“…Going into medicine can never exclude the vocation and human sense of the profession …”
Professor António Gentil Martins

On the 13th of January 2010 there was the first holding of a debate cycle promoted by the AAAFML, to be held every three months from now on and with the aim of promoting a broad academic reflection and listening to the different views on issues involving medical education, civil society, doctors and health professionals.
What doctors do we want for our country?
What doctors are we currently training?
These were the two questions behind the first encounter on issues related to medical teaching and practice.

The debate was moderated by Dr Rui Simões Bento, cardiothoracic surgeon, former President of the Medical Order National Council of Deontologies and Ethics and President of the AAAFM.
The speakers were Professor José Fernandes e Fernandes, Dean of the Faculty of Medicine of the University of Lisbon (FMUL), Professor João Martins e Silva, Full Professor and clinical pathologist, former Dean of the FMUL and of the Institute of Chemical Biopathology, author of the book “A Medical Education Project”, Dr Fernando Esteves Franco, an orthopaedist, former Director of the Orthopaedics Service and of Faro Hospital, and Diogo Medina, a fifth year student on the Integrated Masters Course in Medicine and President of the FMUL Students’ Association.

In his introduction to the debate, the moderator, Dr Rui Simões, spoke of the pertinence of the questions facing doctors. “There are 40,673 doctors enrolled in Portugal, distributed over 47 specialties in a National Health System that has been developed, with alterations in training introduced through the European Union and with new courses in Aveiro and in the Algarve”.
Then the Dean of the Faculty of Medicine of the University of Lisbon, Professor Fernandes e Fernandes, spoke, thanking the association for the initiative and for contributing towards the dialogue between generations of doctors. He started by talking about the current situation of the Faculty of Medicine. ”According to the Bologna Process Medicine is not a First Degree, but an Integrated Masters Course. We also have an important collaboration with the Higher Technical Institute for an Integrated Masters in Biomedical Engineering, and several post-graduation courses in the subjects of health. The FMUL cannot be restricted to undergraduate teaching, and we must turn to post-graduate teaching and permanent medical education as that is also our responsibility,” he stated. The Dean of the FMUL also considered that XXI century medicine will be based on science and centred on the patient. “For this it is necessary for there to be the capacity for communication, the need for self-teaching and permanent education,” he continued. “The students must be made to understand that medicine will be practised in multidisciplinary teams, centred on the values of the patients, because they are the ones who have the right to access to their data and to a second opinion. Because this is a demanding course it should allow an informed choice of the profession,” Professor Fernandes e Fernandes added. During his speech he also stressed the importance of the publication of the law that created the Lisbon Academic Medical Centre, a consortium that includes the Faculty of Medicine, the Institute of Molecular Medicine and the North Lisbon Hospital Centre, which will allow a greater articulation among these three institutions.

The second speaker, the President of the Association of Former Students, mentioned that this was an important issue and was consistently brought up in connection to the notion of that which makes a good doctor on the level of relationship with the patient. “Today, however, in many specialties there is a disposition, a special methodology that to some extent limits that doctor-patient relationship because our profession has become very specialised,” he considered in relation to this aspect. What society demands, what the patients demand and what students want form a set of questions that, in Professor Martins e Silva’s view, should be dealt with in medical training. To finish off he focused upon learning, because, as he said, “there should not just be subject matter but also a reflection upon that matter in order to reach the capacity for therapeutic intervention”.

One of those intervening in the debate, Dr Fernando Esteves Franco, considered that doctors have to demand participation in hospital organisation. He thus gave a positive mark to the Minister for Health, Ana Jorge, for the idea of creating consultative committees in 2010. To the contrary, he criticised the lack of articulation between primary and differentiated care, as well as the fact that good doctors are being produced in Portugal yet without granting them good working conditions. “Too much work and doctors flitting from emergency unit to emergency unit are situations that do not help the humanisation of the health services,” he stated.

In turn, Diogo Medina focused some essential issues in relation to practising medicine. He considered that in this area the students are the ones who have the best academic preparation and that it is the intellectual challenge that moves many of them: “what we learn should lead us to like medicine”, he stressed. “In the past the course was more directed towards the human part. Fortunately it is no longer like that today”. He also refered “If there has in fact been an improvement in the human component it is time to make a re-assessment. A new curricular reform is needed, highlighting the liking for research, which looks at academic results, at the optional units and at the Socrates-Erasmus Programme”.

He also mentioned the International Cooperation Nucleus, which in his view “does not work and in which it is necessary to give support to the students”. As positive points he referred to the fact that clinical teaching is given increasingly early, the final work for the Masters degree and also the cooperation among faculties, which should be increased, ending the system of the “closed shop”. Diogo Medina also left a request: for these sessions to continue in the future in the afternoon, so there might be greater participation on the part of students and teachers.

In the ensuing debate, Pedro Nunes, the President of the Medical Association, considered that the “National Health Service has been taken over by managers, and what it produces has become the most important thing, having lost any impulse for reflection”. Pedro Nunes also pointed out that “the image that the media presents of doctors is different to what people think in their daily contact, because there is still an idea of credibility and seriousness in relation to the medical class”. “The most scarce value is time, and we increasingly rarely manage to reflect upon our profession”, he complained.

Another speaker, Professor António Gentil Martins, wished to make it clear that “we do not want doctors who have clients, but doctors who have patients!” In relation to this issue he also discussed the proposal for a vocation for the course in medicine in which he considered that one should do social volunteer work in the secondary school before starting out on a medical career, in the same way that a curricular assessment should be made during the entrance process.
The Association has organised debates on the following issues each quarter, albeit without fixed dates yet:

– PROFESSIONAL ETHICS AND DEONTOLOGY. Do these exist as values or are they reminiscences to be forgotten or ignored? Do they still prevail or are they countervalues?
– ENLIGHTENED CONSENT… How far have you been informed?
– LIVING WILL. Aberration or right?
– CONTINUED CARE, Utopia or consequential practice?
– EUTHANASIA. Choosing to give up or Persistence?

The sessions are planned for a maximum length of time of two hours, from 11 am to 1 pm, but, as was pointed out in this session, the timetable may be altered in order to allow greater participation, given that, as the organisers have acknowledged, this is a period for consultations and operating blocks for practitioners and for classes for the students.ML FMUL

Further information on the Official Site: http://sites.google.com/site/aaafmul/Home or on the Blog by the Former Students Association http://aaafml.blogspot.com/

Carlos André
Editorial Team news@fmul
carlos.andre@campus.ul.pt