the exclusivity of medical practice in multiple areas, the Medical Act ends up intensifying conflicts with health professions that share their professional acts. The article concludes that the Medical Act could also be understood as the result of a movement for the valorization of the liberal bases of action, aiming at defending individual practice, free choice, the payment of services by the client, and the direct provision of services.

A new standardised nomenclature in ophthalmology: Criteria and quantitative evaluation indicators of medical procedures. / Nuevo nomenclátor estandarizado en oftalmología: Criterios e indicadores cuantitativos de baremación de actos médicos.

PURPOSE: To create a new list of medical procedures in ophthalmology based on the International Classification of Diseases ICD-9-CM. To establish the general principles that define criteria, quantitative indicators, and scales. To develop the algorithms needed to calculate fees for medical procedures. METHODS: The out-of-date processes were removed from the list, and new techniques were added, descriptors were modified, procedures with similar descriptions were grouped together, and others were relocated to other group according to surgical complexity conditions. The criteria to calculate the medical fees were defined: training and complexity (U), proficient responsibility (R), and health value (V), with their respective quantitative indicators: period of training necessary to master a technique, frequency of complications that worsen the preoperative situation, and days of incapacity for work due to the process. The Relative Value Unit (RVU) was defined as the score sum of R, V and U. The final fee per medical procedure was calculated as the product of the RVU by its unit cost and by the weighting coefficient (WC). RESULTS: A new catalogue was prepared with 161 medical procedures, grouped into consultations, diagnostic procedures (DX.PR), therapeutic procedures (TX.PR), and surgical interventions, increasing in complexity from group 0 to group 8. The following characters were described for each one of the procedures: OMC and ICD-9-MC code, descriptor term, group, proposed modification: no changes or minimums in the descriptors, grouping of acts by similar definitions, change of origin group, new procedures, and procedures removed. The indicators for assessment were also scored: U between 1-4 points, and R and V between 0-3 points. Using their sum, the number of RVUs per medical procedure (between 1 and 10) was calculated which, together with the unit cost of the RVU and the WC (between 0.05 and 1), will determine the final rate. CONCLUSIONS: The new standardised ophthalmological nomenclature updates and improves the old classification, adapting the procedures to the descriptors included in the ICD-9-CM, and incorporating all the new techniques. Additionally, the declaration of the general principles allows defining new criteria, quantitative indicators, rating scales, and algorithms to calculate fees for medical procedures.

Nazis, Teleology, and the Freedom of Conscience: In Response to Gamble and Pruski's 'Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?'

Medical practitioners of all specialisms (e.g. RN, MD) are identified by their professional titles. Their function is determined by their regulators, and subject to voluntary employment contracts. Whilst they are expected to act in their patients' best interests, there are situations in which a physician - having human rights - can object to certain acts. This right of objetction arises from the recognition of the practitioner's own conscience rather than the end or purpose of the procedure being performed. Gamble and Pruski explore an act-centred morality, and therefore define acts as medical (and subject to compulsion) and non-medical (therefore voluntary). This analysis has merit when applied to health-systems as a whole, but fails to take into account the humanity of physicians and the specific interactions with patients in different contexts. As such, it serves as a way of compelling physicians to act against their conscience rather than protecting them.

Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?

A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform 'medical activities,' what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate. It argues that physicians (and other healthcare professionals) can only be expected to perform and support medical acts - acts directed towards their patients' health. That is, physicians cannot be forced to provide or support services that are not medical in nature, even if such activities support other socially desirable pursuits. This does not necessarily mean that medical professionals cannot or should not provide non-medical services, but only that they are under no obligation to provide them.

Las profesiones de la salud y la petición de un aborto / Health professions and the request for an abortion

Al aprobarse en Chile una ley que permite el aborto en algunas circunstancias y frente a la posibilidad de que en el futuro existan leyes aún más permisivas, surge la necesidad de reflexionar sobre la actitud que debe tener una institución como la nuestra que forma a profesionales de la salud. Tenemos que tener claridad en que nuestra oposición al aborto no es por razones religiosas ni otras particularísimas. Nos oponemos a realizar esas intervenciones porque ellas vulneran principios y valores propios de la profesión médica. Tenemos en una mujer embarazada a dos pacientes, y la medicina siempre debe respetarles la vida y otorgarles los cuidados de su salud. Debemos enseñar a nuestros alumnos a cuidar y acoger a todos nuestros pacientes como siempre lo hemos hecho.(AU)

Once approved in Chile a law that allows abortion in some circumstances and facing the possibility that in the future more permissive laws may exist, the need to think about the attitude that must take an institution as ours that forms health professionals arises. We must be clear that our opposition to abortion is not under religious or other very specific reasons. We oppose these interventions because they violate principles and values of the medical profession. We have two patients in front when we treat pregnant women, and medicine must always respect their lives and give them healthcare. We must teach our students to care for and welcome all our patients as we have always done.(AU)

[Compensation of unforeseeable medical complications following cosmetic surgery finally made possible by ONIAM]. / L'indemnisation enfin possible par l'ONIAM des aléas thérapeutiques après un acte de chirurgie esthétique.

In the absence of any proven medical fault by a plastic surgeon, the patient could not obtain compensation through national solidarity (as stipulated by the Law of March 4th 2002). Indeed ONIAM (France's National Office for Medical Accidents' Compensation) has always rejected any claims on the grounds that cosmetic surgery differs from medical care. Through its judgment of February 5th 2014, France's final Court of Appeals settled the question and considered cosmetic surgery as medical care; in case of serious injuries following unforeseeable medical complications, the patient may be compensated by ONIAM, as with any other medical act. This jurisprudence will certainly result in medical liability insurers be no longer those only responsible for compensation of injuries following cosmetic surgery. Plastic surgeons' insurance premiums should logically become cheaper.

[ICU patients and days of intensive care: A mathematical model optimizing the consequences of ICU unit function, intensive care and continual monitoring on incurred supplementary costs]. / Patient de réanimation, journées de réanimation ? Modélisation d'un fonctionnement optimisé des unités de réanimation, de soins intensifs et de surveillance continue et conséquences sur les suppléments tarifaires induits.

INTRODUCTION: "Critical Care Units" are intended to admit patients with multiple organ failure. The severity of patients admitted is variable. The aim of the study was to estimate the number of days that an optimum care organization could release, and therefore the additional admissions that would have been allowed. Estimates of earnings related to the various supplements were carried out jointly. METHODS: Reporting days associated or not with a resuscitation care during the year 2011 in an ICU of a university hospital (16 beds), optimized patient flow simulation, and computation of medical act inducing financial supplements. RESULTS: Six hundred and fifty-seven patients (SAPS II from 0 to 110, 41% ventilated more than 48hours, mortality=26%) were admitted representing 5095days (occupancy rate=87%). Two hundred and twenty-two patients (34%) did not trigger supplement for resuscitation care for 415days in the unit. Four hundred and thirty-five patients have triggered this supplement representing 4680days, including 3035days with resuscitation care and 1645 (35% of days valued resuscitation, 32% of total days) without any. The entire year 2011 has generated earnings of 3,980,192€. Optimization of management would have allowed the admission of additional 235 to 295 patients and potential additional earnings from 524,735€ to 1,063,804€, depending on the occupancy rate chosen (80% or real 2011s) and the severity of discharged patients. CONCLUSION: Optimization of the patients flow between "Critical Care", Intensive Care and Continuous Monitoring Units would increase the number of patients admitted in "Critical Care" Units without any financial loss related to supplements.

¿Y antes de Fauchard qué?: la odontología en las cavernas, los templos, los hospitales y las universidades / And what was there before Fauchard?: dentistry in caverns, temples, hospitals and universities

Este trabajo muestra los orígenes de la odontología entre los primitivos habitantes del planeta, entre los médicos de la Antigüedad, el Renacimiento y la Edad Media hasta los tiempos modernos y la instauración del concepto de hospital clínico universitario. Sostiene que la práctica de la odontología es por definición un acto médico que tiene por objeto al ser humano en la sociedad y la salud a restablecer como bien único e indivisible, siendo ambos conceptos los que delimitan y enmarcan toda la práctica médica. La odontología nace junto con el ser humano, junto con el enfermar, el envejecer y el morir.

This paper shows the origin of dentistry among the primitive inhabitants of the planet, the physicians of the Antiquity, Renaissance and Middle Ages up to the modern times and the establishment of the concept of university clinical hospital. It endorses the practice of dentistry by definition as a medical act that has the human being in the society as the object of the act itself, and the health to restore as the one and indivisible good to enhance. Both concepts are the limits and natural frame of all the medical practice. Dentistry was born with the human being, together with getting sick, ageing and dying.

O Projeto de Lei do “ato médico” e a perspectiva dospsicólogos e de outros profissionais no campo da saúde / The “medical act” Law project and the perspective of thepsychologists and other health professionals

Este artigo discute o projeto de lei do ato médico (PL 7.703/06) que visaestabelecer as bases do exercício da Medicina no Brasil. Nele, discute-se a validadecientífica, ética e legal de um conjunto de afirmações contidas no referido projeto de lei.Inicialmente é posta em questão a exclusividade dada aos médicos sobre o diagnósticodas psicopatologias, tal como está proposto na lei. É mostrado que os psicólogos foramcoautores do campo das psicopatologias desde a criação da psicologia do anormal, nãosendo legítimo excluir do conjunto das suas competências o diagnóstico clínico a elasreferente. Com intuito de demonstrar a competência do psicólogo para a tarefa dediagnosticar as psicopatologias, é realizada uma comparação entre os currículos degraduação do médico formado pela USP (Universidade de São Paulo) e do psicólogoclínico formado pela UnB (Universidade de Brasília). O principal objetivo deste artigo éapresentar argumentos para mostrar que, no caso de acontecer promulgação integral dotexto apresentado, esse fato acarretará sérios prejuízos financeiros e morais para asdemais categorias de profissionais da saúde, para o SUS (Sistema Único de Saúde) etambém para os usuários dos serviços de saúde no Brasil(AU)

This article discusses the Medical Act Law project (LP 7.703 / 06) that is intendedto give the foundations for medical practice in Brazil. The legal, ethical, and scientificvalidity of a collection of statements contained in that Bill are discussed herein. Initiallythe exclusivity of physicians on the diagnosis of psychopathology is questioned, as proposedin the law. It is shown that psychologists were co-authors of the field of psychopathologysince the creation of abnormal psychology and it is not legitimate to exclude from the setof their competencies clinical diagnosis referring to them. In order to demonstrate thecompetence of the psychologist for the task of diagnosing psychopathology, a comparisonbetween the undergraduate curricula of a medical graduate from USP (University of SãoPaulo) and clinical psychologists trained by UnB (University of Brasilia) is made. The mainobjective of this paper is to present arguments to show that, if the Law is issued just as fullreproduction of the text presented in the project, this fact will bring serious financial andmoral damage to the other categories of health professionals, for SUS (Unique HealthSystem) and also for the Brazilian health care clientship(AU)

A formação da identidade do psicólogo clínico estadunidense esuas repercussões para a Psicologia no Brasil / Formation of the American clinical psychologist’s identity and itsrepercussions on the Psychology in Brazil

A Psicologia Clínica é uma prática centenária. Nos Estados Unidos ela tem seulugar definido dentro do campo da Psicologia Científica, sendo também reconhecida comouma prática efetiva de tratamento psicológico. Existe ampla literatura científica quedemonstra estas condições, não apenas nos Estados Unidos, mas em todo o mundo. Ospsicólogos também são reconhecidos mundialmente como profissionais capacitados paradiagnosticar psicopatologias e para aplicar psicoterapias como meios efetivos detratamentos delas. Contudo, apesar de tantas evidências a favor da utilidade da PsicologiaClínica, no Brasil, este caminho não tem sido seguido. Neste país, algumas leis forampropostas nos últimos anos, limitando a aplicabilidade clínica da Psicologia. Mesmo nãohavendo razões científicas para justificar estas leis, os psicólogos brasileiros não foramcapazes de se defenderem, correndo risco real de se tornarem impedidos legalmente derealizar o diagnóstico nosológico das psicopatologias, tal como propõe a Lei do Ato Médicoque se encontra em fase de aprovação no Congresso brasileiro. Considerando que existeampla literatura para demonstrar que os psicólogos realizam de modo eficiente odiagnóstico das psicopatologias, como entender a dificuldade dos psicólogos brasileirosde justificarem sua autonomia clínica? Os psicólogos clínicos não se defenderam porqueeles não conseguiram se unir em torno da causa da Psicologia. O objetivo do presenteartigo é discutir este acontecimento e algumas de suas consequências para a Psicologiano Brasil(AU)

Clinical psychology is a centuries-old practice. In the US it has its definite placein the field of cientific psychlogy, and is also recognized as an effective treatment aspsychological practice. There is extensive literature that demonstrates these conditions,not only in the United States, but around the world. The psychologists are also recognizedworlwide as professionals to diagnose psychopatologies and to apply psychotherapy aseffective treatment. However, despite all the evidence for the usefulness of clinicalpsychology, in Brazil this path hasn’t been followed. In Brazil a few laws have been proposedin recent years limiting the clinical applicability of psychology. Although there are no scientificreasons that justify these laws the Brazilian psychologists were unable to defendthemselves, running a real risk of becoming legally unable to perform the nosologicaldiagnosis of mental ilness as proposed by the law of the medical act that is pendingapproval by the Brazilian Congress. How to understand the difficulty of Brazilianpsychologists in justifying their clinical autonomy whereas there is extensive literature demonstrating the diagnosis of psychopathology be performed efficiently. Clinicalpsychologists have not defended themselves because they have failed to unite around thecause of psychology. The aim of this paper is to discuss this event and some of theconsequences for psychology in Brazil(AU)

Desatando o ato médico / Unknoting the medical act bill

Ato Médico é o nome dado a projetos de lei atualmente em tramitação no Congresso Nacional. Ele se constitui em um dos temas mais polêmicos para as profissões de saúde – inclusive a psicologia – sendo alvo constante de manifestações e protestos. Ainda assim, estudos sobre os projetos são escassos e grande parte das produções que o criticam, o fazem de modo infundado. Este ensaio tem como objetivos: (1) esclarecer a origem e a história da criação desses projetos, (2) analisar alguns pontos dos projetos que teriam implicações à classe dos psicólogos, esclarecendo se eles interferem, ou não, nas atividades da profissão; (3) apontar sugestões de melhoria na redação do projeto que está em análise no Congresso, que minimizariam interpretaçoes controversas e (4) discutir os principais vieses presentes nas críticas feitas aos projetos, na visão dos autores. Por fim, instigamos a necessidade de maior atenção à regulamentação da própria carreira de psicólogo. (AU)

Medical Act is the name given to a group of bill projects currently under study in Congress. It is one of the most polemic discussion themes to all health care professionals – psychology including –, constant target of demonstrations and claims against it. Yet, studies about these projects are scarce and most material criticizing it presents unfounded arguments. In this essay, we have the current goals: (1) clarifying upon the origin and history of these projects, (2) analyzing some of the most relevant project aspects wit consequences to the psychology profession, clarifying if they interfere, or not, in its activities (3) pointing suggestions to improve the bill's compositions ,in currency study in Congress, that could minimize interpretation issues and (4) discussing the main critics' biases made to these projects, in the authors' opinions. Finally, instigate for the necessity of a greater attention to our same psychologist career regulations. (AU)

O ato médico e a subjetividade / El acto médico y la subjetividad / L'acte médical et la subjectivité / The medical act and subjectivity

O presente trabalho enfoca o ato médico sob o prisma de suas implicações subjetivas, discutindo, de maneira pormenorizada, os desdobramentos de uma prática que, cotidianamente, enfrenta impasses cuja importância e possibilidades de manejo são invisíveis ao olhar centrado exclusivamente nos processos biológicos de manutenção da vida. Ênfase é dada aos efeitos iatropatogênicos que tal perspectiva implica, procurando-se descortinar linhas de fuga que favoreçam a criação de alternativas mais produtivas tanto para o profissional quanto para os pacientes que demandam atenção no campo da saúde.

El presente trabajo enfoca el acto médico desde el prisma de sus implicaciones subjetivas discutiendo, de manera pormenorizada, los desdoblamientos de una práctica que cotidianamente enfrenta situaciones de difícil salida cuya importancia y posibilidades de manejo son invisibles a la mirada centrada exclusivamente en los procesos biológicos de mantenimiento de la vida. El énfasis es dado a los efectos iatropatogénicos que tal perspectiva implica, procurando hacer aparecer líneas de fuga que favorezcan la creación de alternativas más productivas, tanto para el profesional como para los pacientes que demandan atención en el campo de la salud.

Ce travail met en évidence l'acte médical sous le prisme de ses implications subjectives et propose pour ce faire une discussion détaillée des conséquences d'une pratique qui, quotidiennement, se trouve face à des impasses dont l'importance et les possibilités de maniement sont invisibles au regard ciblé exclusivement sur les processus biologiques de maintenance de la vie. Les effets iatropathogéniques que telle perspective implique sont mis en relief pour trouver des points de fuite qui puissent favoriser la création d'alternatives plus productives et pour le professionnel, et pour les patients, ce qui exige plus d'attention dans le domaine de la santé.

This article discusses the medical act from the perspective of its subjective implications, and questions the development of a practice that faces continual impasses. The difficulty is that the importance and possibilities related to the management of clinical realities are invisible to perception based exclusively on biological life processes. Emphasis is given here to iatropathogenic effects that this perspective implies. The author thus offers approaches that may favor the establishment of more productive alternatives for professionals and their patients who require attention in the field of health care.

Estratégias transdisciplinares: o ato médico na compreensão de graduandos da área de saúde / Transdisciplinaries strategies: the "medical act" in the health undergraduation students' comprehension

Trata-se de uma pesquisa descritiva e exploratória, com abordagem qualitativa, voltada para analisar as repercussões do Ato Médico (AM) a partir do ponto de vista de estudantes de graduação da área de saúde e estimular o desenvolvimento do senso crítico acerca da transdisciplinaridade para harmonia do trabalho em equipe. Os sujeitos do estudo são 105 estudantes de graduação, a saber: 34 de Enfermagem (6º Período), 45 de Nutrição (2º Período), 17 de Fisioterapia (1º Período) e 9 de Medicina (4º Período) e o instrumento utilizado para coleta de dados limitado a uma questão aberta, visando captar os significados do ato médico para os mesmos. A coleta dos dados ocorreu no primeiro e segundo semestres de 2004. Os resultados apontam o AM como retrocesso para a transdisciplinaridade, em decorrência da indevida apropriação do conhecimento em saúde pela medicina, contrapondo a legislação vigente. Conclui-se que o incentivo às discussões sobre o tema com estudantes da área de saúde possibilita maior esclarecimento de cada categoria acerca do domínio de conhecimento das demais, sobretudo, na compreensão de que o AM infringe um dos mais importantes princípios da transdisciplinaridade, o trabalho em equipe.

It is a descriptive and exploratory research, with qualitative approach, gone back to analyze the repercussions of the “Medical Act” (MA) starting from the health sciences undergraduation students' point of view and to stimulate the development of the critical sense concerning the transdisciplinarity for harmony of the work in team. The subject of the study are 105 undergraduation students, 34 of Nursing (6th Semester), 45 of Nutrition (2nd Semester), 17 of Physiotherapy (1st Semester) and 9 of Medicine (4th Semester), and the instrument used for collection of data limited to one open subject, seeking to capture the meanings of the medical act for the same ones. The data collection happened in the first and second semesters of 2004. The results aim MA as setback for the transdisciplinarity, due to the improper appropriation of the knowledge in health for the medicine, opposing the effective legislation. It is ended that the incentive to the discussions on the theme with students of the area of health facilitates larger elucidate of each category concerning the domain of knowledge of the others, specially, in the understanding that AM infringes one of the most important beginnings of the transdisciplinarty, the work in team