Health care concerns everybody. Man{\crq}s right to health care is one of the fundamental human rights. There is no ideal health care system as yet, and states reform their health care systems and the ways of their funding. The reform of the health care system has been conducted in this country for a long time. No minister, however, has introduced more substantial changes and interferences in the present system than the Health Minister MUDr. Tomáš Julínek. This reform is known to citizens especially because of the introduction of fees for health treatment. However, the reform reaches farther. Further steps of the reform propose changes in the public health insurance, providing health care and in education, science and research. The transformation of the health care system of the Czech Republic has not completely resolved and finished a number of matters. Finishing these matters is braked by disputes in the political representation. This thesis is focused on finding out the understanding and attitudes of physicians towards the present reform of the health care system. To collect data, I used the questionnaire method. Its data were collected between January and March 2009. The return rate of questionnaires reached 84 per cent. The set of respondents consisted of physicians from the Vysočina Region in the districts of Havlíčkův Brod and Jihlava. The objective of my thesis was to find out the attitudes of physicians towards the present reform of the health care system. The objective of my thesis was fulfilled. I verified the following hypotheses by my research: Hypothesis 1: Opinions of self-employed physicians are different from those in employment relationship. Hypothesis 2: Differences in physicians{\crq} opinions are also dependent on their specialisations. Both hypotheses were confirmed in most aspects. I suppose that my research has brought new information concerning the opinions of physicians of the Czech health care system and of the changes going on in it. A number of things changed while this diploma thesis was being written, and the reform of the health care system did not proceed in the way it had been planned. I think that despite this the research results are useful and may be used as a basis for further research in this field, and thus enlarge information concerning this subject.

The presented diploma thesis is conserned with the personality of Budweiser?s doctor Emil Flusser and tries to enter his intellectual world with the historical-anthropological method. Based on his two main writings analysis (Křičící kojenec, Válka jako nemoc) and preserved souces analysis (press of the period, the doctor?s own texts), German-speeking Jewish doctor Emil Flusser, is placed into both czech and german cultural society in Budweis. This diploma thesis is focused not only on his doctor?s work, war and protest against the war are main themes of this diploma thesis. Since Dr. Emil Flusser knew important people (Albert Einstein, Karl Kraus), based on contemporary press study I?ve tried to reconstruct their art of world understanding in period close to the second world war.

This study sought to explore and describe the perceptions and beliefs of physicians about adherence to antiretroviral treatment by patients in the South-East district of Botswana. The Health Belief Model (Naidoo & Willis 2003:222) was adapted to suit and be used in the study. A descriptive, exploratory qualitative design was used. Unstructured interviews and unstructured observation data collection methods were applied. Informed consent was obtained prior to data collection. For triangulation purposes, observations were done following interviews, and data analysis was done by two different people. The findings of the study revealed that the perceptions and beliefs of treating physicians contributed towards adherence. Physicians perceived adherence as an important aspect in the success of antiretroviral treatment. Giving patients correct information, personal motivation, patients' understanding of treatment, traditional and religious beliefs were among other factors perceived by physicians to be impacting on adherence. / Health Studies / M.A. (Public Health)

Made available in DSpace on 2015-07-22T20:49:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Support Produtos Nutricionais Ltda / Objetivo: Avaliar o conhecimento e a prática de profissionais pediatras, gastroenterologistas pediátricos, alergistas e nutricionistas quanto à prevenção da alergia alimentar. Métodos: Trata-se de um estudo descritivo e transversal, do qual participaram pediatras (n=80), gastro-pediatras (n=120), alergistas (n=100) e nutricionistas (n=220), totalizando 520 profissionais. O instrumento de coleta foi um questionário auto-administrado elaborado a partir das recomendações atuais das principais sociedades de especialidades sobre a prevenção da alergia alimentar. Resultados: A média de idade dos profissionais foi 29,1±5,8 anos. A maioria dos profissionais era do sexo feminino, constituindo um total de 90,4% (n = 470) dos entrevistados. A média do tempo de graduação dos profissionais foi 7,2±5,8 anos. Quanto à recomendação de dieta de exclusão alimentar na gestação, 89 (17,1%) profissionais concordaram com tal prática, sendo maior a indicação por parte dos nutricionistas. Os gastro-pediatras diferenciaram-se estatisticamente dos demais profissionais por apresentarem a menor taxa de recomendação (p< 0,001). A recomendação de dieta de exclusão alimentar materna na lactação foi indicada por maior número de profissionais, sendo recomendada por 212 (40,8%) entrevistados, verificando-se novamente maior recomendação dos nutricionistas e também dos pediatras em comparação aos alergistas e gastroenterologistas (p< 0,001). A duração de aleitamento materno exclusivo considerada ideal foi o período de 4 a 5,9 meses indicado por 275 (52,9%) profissionais, sendo o período de escolha da maioria dos nutricionistas, pediatras e gastro-pediatras. No entanto, 65 alergistas (65,0%) indicaram a faixa de 6 a 7,9 meses. Quanto à época de introdução da alimentação complementar, 218 (41,9%) profissionais afirmaram modificar a idade de introdução com o objetivo de prevenir o desenvolvimento da alergia alimentar. O principal período indicado foi a idade entre 6 a 7,9 meses, assinalada por 118 (54,1%) entrevistados. Comparando a indicação da época de introdução da alimentação complementar entre os profissionais, 70 (70,0%) dos alergistas afirmam modificar a época de introdução da alimentação complementar (p< 0,001). As principais fórmulas infantis especiais indicadas nos casos de impossibilidade de aleitamento materno com o objetivo de prevenir o aparecimento da alergia alimentar foram: Alfaré® (70,6%), Neocate® (66,2%), Pregomin® (57,5%), e Nan HA® (42,1%). Conclusões: Esse estudo revelou que existem erros conceituais no que tange a prevenção da alergia alimentar entre todas as categorias de profissionais. Nossos resultados confirmam que a avaliação do conhecimento e da prática dos profissionais contribui na definição de conteúdos que devem fazer parte dos programas de educação continuada na área da alergia alimentar. / Objective: To evaluate the knowledge and practice of pediatricians, gastroenterologists pediatricians, allergists and nutritionists regarding the primary prevention of food allergy. Methods: A descriptive cross-sectional study that enrolled pediatricians (n = 80), gastro-pediatricians (n = 120), allergists (n = 100) and nutritionists (n = 220), an amount of 520 professionals. The instrument collects used was a self-administered questionnaire prepared by the authors based on current recommendations of the major committees and societies related to prevention of food allergy. Results: The average age of professionals was 29.1 ± 5.8 years. The vast majority of the professionals was female, constituting a total 90.4% (n = 470) of respondents. The average time of graduation of professionals was 7.2 ± 5.8 years. Regarding the recommendation of exclusion diet on pregnancy, 89 (17.1%) professionals agreed with such practice, being the most indication by nutritionists. The gastro-pediatricians statistically differ from the others professionals by submitting the lowest rate of recommendation (p < 0.001). The recommendation of maternal exclusion diet on lactation was indicated by more number of professionals, constituting 40.8% (n = 212) of the sample, with the highest recommendation by nutritionists and pediatricians compared to pediatricians and allergists (p < 0.001). The duration of exclusive breastfeeding considered ideal was the period of 4 to 5.9 months indicated by 52.9% (n = 275) of professionals, according with the choices of most nutritionists, pediatricians and pediatricians. However, most allergists (65%; n = 65) indicated the range of 6 to 7.9 months. Regarding the time of introduction of complementary feeding, 218 (41.9%) professionals recommended modify the age of introduction to prevent the development of food allergy. The main period indicated was aged 6 to 7.9 months, indicated by 118 (54.1%) of respondents. Comparing the indication of the time of introduction of complementary feeding among professionals, 70 (70%) of allergists affirmed modify the time of introduction of complementary feeding (p < 0.001). The majority of special infant formulas indicated in case of impossibility of breastfeeding to prevent the development of food allergies were: Alfare® (70.6%), Neocate® (66.2%), Pregomin® (57.5%) and Nan HA® (42.1%). Conclusions: This study revealed there are misconceptions regarding the prevention of food allergy among all the categories of professionals. Our results confirm that the evaluation of knowledge and professional practice contributes to the definition of content that should be part of continuing education programs in the area of food allergy. / TEDE / BV UNIFESP: Teses e dissertações

Made available in DSpace on 2012-09-06T01:11:21Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 132.pdf: 1578645 bytes, checksum: c4e2b53095b2d457290ae90e4019719e (MD5) Previous issue date: 1997 / A violência de gênero no âmbito doméstico é um fenômeno extremamente complexo, que perpassa as classes sociais, os grupos étnicos-raciais e as diferentes culturas de inúmeras famílias brasileiras. As mulheres em situaçöes de violência procuram freqüentemente atendimento nos serviços de saúde por agravos à saúde física, à saúde reprodutiva e à saúde mental relacionados direta ou indiretamente com a violência. Entretanto, os profissionais de saúde tem sérias dificuldades para identificar esse fenômeno, inclusive quando as mulheres apresentam severos danos a sua saúde e na ampla maioria dos casos em que se suspeita de violência, estes näo säo investigados. Analisa as representaçöes dos profissionais de saúde sobre a violência de gênero no âmbito doméstico e da forma como essas representaçöes influenciam a visäo destes profissionais acerca do papel dos serviços públicos do setor, diante desse tipo específico de violência. As questöes básicas que a pesquisa busca responder säo: como os profissionais de saúde percebem a questao da violência contra a mulher? será que eles consideram essa realidade como um "problema privado" e que "em briga de marido e mulher ninguém mete a colher? qual a prática atual dos profissionais perante mulheres em situaçäo de violência? de que maneira as dificuldades relacionadas com a organizaçäo de serviços, o tipo de inserçäo nos programas de saúde e a escassa experiência de atuaçäo diante da violência doméstica estao influenciando as propostas desses profissionais sobre o papel do seus próprios serviços? Para compreender a complexidade dessa temática, adota-se como referencial teórico a categoria de GENERO, que postula a construçäo histórica das relaçöes sociais entre os sexos e a REPRESENTAÇAO SOCIAL que analisa a construçäo do sujeito enquanto sujeito social, articulando elementos efetivos, mentais, integrando a cogniçäo, a linguagem, a comunicaçäo às relaçöes sociais que afetam as representaçöes sociais e à realidade material sobre a qual elas intervêm. Adotou-se a metodologia qualitativa e desenvolveram-se 30 entrevistas semi-estruturadas com profissionais (médicos, enfermeiros, assistentes sociais, auxiliares de enfermagem e psicólogos) inseridos em dois modelos de atençäo primária (Centros de Saúde do Rio de Janeiro e no Programa Médico de Família em Niterói). Discute a prática dos profissionais, as dificuldades para identificar e atuar diante deste fenômeno e, as possibilidades de atuaçäo que podem ser consideradas em alternativas para contribuir junto com as mulheres a enfrentar e superar a violência doméstica. Os resultados apontam que as diferenças encontradas em ambos modelos de atençäo está fortemente associada à organizaçäo desses serviços, definindo práticas que favorecem ou dificultam a abordagem integral da violência de gênero. Nesse sentido, existe a necessidade de capacitar os profissionais e acompanhar suas açöes permanentemente assim como construir respostas interdisciplinares e intersetoriais. / Domestic gender-based violence is an extremely complex phenomenon cutting across social classes, ethnic/racial groups, and different cultures in a large number of Brazilian families. Women living in violent relantionship frequently seek treatment at health care facilities because of damage to their physical, reproductive, and mental heath related directly or indirectly to violence. However, health professionals have serious difficulty in identifying this phenomenon, even when the woman’s health is severely jeopardized. The vast majority of suspected cases of violence are not investigated. Considering the importance of active participation by health services, this study focuses on health care professionals’ representations concerning domestic gender-based violence and the way these representations influence their view of the role of public health care services towards this specific type of violence. The basic questions the research aims to answer are the following: how do health care professionals perceive the issue of violence against women? do they consider this reality a “private matter”, and do they agree with the Brazilian saying that “it takes two to fight, so don’t break one up between husband and wife”? what is the current stance by health care professionals towards women subject to violence? how are the difficulties related to organization of health care services, type of participation, and limited experience in dealing with domestic violence influencing these professionals’ proposals towards the role of their own health care facilities? In order to understand this issue’s complexity, the basic theoretical references for this research are the GENDER category, proposing the historical construction of social relations between the sexes, and that of SOCIAL REPRESENTATION, which analyzes the construction of the subject as a social subject, linking affective and mental elements, integrating cognition, language, and communications with the social relations that affect social representations and the material reality in which they intervene. The research use a qualitative methodology, developing 30 semi-structured interviews with health care professionals (physicians, nurses, social workers, nursing aids, and psychologists) working in two primary health care models (Public Health Centers in the city of Rio de Janeiro and the Family Physician Program in the city of Niterói). Based on an analysis of the interviewees’ discourse, the study discusses the health care professionals’ practice, difficulties in identifying and intervening on this phenomenon, and possibilities for working together with women as alternatives to help confront and overcome the problem of domestic violence. The results suggest that the differences between the two health care models are heavily correlated with the way they are organized, establishing practices that favor or hinder an integral approach to gender-based violence. In this sense, there is a real need to train these professionals and monitor their activity on an on-going basis, as well as to develop interdisciplinary and intersectorial approaches.

Introdução: Muitos programas de intervenção na primeira infância vêm mostrando-se eficazes na melhoria do desenvolvimento das crianças, sendo necessária sua implantação em uma realidade coma a brasileira. A Estratégia Saúde da Família é um espaço que possibilita a ampliação das ações dos profissionais de saúde para além do biológico, pois atua no lócus familiar. Neste contexto a implantação de tecnologias como a do projeto Nossas Crianças: Janelas de Oportunidades torna-se favorável para ampliar e qualificar a atenção à criança, com ênfase no fortalecimento do desenvolvimento infantil. Com a introdução de novas tecnologias na prática dos profissionais de saúde a avaliação das mesmas torna-se necessária, pois é um processo contínuo de análise e síntese de seus benefícios. Objetivo: Avaliar a incorporação das tecnologias do Projeto Janelas pelos profissionais de saúde. Metodologia: Trata-se de uma pesquisa avaliativa com triangulação de métodos utilizando os quatro níveis de avaliação de Kirkpatrick (Reação, Aprendizagem, Comportamento e Resultados). Os sujeitos de estudos foram nove médicos e dezessete enfermeiros de dezoito Equipes das Unidades Básicas de Saúde do Projeto Região Oeste que foram capacitados com a 2a edição do Projeto Nossas Crianças: Janelas de Oportunidades. Resultados: três Equipes incorporaram a tecnologia, nove incorporaram parcialmente e seis não incorporaram a tecnologia. Três enfermeiros e dois médicos incorporaram a tecnologia, nove enfermeiros e cinco médicos incorporaram parcialmente e cinco enfermeiros e dois médicos não incorporaram a tecnologia. Foram identificadas cinco categorias de mudança de comportamento: a) ampliação da clínica dentro da prática da consulta; b) utilização do Caderno da Família em sua prática; c) incorporação em sua prática de conceitos teóricos relacionados a família; d) organização do trabalho e e) estímulo da família para apropriação da tecnologia. Foram também identificadas quatro dimensões relacionadas com a incorporação de tecnologia: a) dimensão ética, técnica, política e econômica da tecnologia em si; b) dimensão aceitação e satisfação do paciente; c) dimensão características do serviço de saúde e d) dimensão processo de trabalho. Conclusões: A incorporação das tecnologias do Projeto Janelas mostrou-se estritamente relacionada com o processo de educação permanente dos profissionais de saúde do Projeto Região Oeste. A análise do cotidiano do trabalho dos profissionais fornece pistas a respeito das tecnologias já em uso pelas Equipes e das necessidades de incorporação do uso de uma nova tecnologia / Introduction: Many intervention programs in early childhood have proven effective in improving the development of children, in a reality like the Brazilian its implementation is required. The Family Health Strategy is a space that allows the expansion of the actions of health professionals beyond the biological, because it acts in the family locus. In this context the deployment of technologies as from the project Our Children: Windows of Opportunities becomes favorable to widen and improve the care of children, with emphasis on strengthening the child development. With the introduction of new technologies in the practice of health professionals their evaluation becomes necessary, because it is an ongoing process of analysis and synthesis of its benefits. Aims: To evaluate the incorporation of the Technologies of the Windows Project by health professionals. Methodology: This is an evaluation research with triangulation methods using the Kirkpatricks four levels of evaluation (Reaction, Learning, Behavior and Results). The subjects of study were nine physicians and seventeen nurses of eighteen health Teams of the Health Basic Units from Western Region. Results: Three Teams incorporated the technology, nine incorporated partially and six have not incorporate the technology. Three nurses and two physicians incorporated the technology, nine nurses and five physicians incorporated partially and five nurses and two physicians have not incorporated the technology. Were identified five categories of behavior change: a) clinical expanding within the query practice; b) use The Family Booklet in their practice; c) incorporate into their practice the theoretical concepts related to family; d) organization of work and e) stimulus the family for appropriation of technology. Were also identified four dimensions related to the incorporation of technology: a) ethical, technical, political and economic dimension of the technology itself; b) acceptance and patient satisfaction dimension; c) dimension of the health service characteristics and d) working process dimension. Conclusions: The incorporation of technology showed closely linked to the process of permanent education of the health professionals from the Western Region Project. The professional work routine analysis provides clues about the technologies already in use by the Teams and the needs of incorporating the use of a new technology

The topic of the thesis is {\clqq} The examination of state of health of citizens for the purposes of social welfare benefits.{\crqq} Medical statement sevice ensures this activity, which has a wide medical, social, employment and economic importance. On 1st January 2006 the first instance medical statement service was divided into the insurance and non-insurance system. OSSZ and ČSSZ continues providing examinations for the insurance systems while the examination for the non-insurance system is carried out by physicians of the newly created examination services of employment agencies. The paper aims at analysing the so far experience of the medical statement service after the division into the insurance and non-insurance system. I presume that the division of the medical statement service and its transformation have been effective. I have dealt with the medical statement system in the most wide context. In the theoretical part I have concentrated on historical development of the medical statement service, on its system and the scope of activity of the medical statement service and I did not omit the examination of state of health of citizens for the purposes of the social welfare systems. In the practical part I concentrated on physicians carrying out medical statements for employment agencies and district administrations of social welfare, on their feelings, opinions on the reorganization of the medical statement service in 2006. The research was carried out in Central Bohemia region with the view to evaluate the division of the medical statement service in the insurance and non-insurance system. A quantitave attitude was chosen for this research usingt the questionnaire method. Two types of questionnaires were handed out: for physicians of the medical statement service of employment agencies and for physicians of medical statement service of district administration of social welfare system. In total there were 40 questionnaires handed out to the physicians of medical statement service of district administration of social welfare system and 25 to the physicians of the medical statement service of employment agencies. 34 (100%) questionnaires were used filled by the employment agencies physicians and 16 (100%) questionnaires filled by the physicians of the district administration of social welfare system. I chose the graph form to process the research part of the paper. The principal hypothesis was confirmed. For both the physicians of the medical statement service of employment agencies and physicians of medical statement service of district administration of social welfare system was proved that the division of the medical statement service into the insurance and non-insurance system was effective. Further activities within the organization of the medical statement service should endeavour to depict small discrepancies and to ensure a continuous improvement of the system.

{\clqq}Everyone is equal before the law{\crqq} which applies also for the field of social services since 1st January 2007 because after many years of preparatory stages Act n. 108/2006 Sb. On Social Services entered in force. This act having been passed means a break through moment for social workers, social services providers as well as for the citizens and beneficiaries of social benefits and services. The paper is divided in a theoretical and a practical part. In the theoretical part I dealt with the development of social services, introduction of the new Act n. 108/2006 Sb. On Social Services into our social system and I compared the allowance for attendance of a next of kin or other person according to Act n. 100/1998 Sb. On Social Welfare and the attendance allowance according to Act n. 108/2006 Sb. On Social Services. In the practical part I concentrated solely on the attendance allowance since, according to my point of view, this is the greatest change the new Act On Social Services brought about and it plays a very important part in this field. The research was carried out using the questionnaire research method. The questionnaire was filled out by social workers employed in the attendance allowance department at local authorities of communities with extended powers in South Bohemia. 57 questionnaires were handed out, 48 of which were in total used for the paper. Graphs were used to evaluate the research part. The goal of the paper was the assessment using the SWOT analysis of the allowance for attendance of a next of kin or other person according to Act n. 100/1998 Sb. On Social Welfare and the attendance allowance according to Act n. 108/2006 Sb. On Social Services. Regarding this goal the following hypothesis was set: Social workers consider the attendance allowance according to Act n. 108/2006 Sb. On Social Services offering more strong points and more opportunities than the allowance for attendance of a next of kin or other person according to Act n. 100/1998 Sb. On Social Welfare. Results of the carried out research confirm this hypothesis. In spite of other problems that are to be dealt with in connection with this Act, we can presume that the introduction of the attendance allowance into the system of social services was and shall be the right step.

Contexte : La chronicité de la maladie est difficile, autant pour le soigné que pour le soignant. Malgré de nombreux travaux et recherches (réalisés principalement chez le soigné), la douleur chronique reste un fléau. Il est suggéré qu’une approche centrée sur la personne soit la meilleure pour aider ces patients. Il serait donc possible que la façon dont le médecin adapte sa clinique face au patient ait une influence. En regard de la douleur chronique, sa prise en charge difficile peut mener le soignant à ressentir de l’impuissance. Quelles stratégies utilise le soignant lorsque la pharmacopée est insuffisante ? S’il est répandu que les engagements spirituels des patients permettent d’attribuer un sens aux expériences de la douleur, peu de choses sont connues du côté des médecins. But : La présente étude explore les facteurs influençant la prise en charge par les médecins du patient douloureux chronique afin de comprendre comment leurs caractéristiques identitaires, spirituelles et relationnelles orientent leur approche de soins. Méthodes : Un dispositif de théorisation ancrée en recherche qualitative a été retenu. Le cadre conceptuel élaboré repose sur deux concepts clés : celui de l’identité narrative selon Ricœur et celui du temps selon Tillich. Les participants furent recrutés selon un échantillonnage de convenance. Des entrevues individuelles semi-structurées ont été conduites auprès de sept médecins de diverses spécialités, confrontés aux difficultés de prise en charge en contexte de douleur chronique. La moitié des participants ont été interviewés une seconde fois afin d’approfondir le thème de l’identité, et ce, jusqu’à saturation des données. Les transcriptions sont analysées selon la méthode de codification Strauss et Corbin. Résultats : Si le facteur temps était théoriquement connu de par la littérature sur la maladie douloureuse chronique, la collecte et l’analyse des données en a favorisé son émergence en tant que concept, révélant ainsi son importance implicite cruciale au sein de la relation thérapeutique. Notre approche, cadre à la fois théologique et inspirée de l’anthropologie philosophique, a permis d’identifier la reconnaissance en tant que processus émergent des données pour expliquer le cheminement de l’identité du médecin – professionnelle et personnelle – en contexte clinique de douleur chronique. Bien que non recherchée de façon explicite, la reconnaissance par le médecin (et indirectement par le douloureux chronique) apparaît comme source de motivation et d’énergie insoupçonnée afin d’entretenir une relation de qualité. La particularité du mot reconnaissance de se décliner en différents termes polysémiques a permis d’élaborer le processus de la re-connaissance vers la re-co-naissance mutuelle qui est ici proposé comme cadre explicatif de l’évolution de l’identité du médecin en contexte clinique relationnel de prise en charge du douloureux chronique. Le médecin doit ainsi se définir à nouveau en tant que thérapeute en vue de ne pas vivre l’échec. Conclusion : La compétence relationnelle acquise, ajoutée à sa compétence professionnelle, permet au médecin d’enrichir ses connaissances (savoir et expérience), mais aussi de cheminer, au fil du temps, avec son patient douloureux chronique, passant d’une re-connaissance (identitaire et spirituelle) à une re-co-Naissance mutuelle et dynamique dans la relation en contexte de douleur chronique. Les différentes perspectives pour les cliniciens et soignants s’occupant de ces patients sont discutées. / Abstract : Background: Chronic pain is difficult, both for the patient and the caregiver. Even though many studies and researches have been conducted (mostly with patients), chronic pain remains. It is suggested that a person-centered approach is the best way to help these patients. However, little is known about how physicians adapt their practice to their powerlessness when faced with chronic pain patient. Which strategies are to be used when the pharmacopoeia is insufficient? Though it is known that religious and spiritual commitments may allow patients to give meaning to their pain, little is known about how physicians deal with these commitments. Purpose: This study explores the factors influencing how physicians take charge of chronic pain patients to understand how their identity, their spirituality and their relationship shape their care approach. Methods: Within a qualitative research design in grounded theory, the conceptual framework developed is based on the two key concepts: the narrative identity by Ricœur and the concept of time by Tillich. Participants were recruited using a convenience sampling. Semi-structured individual interviews were conducted with seven physicians in various specialties dealing with the difficulties of chronic pain management. Four of them were interviewed a second time to further investigate the subjet, until data saturation. The transcripts were analyzed by Strauss and Corbin’s method of codification. Results: If the time factor was theoretically known from the literature on chronic pain, continuous and simultaneous data collecting and analyzing has brought its emergence as concept (axial coding), revealing thereby its implicit crucial importance within the therapeutic relationship. Our approach, inspired from both theological and philosophical anthropology‘s frames, have allowed us to identify “recognition” as an emerging process to explain the flow scheme of the physician’s professional and personal identity when faced with chronic pain. Although not researched explicitly, mutual recognition between patient and physician is a source of motivation to improve the quality of the relationship. The process of recognition to mutual re-co-birth (“re-co-naissance” in French) is proposed here as an explanatory framework for the development of the physician’s identity in the clinical context of chronic pain patient care. The French word “reconnaissance” (recognition) thus can be broken down into “re-co-naissance” (re-co-birth), the co-rebirth of a relationship to define oneself anew as a therapist and to not experience failure. Conclusions: The new acquired confidence and competence between physician and the patient, in addition to actual professional skills, enables the concerned physician not only to enrich his knowledge but also to make progress in time, along with his chronic pain patients, moving from professional identity to spiritual recognition and to a dynamic relationship of mutal re-birth and re-acknowledge (“re-co-naissance”), so that he no longer experiences medical failure. Various perspectives for clinicians and caregivers will be further discussed.

Digital transformation is evolving, and it is driving at the helm of the digital evolution. The amount of information accessible to us has revolutionized the way we gather information. Mobile technology and the immediate and ubiquitous access to information has changed how we engage with services including healthcare. Digital technology and digital transformation have afforded people the ability to self-manage in different ways than face-to-face and paper-based methods through different technologies. This study focuses on exploring the use of the most commonly used digital health technologies in the healthcare sector and how it affects physicians’ daily routine practice. The study presents findings from a qualitative methodology involving semi-structured, personal interviews with physicians from Sweden and a physician from Spain. The interviews capture what physicians feel towards digital transformation, digital health technologies and how it affects their work. In a field where a lack of information regarding how physicians work is affected by digital health technologies, this study reveals a general aspect of how reality looks for physicians. A new way of conducting medicine and the changed role of the physician is presented along with the societal implications for physicians and the healthcare sector. The findings demonstrate that physicians’ role, work and the digital transformation in healthcare on a societal level are important in shaping the future for the healthcare industry and the role of the physician in this future. / Den digitala transformationen växer och den drivs vid rodret för den digitala utvecklingen. Mängden information som är tillgänglig för oss har revolutionerat hur vi samlar in information. Mobila tekniker och den omedelbara och allmänt förekommande tillgången till information har förändrat hur vi tillhandahåller oss tjänster inklusive inom vården. Digital teknik och digital transformation har gett människor möjlighet att kontrollera sig själv och sin egen hälsa på olika sätt än ansikte mot ansikte och pappersbaserade metoder genom olika tekniker. Denna studie fokuserar på att utforska användningen av de vanligaste digitala hälsoteknologierna inom hälso- och sjukvårdssektorn och hur det påverkar läkarnas dagliga rutin. Studien presenterar resultat från en kvalitativ metod som involverar semistrukturerade, personliga intervjuer med läkare från Sverige och en läkare från Spanien. Intervjuerna fångar vad läkare tycker om digital transformation, digital hälsoteknik och hur det påverkar deras arbete. I ett fält där brist på information om hur läkare arbetar påverkas av digital hälsoteknik avslöjar denna studie en allmän aspekt av hur verkligheten ser ut för läkare. Ett nytt sätt att bedriva medicin och läkarens förändrade roll presenteras tillsammans med de samhälleliga konsekvenserna för läkare och vårdsektorn. Resultaten visar att läkarnas roll, arbete och den digitala transformationen inom hälso- och sjukvården på samhällsnivå är viktiga för att utforma framtiden för vårdindustrin och läkarens roll i framtiden.