Biomedical subjects

Alejandro Goic

Publications and source records attributed to Alejandro Goic.

10 recordsLinked to original sources

PubMed2006

[Biographical notes on Professor Hernan Alessandri, M.D].

Hernán Alessandri, a renowned Chilean medical educator, was born in Santiago in 1900. He received his medical degree at the University of Chile in 1923. When in 1927 his father, then President of Chile, was sent into exile, he used the opportunity to deepen his medical knowledge in France and Germany. At the University of Chile, he became successively Professor of Clinical Medicine (1932), of Medical Semiology (1937), and Full Professor and Chair of Medicine (1944). At the Hospital del Salvador in Santiago, he organized a Clinical Department exemplary for its discipline, academic environment and dedication to patients and students. He was one of the prime movers for the reform of medical teaching in 1943, created medical residency programs for the training of specialists in 1952, served as Dean of the Faculty of Medicine from 1958 to 1962, and was a founding member of the Chilean Academy of Medicine (1964). He was the first Latin American to be named Honorary Member of the American College of Physicians (1968) and became Emeritus Professor of the University of Chile in 1973. He died in his hometown in 1982. His disciples and friends established in his honor a social and teaching foundation which they named after him. His clinical and diagnostic skills, along with his outstanding intelligence, made him the most brilliant clinician of his time and an exceptional medical educator who has inspired several generations of physicians.

Chile↗

PubMed2005

[Notes on euthanasia].

In the Judeo-Christian tradition, human life is held to be sacred, a semblance of the divine and a gift from God which the individual cannot dispose of at his or her own will. Hence, these monotheistic religions have made of the crime of murder a transgression of God's own commandment not to kill and have extended the applicability of this commandment to the practice of euthanasia and suicide. On the other hand, some non-religious traditions offer plausible reasons favoring euthanasia. This is a delicate matter for physicians, since the Hippocratic tradition forbids euthanasia and because as care-givers they must also bear the psychological, moral and emotional burden of carrying it out. Physicians are trained to preserve life but not to bring it to an end. As human beings, they must always respect the principle of nonmaleficence, and as physicians they must always respect as well the principle of beneficence. It is difficult to accept the fact that ending a human life can be an act of beneficence. In order to differentiate between passive and active euthanasia, the concept of proportionality of medical acts must be brought into consideration. For instance, using high doses of opiates to alleviate pain or withholding the use of an extraordinary method of treatment are not passive acts aimed at ending the life of a terminally ill patient, but medical acts that are reasonable, judicious and proportionate to the condition and irreversibility of a patient's illness. Therefore, so-called passive euthanasia cannot be considered the same as euthanasia. On the other hand, medically assisted suicide is a deceitful form of active euthanasia. The aim of this act is to cause death and the physician is morally responsible for such a death, since he is providing the means for bringing a human life to an end. Many times the desire to die expressed by terminally ill elderly and helpless patients is a request for help and an expression of reproach against a society that allows for their abandonment and neglect.

Euthanasia, Active↗

PubMed2004

[The diagnosis of death].

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.

Brain Death↗

PubMed2004

[The ethics of health care organization].

Health care organization is not only a technical issue. Ethics gives meaning to the medical profession's declared intent of preserving the health and life of the people while honoring their intelligence, dignity and intimacy. It also induces physicians to apply their knowledge, intellect and skills for the benefit of the patient. In a health care system, it is important that people have insurance coverage for health contingencies and that the quality of the services provided be satisfactory. People tend to judge the medical profession according to the experience they have in their personal encounter with physicians, health care workers, hospitals and clinics. Society and its political leaders must decide upon the particular model that will ensure the right of citizens to a satisfactory health care. Any health care organization not founded on humanitarian and ethical values is doomed tofailure. The strict adherence of physicians to Hippocratic values and to the norms of good clinical practice as well as to an altruistic cooperative attitude will improve the efficiency of the health care sector and reduce its costs. It is incumbent upon society to generate the conditions where by the ethical roots of medical care can be brought to bear upon the workings of the health care system. Every country must strive to provide not only technically efficient medical services, but also the social mechanisms that make possible a humanitarian interaction between professionals and patients where kindness and respect prevail.

Bioethical Issues↗

PubMed2003

[Seminar about medical training in Chile in the current time].

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.

Chile↗

PubMed2003

[The University of Chile School of medicine : 170 years serving the country].

The first course on Medical Sciences in Chile was inaugurated in 1833, being its director William C Blest, MD, an Irish physician graduated in Edinburgh University. Therefore, Dr. Blest can be considered the founder of Chilean formal medical education. When the University of Chile was established (in 1842), among its five initial Faculties was included Medicine, on the basis of the Medical Sciences course created ten years before. By then, the medical profession was not yet socially reputed and the initial years of the Faculty were difficult. During the 19th Century and until the second decade of the 20th century, this was the only medical school in the country. Its development was slow but sustained, reaching its apogee in the middle of the 20th Century, when it had outstanding clinical and basic sciences teachers and investigators. Clinical research, postgraduate teaching and medical specialization had a great development during that period. Nowadays, it is a complex Faculty that teaches eight health sciences courses leading to different professional titles, gives higher academic degrees in biomedicine and public health and certifies different medical specialties. It has a modern, well equipped library and a unique Museum of Medicine. Besides the traditional Departments in Medical Faculties, it has Departments of Medical Teaching, Bioethics and Medical Humanities. It provides continuing medical education programs and distance teaching has recently experienced a great development. The community is also favored with specific teaching programs. The academic promotion of its faculty members is based in a strict evaluation. During its existence, the Faculty has graduated a large number of physicians and other health care professionals. Our country should be grateful to the University of Chile Faculty of Medicine, in its 170th birthday, for its outstanding contribution to the development, welfare and happiness of Chilean society.

Chile↗

PubMed2003

[Decentralization of health care and medical teaching: the Chilean experience].

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. Chile's 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.

Certification↗

PubMed2002

[Pedro Laín Entralgo, physician and humanist].

This speech of the president of the Chilean Academy of Medicine, Dr Alejandro Goic, is a tribute to the memory of the Spanish physician, scholar, historian, writer and intellectual Dr. Pedro Laín Entralgo, who died in Madrid on June 4, 2001, at the age of 93. On that occasion, the Spanish newspaper "El Pais" defined him as the last humanist. The Spanish civil war started when Laín was 28 years old and he aligned with Franco's supporters. In 1940, when he founded the magazine "El Escorial", he was separated from the official party. He and other intellectuals declared themselves in an "interior exile". His autobiographical book, "Lightening the burden on the conscience" refers to his painful personal history. He obtained the History of Medicine chair, at the Complutense University, at the age of 34 and remained at that post until his retirement in 1978. His intellectual production is magnificent and calls to a mutual understanding, hope, friendship and love. Outstanding, among others, are his books "The wait and hope", "Theory and reality of the other", "Spain as a problem", "Medicine and history", "The clinical history", "Patient physician relationship", "Medical anthropology". He directed the collective work composed of seven volumes, called "Universal History of Medicine". He was a member of the Royal Academies for Language, History and Medicine. In Chile, he was named honorary member of the Faculty of Medicine of the University of Chile and of the Academies of Language, History and Medicine. He dictated a course of Medical Anthropology that had a profound impact on the thought of Chilean physicians. In 1949 he wrote that Chile was the most solid state of Latin America and that "Chile needs to leave his traditional calm, through a historical gesture, and create the river beds required by his magnificent spiritual and geographical gifts. There is a lack of a beautiful craziness". It was an invocation for an understanding with our neighboring countries "for ever and ever".

Anthropology↗

PubMed2002

[The Revista Médica the Chile and medical education].

With this issue, Revista Médica de Chile will have been published uninterruptedly, for 130 years. Formal medical education had an early development since Chile became independent from Spain (1817). The first Medical Sciences Course was organized in 1833 by the Irish physician William C Blest. The Santiago Medical Society was founded in 1869 and its journal-Revista Médica de Chile--in 1872. Its first director was Dr. German Schneider. Revista Medica is the oldest serial publication in South America and the second oldest in the Spanish speaking world. This is a remarkable fact for a comparatively young country. With the creation of the Medical Society and Revista Medica, a process of continuous medical education was started and they became a real Graduate School. The Journal has adopted the main changes in knowledge and technology. Some important milestones of its development, during the second half of the 20th century, were the definition of its objectives and structure, the incorporation of peer review of manuscripts (even with foreign reviewers) the adoption of international guidelines for publication, its incorporation into the main biomedical journal indexes, the modernization of its printing process, the making of a computer generated index of all papers published since 1872, its incorporation into a digital library in INTERNET and the active participation of its editors in the World Association of Medical Journal Editors. The success of the journal is influenced by the independence that the Medical Society has conferred to the editors (all outstanding University Professors), as well as to the characteristics of an educational campus "invisible and without tumult" (Ingelfinger).

Chile↗

PubMed2002

[Proliferation of medical schools in latin America. Causes and consequences].

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.

Chile↗