Tuesday, 28 March 2017

The Gynecologyst and the Family Doctor as Lawyers

Obstetricians and Gynecologists manage to solve problems of health of the woman in state of pregnancy, puerperium and lactation as well as the physiological and clinical pathological states proper to its sex. They treat the diseases related to the genital apparatus of the woman benign or malignant and the alterations that compromise its functional state. They also provide care to women with ethics and a critical spirit that allows them to rationalize diagnostic methods for the study of their problems. The gynocologist proposes adequate guidelines for the therapeutic management of the problem at the collective or individual level. On the other hand, family doctors are the first point of entry for health-care delivery, with links to higher levels of the health system and other services. Family physicians do not treat diseases but take care of people. Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family within the context of community. Providing family-oriented primary care is one of the distinguishing features of this specialty. 

Gynecologists and family doctors are the two medical specialties that fundamentally share medical care for health problems and preventive actions in women. In this field, both have to work as a team. And they share the difficulties of managing women’s health problems. Both also have to face a major risk: overdiagnosis and overtreatment. Although this phenomenon occurs in all medical specialties, women take better care of their health, and they rely more on prevention than men, so it is not surprising that they are more affected by the excess of all types of health activities; the “excess medicine”.The clinical work is involved in the uncertainty because the application of the Truths of biomedical science in the life and in the circumstances of each individual patient will always be uncertain. So doctors, especially young doctors, are learning to fear to the uncertainty. We are asking for more and more evidence. To try to assure ourselves, often in vain, of what we are seeing. And because we are afraid that those who are in the kingdom of the healthy, perhaps should be in the realm of the sick, continually divert resources from the sick to the healthy, and so the overdiagnosis is inevitably linked to the insufficient treatment of those who are already sick. Overdiagnosis of the healthy and insufficient treatment of the sick are two sides of the coin of modern medicine.

 In this context, it can be logical that the concepts and theories that belonging to Interface between gynecology and family medicine are often difficult to explain and to understand. To show this interface, with an educational approach, we can do it through metaphors. Metaphors enable us to understand something that is unknown in terms of its familiarity. For this reason, they are used frequently in all sciences that adopt common words to name complex realities. The metaphors are analogue devices, used to illuminate reality. Metaphors can simplify expert knowledge, not by ignoring or reducing the inherent complexity, but by providing a point of entry for its comprehension. They are a means of generating ideas, promoting creativity, and constructing concepts and theories. Thinking based on metaphors and comparisons is a way of transforming a concept into something that is so suggestive, interesting, and surprising, that it reaches people more easily.

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