Alejandro oic G

The future of medicine

: Predicting the future of medicine is daring. One can speculate about some of its future traits at the most. The spectacular progress in biological sciences has nurtured the hope that medicine will be able to dominate all ailments, improve the quality of life and longevity. Physicians are uncomfortable with the weak knowledge that they have about some diseases such as cancer, connective tissue diseases, degenerative diseases, mental and psychosocial conditions. They are also worried about the aggressive and mutilating surgical procedures that are required nowadays. One can foresee that molecular medicine and applied technology will advance at a great speed and will modify the therapy of several diseases and the social organization of health care. Scientific progress will also change our values and will pose new political and economical challenges. I believe that medical ethics and bioethics will become a growing concern for medical education and professional organizations. The so called biotechnology century will also be the bioethics century. The revision and elucidation of the fundamentals of medicine will differentiate, in the future, a medicine devoted to mankind with a solid ethical background from an impersonal health care that considers man as an object or maybe a merchandise. The second option will cast medical care through the abyss of decadence, to its end.

Proliferación de escuelas de medicina en Latinoamérica: causas y consecuencias

Significant changes in university education have occurred in Latin America, caused by the strategic importance that it has on economical and social development. The educational system expanded and science, technology and informatics, experienced an important development. The eighties were characterized by a reduction in government expenditures, a more efficient use of resources, an increase in the number and variety of universities and university students. The creation of new universities, mostly private, was favored by a highly unregulated market. In Latinamerica, more new universities were created during the eighties than in the previous one hundred years. Since 1981, the number of universities in Chile increased from 8 to 60, the type of institutions was diversified, the government financing of public universities decreased substantially and the regulatory role of the market was emphasized. These changes have been quantitatively understandable but qualitatively unsatisfactory. Since 1981, the number of university students between 19 and 24 years old has triplicated. The number of medical schools and the annual admission of students has duplicated. In most Latin American countries, there is an insufficient number of physicians (Chile has one physician per 783 inhabitants). Since the decade of the nineties, an effort has been made to regulate the market, to introduce new barriers for the acceptance of new educational institutions, to improve the transparency of the system and to preserve the quality of teaching. The quality control of medicine and health is one of the most serious problems in Latin American countries. This includes accreditation of medical schools, health centers and specialists. In Chile there have been some progress in these topics but quality control is still unsatisfactory (Rev Med Chile 2002; 130: 917-24).

Descentralización en salud y educación: La experiencia chilena

In Chile there has been a close interaction between medical teaching and health care. In 1943, the University of Chile School of Medicine (founded in 1833) created Chairs in several public hospitals. The University of Chile School of Public Health (founded in 1943) played a key role in the creation in 1952 of a centralized National Health Service (NHS). The NHS had outpatient clinics and hospitals all over the country and was responsible for health care and for the promotion of health and disease prevention programs. In 1954, the NHS and the School of Medicine set up Residencies and General Practitioners programs aimed at improving the distribution of specialists and general practitioners throughout the country. In 1979, the NHS was replaced with 27 autonomous Health Services headed by the Ministry of Health, while the administration of primary care outpatient clinics was transferred to the municipal government. However, sanitary programs were still managed at the central level. Higher education also expanded and was decentralized. There are currently 60 universities and 17 medical schools, compared to eight and six, respectively, in 1981. The number of students in higher education has increased by 370% in 20 years. At the present time, the Chilean health case system is a predominantly public system with a strong and sizeable private system. Sixty two percent of the population is covered by public health insurance, while 27% is covered by private insurance. New and well equipped private clinics have multiplied. Private non profit institutions manage the prevention and treatment of work related injuries and diseases. Chiles outstanding health indicators (fertility rate: 17.2 x 1,000; mortality: 5.4 x 1,000; maternal mortality: 2.3 x 10,000; neonatal mortality: 4.5 x 1,000; life expectancy: 76 years) are a direct consequence of the improved social, cultural and economic condition of the general populations as well as of the sanitary programs sustained over the past half century (Rev Med Chile 2003; 131: 788-98)

Seminario sobre formación de médicos en la actualidad en Chile

: The Chilean Academy of Medicine is concerned about the significant increment in the number of Medical Schools in Chile, from six in 1981 to 16 in 2002. All these Schools were invited to participate in a seminar about medical training. Eleven Schools are private and 5 are public (3 private Schools are subsidized by the state). There are nine Medical Schools in Santiago and 7 in other regions. The students admission criteria varies from one School to another. One thousand one hundred twenty two students are admitted to these Schools each year. Clinical hospitals, urban and rural outpatient clinics are used as training fields. These pertain to the Ministry of Health, Universities, Armed Forces, Private Clinics and City Halls. The main recommendations of the seminar were: to promote an early contact of students with clinical problems and to analyze these problems from the perspective of basic sciences; to enhance semiological, clinical and physiopathological training; to increase the contact with outpatients; to favor health promotion and preventive activities; to educate professors in ethical and humanistic issues; to regulate the use of clinical campus and reinforce the formation of specialists in family medicine, internal medicine and pediatrics. The accreditation of Medical Schools and clinical training centers was recommended. The establishment of a national medical examination for Chilean and foreign graduates, was proposed. The Academy of Medicine is interested in assuring a good quality medical training and to avoid teaching activities in unqualified schools and hospitals.

Sobre el uso de epónimos en medicina

A distinctive feature of medical language is the use of eponyms or denominations constructed using the names of real or imaginary persons. Some consider this practice as inappropriate, because eponyms are sometimes more a reflection of influence and power rather than the real authorship of discoveries. On the other hand, others consider valid the use of eponyms since they are a part of a scientific domain used to name objects and diseases. The fact is that tradition and use have finally imposed eponyms in medical language and demonstrated its usefulness. They facilitate the communication between peers and are also a tribute to the clinical sagacity and observational skills of their discoverers. A reasonable practice is to favor the use of those classical eponyms that have endured the pass of time due to their clinical importance, specificity diagnostic significance or historical relevance. Moreover, the knowledge of the biography or historical environment of discoverers of signs, syndromes or diseases gives us a historical perspective of medicine and sheds light on the past, evolution and present knowledge and practice of medicine.

Diagnóstico de Muerte

This paper undertakes an analysis of the scientific criteria used in the diagnosis of death and underscores the importance of intellectual rigor in the definition of medical concepts, particularly regarding such a critical issue as the diagnosis of death. Under the cardiorespiratory criterion, death is defined as «the irreversible cessation of the functioning of an organism as a whole» and the tests used to confirm this criterion (negative life-signs) are sensitive and specific. In this case, cadaverous phenomena appear immediately following the diagnosis of death. On the other hand, doubts have arisen concerning the theoretical and the inner consistency of the criterion of brain death, since it does not satisfy the definition of «the irreversible cessation of the functioning of an organism as a whole», nor the requirement of «total and irreversible cessation of all functions of the entire brain, including the brain stem». There is evidence to the effect that the tests used to confirm this criterion are not specific enough. It is clear that brain death marks the beginning of a process that eventually ends in death, though death does not occur at that moment. From an ethical point of view, the conflict arises between the need to provide an unequivocal diagnosis of death and the possibility of saving a life through organ transplantation. The sensitive issue of brain death calls for a more thorough and in-depth discussion among physicians and the community at large (Rev Med Chile 2004; 132: 95-107).

El Sistema de Salud de Chile: una tarea pendiente

The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%. From 1952 to 2014, public health care policies made possible a remarkable improvement in Chiles health indexes: downward trends in infant mortality rate (from 117.8 to 7.2 x 1,000 live births), maternal mortality (from 276 to 18.5 x 100,000), undernourished children < 5 years old (from 63% to 0.5%); and upward trends in life expectancy at birth (from 50 to 79,8 years), professional hospital care of births (from 35% to 99.8%), access to drinking water (from 52% to 99%), and access to sanitary sewer (from 21% to 98.9%). This went hand in hand with an improvement in economic and social indexes: per capita income at purchasing power parity increased from US

Sources of error in clinical practice

3,827 to US

Apuntes sobre la eutanasia

20,894 and poverty decreased from 60% to 14.4% of the population. Related indexes such as illiteracy, average schooling, and years of primary school education, were significantly improved as well. Nevertheless, compared with OECD countries, Chile has a relatively low public investment in health (45.7% of total national investment), a deficit in the number of physicians (1.7 x 1,000 inhabitants) and nurses (4.8 x 1,000), in the number of hospital beds (2.1 x 1,000), and in the availability of generic drugs in the market (30%). Chile and the USA are the two OECD countries with the lowest public investment in health. A generalized dissatisfaction with the current Chilean health care model and the need of the vast majority of the population for timely access to acceptable quality medical care are powerful arguments which point to the need for a universal public health care system. The significant increase in public expenditure on health care which such a system would demand requires a sustainable growth of the Chilean economy.The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%. From 1952 to 2014, public health care policies made possible a remarkable improvement in Chiles health indexes: downward trends in infant mortality rate (from 117.8 to 7.2 x 1,000 live births), maternal mortality (from 276 to 18.5 x 100,000), undernourished children < 5 years old (from 63% to 0.5%); and upward trends in life expectancy at birth (from 50 to 79,8 years), professional hospital care of births (from 35% to 99.8%), access to drinking water (from 52% to 99%), and access to sanitary sewer (from 21% to 98.9%). This went hand in hand with an improvement in economic and social indexes: per capita income at purchasing power parity increased from US

Consideraciones acerca de la “interrupción voluntaria del embarazo”, desde el punto de vista ético-médico (a propósito de un proyecto de ley)

3,827 to US