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As emoções do médico na relação com o paciente: uma abordagem da psicologia junguiana / The Doctor´s Emotions in Relationship With the Patient: An Approach of Jungian PsychologyCastelhano, Laura Marques 13 March 2015 (has links)
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Previous issue date: 2015-03-13 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The purpose of the research was to investigate the emotions of the doctor and their perception of the patient that affects him. This study used a multimethod research and evaluated in quantitative phase, thirty (30) doctors serving in office. For the qualitative phase were chosen four (4) doctors for an in-depth interview as a Case Study. The instruments used for the analysis were: sociodemographic questionnaire, the Inventory of Stress Symptoms for Adults Lipp (ISSL) and the International Affective Picture System (IAPS) and a semi-structured interview. The results showed that 56.7% of doctors experienced symptoms of stress, which is an index within the expected parameters of the test and there was no relationship between the sociodemographic variables. In relation to emotional perception there was no difference between the sample results and the general population, but differences were found in the relation to sociodemographic variables: age, time since graduation, average handle time (consultation) and weekly hours devoted to work in the office, concluding that older doctors, with more time after graduation and more time in consultation with the patient, felt more impacted on the emotional stimuli than other doctors; and doctors who work more hours per week in the office perceived the stimuli in a less pleasant way than other doctors. These data were confirmed by groups of four (4) clusters. It was conducted by a case study following the approach of Jungian theory with a representative of each cluster from pre-set categories related to the research objectives, content and factors attributed to stress; emotional perception; the role of emotion in the doctor-patient relationship; the emotions aroused by difficult patient and not difficult patient and strategies for dealing with emotions. The results revealed that the emotions could influence attitudes and perceptions in the medical activity. There was a suffering from physicians due to an emotional wound that is not recognized and poorly understood, which can result in projections in patients / O objetivo da pesquisa foi investigar as emoções do médico e a percepção do paciente que o afeta. Este estudo utilizou o método misto de pesquisa e avaliou na fase quantitativa, 30 (trinta) médicos com atuação em consultório. Para a fase qualitativa foram escolhidos 4 (quatro) médicos para a entrevista aprofundada em forma de Estudo de Caso. Os instrumentos utilizados para a análise foram: o questionário sociodemográfico, o Inventário de Sintomas de Stress para Adultos de Lipp (ISSL) e o International Affective Picture System (IAPS) e a entrevista semiestruturada. Os resultados mostraram que 56,7% dos médicos apresentaram sintomas de estresse, índice dentro do esperado pelos parâmetros do teste e não houve relação entre as variáveis do sociodemográfico. Em relação à percepção emocional não houve diferença entre os resultados da amostra e a população geral, mas houve diferença na relação com as variáveis sociodemográficas: idade, tempo de formado, tempo médio de atendimento (consulta) e horas semanais dedicadas ao trabalho no consultório, concluindo-se que médicos mais velhos, com mais tempo de formado e que ficam mais tempo em consulta com o paciente, sentiram-se mais impactados diante dos estímulos emocionais do que os outros médicos; e os médicos que trabalham mais horas semanais no consultório perceberam os estímulos de forma menos prazerosa que os outros médicos. Esses dados foram confirmados pelos agrupamentos dos 4 (quatro) clusters. Efetuou-se a análise de caso segundo a abordagem da teoria junguiana com um representante de cada cluster a partir de categorias pré-estabelecidas relacionadas aos objetivos da pesquisa: índice e fatores atribuídos ao estresse; a percepção emocional; o papel da emoção na relação médico-paciente; as emoções despertadas pelos pacientes difícil e o que não desperta dificuldades e estratégias para lidar com as emoções. Os resultados revelaram que as emoções podem influenciar atitudes e percepções na atividade do médico. Observou-se um sofrimento por parte dos médicos decorrente de uma ferida emocional que não é reconhecida e que encontra pouco espaço para ser compreendida, passível de ocasionar projeções nos pacientes
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Ethnicity and primary care : a comparative study of doctor-patient relationship, perceived health, symptomatology, and use of general practitioner services by Asian and white patients, and the Bradford general practitioners' attitudes towards these patientsAhmad, Waqar Ihsan-Ullah January 1989 (has links)
Britain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status.
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La participation du patient insuffisant rénal chronique aux processus de décisions thérapeutiques / The participation of the patient with chronic kidney failure in the process of treatment decisionsSenghor, Abdou Simon 26 January 2017 (has links)
La loi du 04 mars 2002 relative aux droits des malades et à la qualité et à la qualité du système de santé et la loi HPST (Hôpital, Patients, Santé et Territoires) de 2009 qui accorde un cadre légal à l’éducation thérapeutique ont promu l’autonomie du patient en favorisant sa participation aux décisions médicales. L’autogestion de la maladie chronique voulue par les pouvoirs publics en fournissant ces outils juridiques pour améliorer la qualité de soins, a suscité notre intérêt pour programme d’éducation thérapeutique destiné à des patients insuffisants rénaux en pré-dialyse. L’un des objectifs est de favoriser la liberté des patients à choisir une méthode de dialyse. Dans notre travail de thèse, nous avons voulu montrer comment les déterminants sociaux des décisions médicales et ceux liés aux choix d’une méthode de dialyse sont construits. Si en France, les patients semblent davantage se tourner vers une prise en charge à l’hôpital, dans certains pays, c’est le pluralisme médical qui est de mise. L’exercice de l’auto-analyse a montré le poids de l’économique, de la culture, de la famille dans les choix de santé.Par ailleurs, la place de l’éducation thérapeutique dans le processus décisionnel n’est pas figée : l’éducation thérapeutique peut être complémentaire à la pratique médicale, être un outil d’aide à la décision pour certains patients insuffisants rénaux ou être utilisée par les médecins pour favoriser l’observance décisionnelle des patients. Nous avons montré que les patients et les médecins se basent sur plusieurs facteurs qui peuvent influencer la nature de la délibération.Cette étude a montré que le choix est réseauté et que les décisions sont construites car elles sont basées sur des interactions et des stratégies médicales. Ces déterminants permettent également de comprendre comment la confiance est construite dans le processus décisionnel. Tantôt distribuée, tantôt déplacée, la confiance est explicative du type d’information que le patient priorise. Le choix réseauté du patient amène finalement à la relativisation du modèle de décision médicale partagée qui semble de plus en plus avoir un caractère normatif dans la relation entre professionnels de santé et patients. / The law of March 04th, 2002 on the rights of patients and the quality of the health system and the law HPST (Hôpital, Patients, Santé et Territoires) of 2009 that grants legal framework for patients’ education, have promoted the patient’s autonomy by encouraging his participation in medical decisions. Self-management of chronic illness as favoured by public authorities in providing the legal tools to improve the quality of care has aroused our interest in patient education programs for patients with renal failure in pre-dialysis. One of the objectives of this program is to allow patients free choice when deciding on the method of dialysis.Our thesis aims to underline how the social determinants at work in medical decisions and those involved in the choice of a dialysis method are constructed.In France, patients seem to favor hospital patient care, but in some countries, medical pluralism is more frequent. The exercise of self-analysis has revealed the significant part played by economy, culture and family in health choices.Moreover, the part played by patient education in the decision-making process is neither fixed nor pre-determined: patient education can complement medical practice, can be a decision support tool for some kidney patients or be used by doctors to promote patient decision-making compliance.We have shown that patients and physicians rely on several factors that may influence the nature of the discussion.This study reveals that the choice is networked and that the decisions that are made are the outcome of several interactions and medical strategies. These determinants also help to understand how trust develops and leads to decision-making.Sometimes distributed, sometimes shifted, trust accounts for the type of information prioritized by the patient. The networked choice of the patient finally puts the shared decision-making model into perspective as it increasingly seems to have a normative character in the relationship between health professionals and patients.
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[en] THE DOCTOR-PATIENT RELATIONSHIP FROM THE ATTACHMENT THEORY S PERSPECTIVE: THINKING PATHWAYS / [pt] A RELAÇÃO MÉDICO-PACIENTE SOB A ÓTICA DO APEGO: PENSANDO CAMINHOSMARIANA GUERRA BARSTAD CASTRO NEVES 10 August 2018 (has links)
[pt] A relação médico-paciente consiste numa díade que é hierarquicamente assimétrica. Uma parte cuida e a outra recebe cuidado, análogo ao que ocorre nas relações de apego. O médico teria o papel de figura de apego, possibilitando ativar o seu sistema de cuidado. O objetivo deste estudo é analisar como o sistema de cuidado está inserido na relação médico-paciente, analisando o estilo de apego do médico, além de relacioná-lo à capacidade de cuidado que o médico tem com seu paciente. Foram entrevistados onze hematologistas do Rio de Janeiro e São Paulo com experiência no SUS utilizando um roteiro de entrevista semiestruturado e foi aplicado o instrumento de autorrelato EVA (Escala de Vinculação do Adulto). Após análise de conteúdo das entrevistas e análise por clusters do EVA, os médicos entrevistados apresentaram apego seguro, com aspectos defensivos evitativos e amedrontados. Quatro categorias também foram estabelecidas: experiências pessoais com medicina e/ou hematologia; especificidade da hematologia; como lidar com as questões sobre perdas; e cuidado com o outro. Conclui-se que o presente trabalho prioriza o lado do médico nesta relação, e a importância do atendimento às suas necessidades psicológicas e relacionais. Com isso, intervenções podem ser propostas à equipe de saúde, de forma a cuidar de maneira consistente destes profissionais e aprimorar sua relação com o paciente e seus familiares. / [en] The doctor-patient relationship consists of a hierarchically asymmetrical dyad. One side cares and the other receives care, analogous to the attachment relationship. The doctor would have the attachment figure s role, being able to activate his or her caregiving system. The purpose of this study is to analyze how the care system is inserted in the doctor-patient relationship, analyzing the attachment style of the physician in addition to relating it to the care ability that the doctor has with his/her patient. Eleven hematologists from Rio de Janeiro and São Paulo with experience in SUS were interviewed using a semi-structured interview script and the self-report instrument AAS-R (Adult Attachment Scale-Revised) was applied. After content analysis of the interview and a cluster analysis of the AAS-R, all the doctors presented secure attachment, with avoidant-dismissing and avoidant-fearful defensive aspects. Four categories were also analyzed: personal experiences with medicine and/or hematology; hematology s specificity; how to deal with loss; and caring towards other. We concluded that the present it is important to prioritize the doctor s stance in the relationship, and to attend their psychological and relational needs. In that manner, interventions in the healthcare team can be proposed, providing the proper care to the healthcare professional, and, hence, improve their relationship with patients and their family members.
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Annonce de mauvaises nouvelles dans le cadre de la prise en charge de patients atteints de sclérose en plaques : approches phénoménologique et clinique des processus intrasubjectifs et intersubjectifs de la relation médecin-patient / Breaking bad news in multiple sclerosis : phenomenological and clinical approaches for subjective and intersubjective processes analysis of the doctor-patient relationshipHoullé, William 28 November 2017 (has links)
Contexte. Objectifs principaux : explorer l’expérience vécue vécu des neurologues et des patients des annonces de mauvaises nouvelles dans la sclérose en plaques, le vécu de la pathologie ainsi que de la qualité de leur relation dans le contexte du suivi d’un projet thérapeutique, et d’envisager la création d’un outil clinique réflexif pour les neurologues destiné à contribuer au maintien d’une relation de qualité durant l’ensemble du parcours de soins. Méthodologie. Étude qualitative multicentrique ; analyse des verbatims : 63 entretiens cliniques de recherche - 35 patients et 20 entretiens - 20 neurologues ; 3 entretiens - relecture d’items ; triangulation méthodologique ; triangulation des observateurs/résultats ; analyse IPA et analyse clinique d’orientation psychodynamique. Résultats. Les annonces de mauvaises nouvelles dans la SEP sont vécues comme des expérience anxiogènes pour la majorité des neurologues de la recherche, des situations source de frustration et parfois d’impuissance. Les impacts psychiques engendrés par les annonces de mauvaises nouvelles, la perception dans certains cas d’une relation au médecin dénuée d’empathie, le sentiment d’impuissance lié au caractère imprévisible de l’évolution de cette maladie progressivement handicapante ainsi qu’une défiance quant à l’efficacité des traitements proposés expliquent en partie la fragilité de l’alliance thérapeutique avec le neurologue et les réactions psychologiques parfois extrêmes des patients qui en découlent. Conclusion et ouverture. Résultats obtenus : engager une réflexion éthique sur les informations à transmettre au patient, et proposer une formation aux neurologues basée sur l’outil élaboré / Context. This research aims to explore the neurologist’s and patient’s lived experiences of breaking bad news in multiple sclerosis and the lived experience of this disease, to understand the basic conditions of their relationship, and to create reflective clinical tools aimed at helping neurologists to maintain the quality of their relationship with the patients. Methodology. Multicentre qualitative study presents the results obtained from the analysis of 83 clinical research interviews with 35 patients and 20 neurologists, using IPA and a clinical psychodynamic. Results. Breaking bad news (BBN) in multiple sclerosis are lived as stressful experience for the majority of the neurologists of the research, a situations lived with frustration and sometimes powerlessness. Psychic impacts engendered by the BBN, the perception in certain cases of a relation to the doctor divested of empathy, the feeling of powerlessness linked to the unpredictable character of the evolution of this gradually crippling disease as well as a mistrust as for the efficiency of the proposed treatments explain partially the fragility of the therapeutic alliance with the neurologist and sometimes the extreme psychological reactions of the patients. Conclusion and opening. Results obtained : engage an ethical reflection on the information to transmit to the patient, and to suggest training to neurologists based on the tool created in tis research
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Relação médico-paciente: o respeito à autonomia do paciente e a responsabilidade civil do médico pelo dever de informar / Doctor-patient relationship: respect for patient autonomy and medical civil liability of the duty to informPaula Moura Francesconi de Lemos Pereira 25 August 2010 (has links)
O estudo da relação médico-paciente vem ganhando novos contornos não só em razão dos avanços biotecnológicos e da massificação do serviço, mas, principalmente, pelos princípios que o norteiam, como o da dignidade da pessoa humana e o da autonomia, consagrados pela Constituição Federal de 1988. O enfoque do presente trabalho é o caráter predominantemente existencial da relação jurídica decorrente de contrato privado, regulado pelo Código Civil, pelo Código de Defesa do Consumidor, e por outras leis e normas deontológicas. Tal relação surge de um vínculo de confiança, intuitu personae, mediante remuneração entre o paciente e o médico. Isto porque o alvo do contrato de prestação de serviços médicos é a saúde, a dignidade e o bem-estar psicofísico e social do paciente, o que impõe uma releitura do tratamento jurídico da relação médico-paciente, de sua estrutura e função, não mais adstrita ao aspecto patrimonial vigente na ótica oitocentista. Passa-se de um vínculo de perfil lógico-autoritário para o perfil dialógico-consensual, em que predomina a liberdade de escolha do paciente. A autonomia do paciente é a mola propulsora dessa relação da qual decorrem diversos direitos e deveres extrapatrimoniais, com maior ênfase no dever do médico de informar. É a informação que permite ao paciente o exercício de sua autodeterminação, seu poder de decidir acerca da disposição de seu próprio corpo por meio da intervenção médica, que inclui serviços de diagnóstico, terapêuticos, cirúrgicos, preventivos e pesquisa em seres humanos. Só após o paciente ser devidamente esclarecido acerca de seu estado de saúde, do tratamento proposto, dos benefícios e riscos envolvidos, tempo de duração, custos e natureza do procedimento, dentre outros fatores, poderá dar ao médico seu consentimento informado para realização das ações médicas da qual será objeto. O consentimento livre e esclarecido do paciente constitui uma das dimensões mais importantes do princípio da autonomia e legitima o ato médico. A autonomia do paciente é tão relevante que sua inobservância pelo médico, independentemente da prática de erro médico, pode dar ensejo à sua responsabilização civil, por configurar por si só fato ou vício do serviço médico, o que lhe confere direito à reparação integral dos danos injustos sofridos, como vem sendo reconhecido pelos Tribunais brasileiros.
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Habilidades sociais na relação médico-paciente e satisfação no atendimento em serviço público e privado / Social Skills in the Doctor-Patient Relationship and Consultation’s Satisfaction in Private and Social Health ServiceJorge, Cynthia Carvalho 19 February 2015 (has links)
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Previous issue date: 2015-02-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The Doctor-Patient Relationship has been identified as an important variable in Health Care’s adherence, efficiency, and effectiveness; The Doctor’s Social Skills, seem to be essential components in its establishment. The general aim of this study was to evaluate doctors’ social skills who works in social and private health systems, examining the relations between these skills and patient satisfaction with regard to the medical consultation. The Study 1 describes the Matched-Pair Instrument (MPI)’s translation and cultural adaptation; the instrument assesses doctor’s social skills during a consultation. Nineteen (19) individuals were involved in the translation and adaptation process. Psychometric analyzes showed satisfactory internal consistency for the patients version (Cronbach's alpha: α= 0,893), presenting similar properties to the original version. The Study 2 aimed to evaluate the social skills of doctors in both Social and Private Health System, considering the self-perception of the professional and the patient’s perceptions, and, examining how the interaction of these variables influence on
patient satisfaction. The participants were 195 patients and 30 physicians, distributed in both health systems. The instruments used in the study were: the translated and validated version of the Matched-Pair Instrument (MPI), a Partial Version of the Social Skills Inventory (HIS-Del-Prette), and the Medical Care’s Patient Satisfaction Evaluation Questionnaire (QASPAM). The overall average scores in the MPI for both Patients (M = 77.5, SD = 12.3) and Physicians (M = 76.5, SD = 11.8) showed low, positive and statistically significant correlation (r = 0.16, p = 0.030); The Patients showed significantly higher ratings than the Doctors’ one. The professionals of social health system evaluated themselves as less skilled (M=69,93; SD=13,55) than the participants of private system (M=76,5; SD = 10.1). These data were similar to those obtained in the analysis of the patient’s questionnaires, since the overall average of
public system patients (M=72.31; SD= 12.25) was significantly lower than the average of the private system (M=80.80; SD= 10.59). The professionals who worked in both health systems rated themselves, and were rated by their patients, as significantly (p <0.000) more skilled in the private system consultation than in the social one. Patients showed satisfaction with the service offered in both social and private health systems; however, private attended patients presented higher satisfaction’ scores. The scores levels of discontentment in the socials’s attended patients were relatively higher than those of the private system, especially in the following items: The Waiting Time in the office, before the consultation; the duration of the medical consultation and Medical Sensitivity. Future research have been suggested to increase the validity of the instruments used for the investigation. The results of this study seem to show that physicians who work in the private service evaluated up and received more satisfactory evaluations of their patients, in relation to social skills and satisfaction with care, than those who work in the public service. The data obtained in this study emphasized the relevance of both evaluation and training social skills for health professionals. / A Relação Médico-Paciente tem sido identificada como uma variável importante na adesão, eficiência e eficácia do tratamento em saúde. As habilidades sociais do médico parecem ser componentes essenciais no estabelecimento de tal relação. O objetivo geral do presente trabalho foi avaliar as habilidades sociais de médicos que atuam em serviços público e privado de saúde, examinando a relação entre a percepção de tais habilidades e a satisfação do paciente com o atendimento do profissional. O Estudo 1 descreve a tradução e adequação cultural do Matched-Pair Instrument (MPI), instrumento que afere
as habilidades sociais do médico durante uma consulta. Participaram dezenove (19) pessoas nos processos de tradução e adaptação do instrumento. Análises psicométricas mostraram consistência interna satisfatória, para a versão dos pacientes (α= 0,886), com propriedades similares ao instrumento original. O Estudo 2 visou avaliar as habilidades sociais do médico, através da auto-percepção do profissional e a percepção de seus pacientes. Além disso, foi investigado como a interação destas variáveis influenciavam na satisfação do paciente, nos serviços público e privado de saúde. Participaram 195
pacientes e 30 médicos distribuídos em ambas as redes de atendimento (público/privado). Os instrumentos utilizados foram: Versão Traduzida e Adaptada do Matched-Pair Instrument (MPI), Versão Parcial do Inventário de Habilidades Sociais (IHS-Del-Prette), e o Questionário de Avaliação da Satisfação do Paciente com o Atendimento Médico (QASPAM). Os resultados desse estudo indicaram que os pacientes (M=77,55; DP=12,3) possuíram uma percepção mais positiva das habilidades sociais dos médicos (M=76,5; DP=11,8), que os próprios profissionais, uma vez que apresentaram médias significativamente maiores no MPI; a correlação entre as percepções dos membros dessa díade mostrou-se baixa, porém estatisticamente significativa (r=0,16; p=0,030). No que se refere à avaliação das habilidades sociais dos médicos nos serviços de saúde, pode-se verificar que os profissionais (M=76,49; DP=10,11) e pacientes (M=80,80; DP= 10,59) do sistema privado realizaram avaliações significativamente mais elevadas que os profissionais (M=69,93 ; DP=13,55) e pacientes (M=72,31; DP=12,25) do serviço público. Corroborando com esses dados, os profissionais que participaram da pesquisa em ambos os serviços de saúde se auto-avaliaram, e foram avaliados por seus pacientes, com escores significativamente (p<0,005) mais elevados no serviço privado. Já, no que se refere à avaliação de satisfação, pode-se verificar que pacientes de ambas as redes demonstraram-se satisfeitos com o atendimento médico; todavia, usuários do setor privado apresentaram maiores escores de satisfação. Os níveis de insatisfação foram mais elevados no setor público, e estavam relacionados a questões como: Tempo de espera, Duração do Atendimento e Sensibilidade do médico. Os resultados desse estudo parecem mostrar que médicos que atuavam no serviço privado avaliaram-se e receberam avaliações mais satisfatórias de seus pacientes, no que se refere à disposição de habilidades sociais e satisfação com o atendimento, que aqueles que atendiam no serviço público. Pesquisas futuras foram sugeridas para aumentar a validade dos instrumentos utilizados. Os dados obtidos no estudo enfatizam a relevância da avaliação e da capacitação em habilidades sociais em profissionais de saúde.
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Relação médico-paciente: o respeito à autonomia do paciente e a responsabilidade civil do médico pelo dever de informar / Doctor-patient relationship: respect for patient autonomy and medical civil liability of the duty to informPaula Moura Francesconi de Lemos Pereira 25 August 2010 (has links)
O estudo da relação médico-paciente vem ganhando novos contornos não só em razão dos avanços biotecnológicos e da massificação do serviço, mas, principalmente, pelos princípios que o norteiam, como o da dignidade da pessoa humana e o da autonomia, consagrados pela Constituição Federal de 1988. O enfoque do presente trabalho é o caráter predominantemente existencial da relação jurídica decorrente de contrato privado, regulado pelo Código Civil, pelo Código de Defesa do Consumidor, e por outras leis e normas deontológicas. Tal relação surge de um vínculo de confiança, intuitu personae, mediante remuneração entre o paciente e o médico. Isto porque o alvo do contrato de prestação de serviços médicos é a saúde, a dignidade e o bem-estar psicofísico e social do paciente, o que impõe uma releitura do tratamento jurídico da relação médico-paciente, de sua estrutura e função, não mais adstrita ao aspecto patrimonial vigente na ótica oitocentista. Passa-se de um vínculo de perfil lógico-autoritário para o perfil dialógico-consensual, em que predomina a liberdade de escolha do paciente. A autonomia do paciente é a mola propulsora dessa relação da qual decorrem diversos direitos e deveres extrapatrimoniais, com maior ênfase no dever do médico de informar. É a informação que permite ao paciente o exercício de sua autodeterminação, seu poder de decidir acerca da disposição de seu próprio corpo por meio da intervenção médica, que inclui serviços de diagnóstico, terapêuticos, cirúrgicos, preventivos e pesquisa em seres humanos. Só após o paciente ser devidamente esclarecido acerca de seu estado de saúde, do tratamento proposto, dos benefícios e riscos envolvidos, tempo de duração, custos e natureza do procedimento, dentre outros fatores, poderá dar ao médico seu consentimento informado para realização das ações médicas da qual será objeto. O consentimento livre e esclarecido do paciente constitui uma das dimensões mais importantes do princípio da autonomia e legitima o ato médico. A autonomia do paciente é tão relevante que sua inobservância pelo médico, independentemente da prática de erro médico, pode dar ensejo à sua responsabilização civil, por configurar por si só fato ou vício do serviço médico, o que lhe confere direito à reparação integral dos danos injustos sofridos, como vem sendo reconhecido pelos Tribunais brasileiros.
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Common Psychosocial and Spiritual Factors Among Individuals Who Have Healed from Chronic Lyme DiseaseGreen, Frederick W., III 23 October 2015 (has links)
No description available.
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The psychological impact of infertility on African women and their familiesMabasa, Langutani Francinah 06 1900 (has links)
The purpose of this study was to investigate and describe the experience of infertility of African women, men and family member. It is hoped that this description will contribute to a deeper
understanding of the psychosocial difficulties involved in the area of infertility and ofthe ways in which people respond to the situation of infertility. A qualitative research approach was used, and in particular social constructivist-interpretive research and feminist research approaches. The sample consisted of39 participants: 19 women,
10 men, and 10 family members faced with infertility. The research orientation was field-based, concerned with collecting data using the technique of in-depth semi-structured interviews. Each participant was interviewed individually. The interviews were recorded on tape, transcribed in their full length and translated into English. Data were
analysed on the basis of the interpretive feminist approach. Analysis of individual cases and crosscase analysis were employed.
The findings suggested a contextual definition of infertility, for example, for some, having had an ectopic pregnancy or a miscarriage meant that they did not fit into the definition of infertility. The
findings revealed that for many African women and men, blood ties still defined the family and the persona. Thus, failure to have a blood child resulted in courtship and marital break up, extramarital
relationships, polygamy, and divorce and remarriage.
Infertility had serious psychosocial consequences for both the infertile individuals and their families. Participants experienced repeated periods of existential crisis, which began at different points for different participants. Analysis of gender differences indicated similarities in the experience of the crisis, but differences in terms of expression and ways of responding to the crisis. Family dynamics within the context of infertility were coloured by ambivalent feelings, resentment, insensitivity, and miscommunication, but also affection, and social support. Traditional and modern medical health systems offered the possibility of finding explanations and treatment, but
there was further strain from the negative experiences with the health care system. The findings in this study suggested the need for policy reformulation, for psychosocial intervention as part of the treatment plan, and for future research on the outcome of using various
coping strategies. / Psychology / D. Phil. (Psychology)
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