publicado em 20/12/2012 às 18h07:00
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Between the eye and Technology

Chico D'Angelo, doctor and congressman (PT-RJ)

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Foto: Brizza Cavalcante
Chico D'Angelo, doctor and congressman (PT-RJ)
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Chico D'Angelo, doctor and congressman (PT-RJ)

Twenty-six centuries, Hippocrates laid the groundwork for the foundation of medicine in the West. Instead of attributing the variations between health and disease at the whim of the gods, proposed the broad investigation of nature - not just the body but also of "airs, waters and places", title of one of his books - as an objective of understanding the cause of illness and a possible therapeutic approach. Besides exclude issues of health from the mythological, the Hippocratic medicine expressed the worldview of his contemporaries as human life, its environment and the preservation of both, summarized in a fundamental principle: "First, do no harm."

Since the last century, we have witnessed the increasing consolidation of a new mythology in healthcare, composed equally powerful gods and venerated, which also gives the ability to predict destinations and operate miracle cures: medical technology. Gradually, these fabulous support tools, complementary to professional action, acquired a heroic dimension, and began to play a role in the disastrous medical practice.

Incorporating the fabulous scientific advances to healthcare should be cause for encouragement and even enthusiasm, but also of concern. The production and consumption of medical technology, governed by the market, began to be practiced as an end in itself. Patients and professionals feel compelled to make use of technologies increasingly complex and costly. The excellence of professional practice came to be measured by their degree of compliance with consumer technology. His recognized adverse effects are underestimated or recognized as evils of which you should expect a well.

With absolutely right - the SUS or supplementary care - there is indignation against the impediment or delay in carrying out an examination or treatment. But never ponders about the potential harm of the high number of procedures required in an abusive way, in the form of iatrogenic effects, false positives, unnecessary interventions, increased costs, or simply by the fact of taking the place of someone really needy. For example, the Heart Institute, UFRJ, recently proved that in the last ten years, there was a 500% increase in performing coronary angiography, only the SUS, with a normal rate of 60%. It is normal and even desirable to have tests with normal results, but the internationally accepted standard does not usually exceed 15%.

Matter published in the July 31 newspaper "The New York Times" - "More treatment, more mistakes" - the United States estimates there are about two hundred thousand deaths related to misuse of medical technology. The author stated that the so-called "defensive medicine" practiced in the country, protect the patient means less than professionals and institutions protect against possible lawsuits.

So organized, you need to rationalize and relativize the sovereignty of technology in healthcare. "The clinic is sovereign," it was said in past generations. Only the doctor, through scientific information, experience and extensive knowledge of the life of his patient can decide to conduct more convenient for each case. But this decision must be based on evidence, organized protocols and good practice guides.

The Ministry of Health, the National Health Insurance, the Federal Medicine Council and the Brazilian Medical Association, among other institutions, need to discuss the foundations of an ordering prescription healthcare technology. It is the obligation of public health to ensure the widest access to the Brazilians all available technologies that allow them greater longevity and quality of life, but this relationship needs to be in a critical and under constant review. The practice needs to recover its fundamental principle: "First, do no harm."

Source: CFM
   Palavras-chave:   Western medicine    Hippocrates    Chico D'Angelo   
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