Psychosomatic Medicine Psychosomatic Medicine 2005 2005 Clinical Care & Education Clinical Care & Education Portugal Portugal Berlin, 2005 July 8- -9th 9th European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8 Berlin, 2005 July 8- -9th 9th Psychosomatic Medicine 2005 Psychosomatic Medicine 2005 Rationale Rationale 1. 1. Portugal Portugal 2. 2. Past Past � � Present Present � � Future Future � � Identification of crucial points Identification of crucial points 3. 3. Weaknesses accounting for ultra Weaknesses accounting for ultra- -stability stability � � Strengths to reinforce in order to promote change Strengths to reinforce in order to promote change � � Debate suggestions Debate suggestions 4. 4. Lines of action / Lines of action / opportunities for lobbying at an European level opportunities for lobbying at an European level � � European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8- Berlin, 2005 July 8 -9th 9th 1
Psychosomatic Medicine: Psychosomatic Medicine: theoretical context theoretical context � The road to specialization The road to specialization � � The biomedical deterministic approach The biomedical deterministic approach � � Increasing need for a holistic approach Increasing need for a holistic approach � � Systems thinking: Systems thinking: � The bio- -psychosocial model psychosocial model (Engel, 1977) The bio (Engel, 1977) European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8- Berlin, 2005 July 8 -9th 9th Psychosomatic Medicine in Portugal Psychosomatic Medicine in Portugal � Past Past � � Scarcely represented in Health Care Scarcely represented in Health Care � • Mostly psychoanalytical oriented Mostly psychoanalytical oriented • � Portuguese Psychosomatic Society (90s) Portuguese Psychosomatic Society (90s) � � Present � Present � Future � Future � Crucial characteristics � Crucial characteristics European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8- Berlin, 2005 July 8 -9th 9th 2
Psychosomatic Medicine in Portugal Psychosomatic Medicine in Portugal � Past Past � � Present Present � � Assistance Assistance � • Unrecognized as a clinical area of expertise Unrecognized as a clinical area of expertise • • Clinical practice almost excluded from NHS Clinical practice almost excluded from NHS (no facilities whatsoever) • (no facilities whatsoever) • Conceptual model adopted in an individual basis Conceptual model adopted in an individual basis • • Liaison Liaison- -Psychiatry Psychiatry embodying mainstream • embodying mainstream “ “asylum type asylum type” ” intervention intervention � Teaching and research Teaching and research � • Idiosyncratically adopted to teach psychological and • Idiosyncratically adopted to teach psychological and communicational skills to medical pre- communicational skills to medical pre -graduates graduates • Also adopted, • Also adopted, eventually transvestite eventually transvestite , in some Psychology Schools , in some Psychology Schools • Fruitful paradigm adopted in post • Fruitful paradigm adopted in post- -graduation studies graduation studies � Future Future � � Crucial characteristics Crucial characteristics � European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8- -9th 9th Psychosomatic Medicine in Portugal Psychosomatic Medicine in Portugal � Past Past � � Present Present � � Future Future � � Transversal obstacles Transversal obstacles � • Knowledge accumulation and need for specialized care Knowledge accumulation and need for specialized care • • Pressure of pharmaceuticals economical power shielded behind • Pressure of pharmaceuticals economical power shielded behind recent developments in neurosciences and molecular biology recent developments in neurosciences and molecular biology • Psychotherapy felt as a menace and considered as exclusive Psychotherapy felt as a menace and considered as exclusive • � Case studies Case studies � � Crucial characteristics Crucial characteristics � European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8- Berlin, 2005 July 8 -9th 9th 3
Psychosomatic Medicine in Portugal Psychosomatic Medicine in Portugal Crucial characteristics � � Crucial characteristics Weaknesses (factors of Weaknesses (factors of morphostasis morphostasis) ) � � 1. 1. Cultural, political and socio- Cultural, political and socio -economic context economic context • • System ultra- System ultra -stability stability • “Least effort Least effort” ” principle principle • “ • • Tension regarding the concept Tension regarding the concept • • Theory and ethics neglect Theory and ethics neglect • • Low political commitment Low political commitment • “Established interests Established interests” ” • “ • • Limited resources Limited resources 2. 2. Organizational / institutional constrains Organizational / institutional constrains • • Critical relations between clinical teaching and assistance Critical relations between clinical teaching and assistance • Teaching exclusively in the • Teaching exclusively in the highly highly specialized specialized hospital environment hospital environment Need of action Need of action � � There are no integrated teams in medico integrated teams in medico- -surgical wards surgical wards • • There are no • Psychologists role role within the NHS within the NHS still is almost non still is almost non- -existent existent • Psychologists Strengths (factors of morphogenesis) Strengths (factors of morphogenesis) � � European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8- -9th 9th Psychosomatic Medicine in Portugal Psychosomatic Medicine in Portugal Crucial characteristics � � Crucial characteristics Weaknesses (factors of Weaknesses (factors of morphostasis morphostasis) ) � � Strengths (factors of morphogenesis) Strengths (factors of morphogenesis) � � 1. 1. Post- Post -graduation graduation There is a multiplicity of professionals who have carried out There is a multiplicity of professionals who have carried out � � their post- their post -graduation studies within this framework graduation studies within this framework Mutual recognition of Continuing Medical Education (EACCME) Mutual recognition of Continuing Medical Education (EACCME) � � 2. Pre- -graduation graduation 2. Pre There is also some pre- -graduation psychosomatically oriented graduation psychosomatically oriented There is also some pre � � teaching within the discipline of Medical Psychology teaching within the discipline of Medical Psychology This could prove to be an asset as a framework to C- This could prove to be an asset as a framework to C -L L � � in order to implement proper administrative models in order to implement proper administrative models 3. Unmet needs 3. Unmet needs There are multiple clinical areas willing of such support There are multiple clinical areas willing of such support � � European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8- Berlin, 2005 July 8 -9th 9th 4
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