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Art – Prefácio, Índ#D36ED.Fh11 Editor Filipe Basto 1.ª Edição - Março 2007 PREFACE This edition results from a partnership established between the Internal Medicine Services of Hospital de São João in Porto and the University of Washington Medical Center in Seattle which focused in three fundamental goals: health services organizational improvement and development - namely in the hospital setting; medical education in its graduate and professional development aspects; and quality and productivity improvements for all healthcare services provided. It is understandable how relevant this initiative can be for the Portuguese context. We have a rapidly growing - increased health needs requiring - aging population and a poorly performing national health service, if compared with relevant international standards. Overall, we are also having a difficult time keeping up with the challenges and fast pace of scientific developments in medical sciences and diagnostic technologies, both requiring continuous and demanding update. Also for many years there has been a suicidal policy towards medical and nursing schools conducive to extreme shortness of medical and nursing manpower. Immigration from Spain was insufficient to solve this problem adequately and in due time. These are, in fact, the simple reasons why the Luso-American Development Foundation was interested and supported this project. We need more physicians to become excellent medical professionals, with their minds opened to innovation and dedicated to the public cause. We also need hospitals and health centers to become more efficient and if at all possible to spend less but more effectively. We also need to empower patients to learn and collaborate. Government, Medical Schools and physicians, and those using healthcare services are faced with significant tasks which are not easy to handle. However these represent categorical imperatives that must be accomplished. Editing this book provides the vision to construct on the issues researched and discussed and spark the interest to make them translate from the narrow auditoriums to a broader audience. Let us hope this can be achieved. Lisbon, March 16th, 2007 Rui Chancerelle de Machete III PREFÀCIO O presente volume resulta de uma parceria entre os Serviços de Medicina do Hospital de S. João no Porto e a Universiy of Washington Medical Center em Seatle, que prosseguiu três objectivos fundamentais: a melhoria e o desenvolvimento da organização dos serviços de saúde, designadamente hospitalares, a formação médica nos seus aspectos escolares e ao longo da profissão, e a qualidade e a quantidade dos serviços médicos prestados. Compreende-se o grande interesse da iniciativa no contexto português. Temos uma população que envelhece rapidamente, com carências de saúde cada vez maiores, e um serviço nacional de cuidados médicos de baixa produtividade se o cotejarmos com os parâmetros internacionais competentes. Enfrentamos também dificuldades de um modo generalizado corresponder aos desafios postos pelo desenvolvimento científico muito rápido das ciências médicas e dos meios de diagnóstico, um e outro impondo uma permanente actualização. Acresce que durante anos a política suicidária seguida quanto às faculdades de medicina e escolas de enfermagem ocasionou uma escassez de médicos e profissionais de enfermagem que nem a imigração proveniente da vizinha Espanha tem permitido colmatar por forma atempada e em número suficiente. Estas, aliás, as singelas razões por que a Fundação Luso-Americana para o Desenvolvimento se interessou e apoiou o presente projecto. Precisamos de mais médicos que sejam excelentes profissionais, abertos à inovação e com espírito de serviço. Precisamos também de hospitais e centros de saúde mais eficientes e que, na medida do razoável, possam gastar menos com mais eficácia. Necessitamos ainda que os doentes aprendam e colaborem. Não são tarefas fáceis, nem para o Governo, nem para as Faculdades de Medicina e médicos, nem para os utentes em geral. Mas representam imperativos categóricos a cumprir. A publicação deste livro tem em vista que o que se investigou e discutiu possa ultrapassar os limites estreitos dos anfiteatros e concitar o interesse de uma audiência mais vasta. Esperemos que assim aconteça. Lisboa, 16 de Março de 2007 Rui Chancerelle de Machete V EDITORS NOTES The national imperative to respond to the needs of an ageing population, to the increased individual expectations and to chronic and behavior disease related epidemics now characterizing modern societies, drove health systems to adopt new models of provision that reconcile these primarily centrifugal forces with the constraints necessary for financial sustainability. These new models assume a social responsibility framework, and reflect on the relative value of technology, highlighting the opportunities for increased effectiveness of care through a rigorous medical practice that provides an integrated and holistic dimension to health related problems. In fact these new models emerge from a universe of growing complexity, where multiple systems interpenetrate, interchange and influence each other reciprocally. All these changes favor a new perspective towards the World and the roles of Physicians. Behavior modification, prioritized scientific evidence, safety and quality of care promotion, accountability, outcomes research and team work, all provide novel dimensions for an old profession that continuously regenerates. This book tells us a little bit about our project and its character: the firm belief younger physicians may be attracted by the integrative and eclectic nature of Internal Medicine and also interested in its potential value for the future dynamics of these new systems. It also tells us how this project can be used as a paradigm for Medicine, in the sense that the need for scientific rigor and technical update parallels continued learning, shared information, exchange programs and knowledge about the Individuals and the World. This is the track we have been following for about three years now in this partnership between the Internal Medicine Service in Hospital de São João (HSJ) and the University of Washington Medical Center. Residents exchange activities, Visiting Professor programs, conferences and a series of additional activities took place in HSJ, ultimately gathering support from several healthcare VII professional bodies and leading to new and diverse forms of collaboration between hospitals and academic medical centers. This has been possible with the institutional hold up from HSJ and the vital support from the Luso American Development Foundation (FLAD). It would be extremely difficult to mention all those that contributed to the success of this program but it would be unforgivable not to mention two fundamental contributions: Dra. Idalina Salgueiro for the continued confidence, incentive and the intellectual unrest that kept our goals high; Prof. David Dale for the honor to take this program personally in fact without his collaboration and support this partnership would not have been possible. Reading this book you may encounter some of the main challenges and opportunities to be faced by social systems, healthcare services and physicians. We hope this project may become infectious and help nurture a systemic perspective humanist and integrative that we believe may be necessary for an adequate response to the challenges that future is bringing to one of the most beautiful chapters in science ars medicinae. Filipe Basto Porto, March 19th, 2007 VIII NOTAS DO EDITOR O imperativo de responder às necessidades de uma população em rápido envelhecimento, as expectativas crescentes dos indivíduos e a epidemia de doenças crónicas e comportamentais que hoje caracterizam as sociedades modernas, forçam os sistemas de saúde a adoptar novos modelos de prestação que, conciliem estas pressões, tendencialmente centrífugas, com as exigências de equilíbrio financeiro necessárias à sua sustentabilidade. Estes novos modelos reequacionam o valor relativo das tecnologias e ressaltam a importância de uma prática médica rigorosa que, assente numa visão integrada e holística dos problemas, assuma, num contexto de responsabilização social, a efectividade dos cuidados prestados. Na verdade estes novos modelos procuram assumir uma nova perspectiva do Mundo e do lugar do Médico, num universo de crescente complexidade, onde múltiplos sistemas se interpenetram e reciprocamente se influenciam. Mudar comportamentos, privilegiar o rigor científico, promover a segurança e a qualidade dos cuidados prestados, promover a prestação de contas, investigar os resultados obtidos e trabalhar em equipa, são novas dimensões para uma velha profissão que continuadamente se regenera. Este livro conta um pouco da história de um projecto de convicções: um projecto que acredita que os médicos mais jovens podem ser atraídos pela natureza eclética e integradora da Medicina Interna e pelo valor que esta pode representar para a dinâmica futura destes novos sistemas. Mas também a história de um projecto que serve de exemplo para toda a Medicina, na medida em que alia a necessidade de rigor científico e actualização técnica à aprendizagem continuada, à partilha de informação, ao intercâmbio e ao conhecimento dos Indivíduos e do Mundo. É este o caminho trilhado desde há cerca de 3 anos pela parceria entre o Serviço de Medicina Interna do Hospital de São João e o University of Washington Medical Center. Estágios e intercâmbios de internos, programas Visiting IX Professor , conferências e uma série de outras
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