PAUL TOURNIER CONFERENCE
Juan-AlbertoPerales-Cabrera,B.Sc.,M.D.,Dr.Med.Sc.ExpertExtraordinaryProfessor,InstituteofEthicsinHealth,SanFernandoFacultyofMedicine,
SanMarcosNationalUniversity;HonoraryMember,NationalAcademyofMedicine;andPastPresident,LatinAmericanNetworkofPersonCenteredMedicine,Lima,Peru.
12thGENEVACONFERENCEONPERSON-CENTEREDMEDICINEPromotingWell-beingandOvercomingBurn-out
March25-27,2019
MisterPresident,
Distinguishedcolleagues,respectedaudience,
IamprofoundlygratefulforthehonorofreceivingthePaulTournierAwardfor2019,which,althoughembossedwithmyname,IwishtoreflecttherecognitionthattheillustriousjuryhasgiventotheeffortsofagroupofLatinAmericanprofessionalswhohaveworkedtenaciouslytointroducetoourregionthebasicconceptsandthephilosophyofPersonCenteredMedicine.Suchatask,withafutureofgreatdimensions,inspiredbythehumanistmessageofdoctorsofextraordinarystature,bothscientificallyandspiritually,likePaulTournier,hasbeengreatly
facilitatedbytheinvaluablesupportandguidanceoftheInternationalCollegeofPerson-CenteredMedicine,andofleadersofworldclasspedigreeinthisarea,likeJuanEMezzich(Peru/USA),JonSnaedal(Iceland),JimAppleyard(U.K.)andMichelBotbol(France),whohavebentoverbackwardsineveryrespecttohelpusachievesuccessintheproposedobjective.Inthisfashion,andwithaLatinAmericanteamthatpresentlycompriseshealthprofessionalsfrom9countries(Argentine,Bolivia,Brazil,Chile,Colombia,Paraguay,UruguayandPeru)wehavemanaged,inaperiodof5years,from2014,togenerateaclimateofenthusiasm,reinforcehumanismandtheCentralityofthePersoninallmedicalwork,aswellascreateaspaceofreflection
thatpotentlycombatstherisksposedbyexaggeratedtechnology,theutilitarianconsiderationoftheeconomyinhealthcare,thereificationofthepatient,thecommoditizationofmedicine,andthecompletelackofpracticalimportancethatisgiventohumansufferinginthediseaseprocess,allofwhichareaffectingthepracticeofmedicine.Moreover,suchnegativesocialvariablesarenotonlyaffectingourpatientsbutalsoourownmedicalpersonnelwho,subjectedtounfairandevergreaterdemandsintheworkplacearealreadybeingdebilitatedintheirhealth;thisisreflectedintheincreasingprevalenceofBurnoutSyndrome,forexample.Letmenowshowyouinaverybriefway,whathavewedoneinLatinAmericatothisrespect.
“All art and all research, as well as all action and election, seem to tend to some good; this is why it has been correctly said that good is that to which all things tend to” (Aristotle, Et Nic I 1: 1094 a 1-3.)
HUMANISM: PAUL TOURNIER (1898-1986)
In1940publishedhisfirstbook:“MédecinedelaPersonne”,whereinheadvocatesthatmanismorethanjustbodyandamind,heisalsoaspiritualbeing.
THEPERUVIANCONTRIBUTION§ 1933.HonorioDelgado,emphazisedtheimportanceof
spiritualtraining.§ 1963.CarlosAlbertoSeguin,createstheconceptsof
unconditionalloveandPsychotherapeuticEros”§ 2010.AlfonsoMendozacreatesthe“PATIENTSDAY”§ 2013.JuanEnriqueMezzich,introducesPersonCentered
MedicineinLatinAmerica.
LATINAMERICANNETWORKOFPERSONCENTEREDMEDICINE
§ 2013,December19.SimposioonPersonCenteredMedicineandHealth:UniversityDialogue(SanMarcosandPeruvianCayetanoHerediaUniversities).
§ 2014,November7-9,BuenosAires,Argentine.SecondPersonCenteredInternationalCongress.LatinAmericaAcademicSimposiumonMedicalEducationwiththeparticipaciónofthethefollowingLatinAmericanAcademiesofMedicine:Argentine,Bolivia,Chile,andPeru.
§ 2014,December14.MeetinginLimawiththeparticipationoftheAcademiesofMedicineofBolivia,Colombia,Chile,ParaguayandPeru.
§ 2014,December,TheActofLimabasedonBsAsDeclarationwasissued.ItwasproposedandacceptedtofoundaLatinAmericanNetworktopromotePersonCenteredMedicine.
§ 2015,December18-19.WiththeparticipationofAcademiesofMedicineofColombia,ChileandUruguay,WMA,OPS/OMS,theuniversitiesofSanMarcos,CayetanoHerediaandSantoToribiodeMogrovejo,TheFirstConferenceonPersonCenteredMedicine:“FromConcepttoAction”wascarriedoutinLima,Peru.
§ 2015.ADeclarationofLimawasproduced.
§ 2016. Second Conference on Person Centered Medicine: Science and Humanism. Lima, December 16-17
§ 2016 Declaration was issued.
§ 2017, July 14th, The Peruvian Association of Person Centered Medicine was founded.
§ 2017. Latin America Association of Academies of Medicine, Spain and Portugal devoted a session to Person Centered Medicine, in Bogota, Colombia.
§ 2017. Third Conference on Person Centered Medicine
on Medical Education. Lima, December 14-15
§ The 2017 Declaration was issued.
2018,September7-8th.LaPazBolivia,FourthConferenceon:“PersonCenteredMedicinePrimaryHealth:PopularandScientificKnnowledges,EcologyandCommunityParticipation”The2018Declarationwasissued.
§ 2018.ThePeruvianAssociationonPersonCenteredMedicineislegallyestablished.
§ 2018,FirstPeruvianEncounter,December14-15th
§ 2019TheSecondPeruvianEncounterandFifthLatinAmericanConferencearebeingorganized.
PERSON CENTERED LATIN AMERICAN NETWORK CURRENT PRESIDENT
• Dr.OscarCluzet• NationalAcademyofMedicineofUruguay.• CriticalCareMedicine• Bioethicist
PUBLICATIONS,More than 20 articles on Person Centered Medicine published in scientific journals.
MEDICALEDUCATION§ Dr.JEMezzichisDoctorHonorisCausaofSanMarcosUniversityandcurrentlychairstheHipolitoUnanueInternationalCourseatitsSchoolofMedicine.
§ SeveralSeminarsonPCMhavebeenheldatSanFernandoSchoolofMedicineand
§ FranzTamayoPrivateUniversity(Bolivia)(Dr.HoracioToro)
§ CoordinationshavebegunwithUniversidadCentraldeChile.(Dr.FranciscoLeónCorrea)
§ RESEARCH: PCI TOTAL SCORES
Nº HEALTHINSTITUTION SCORE1º PrivateHospital 106.512º SpecializedPublicHospital 94.313º GeneralPublicHospital 91.67.4º SocialSecurityHospital 63.23
AlbertoPerales,JuanEMezzich,LeventKiriscietal.EvaluacióndelaAtenciónCentradaenlaPersonaenHospitalesLimeños:PCIyOpinióndeProfesionales.FourthConfereneonMCP,2018.LaPazBolivia,
THEINFORMATIONALTHEORYOFPERSONALITYOFPEDROORTIZ
PEDROORTIZINFORMATIONALTHEORYOFPERSONALITY
(OrtizP,1994,1997,2004)
SOCIETY
CONSCIENCE
PERSONALITY
THESTRUCTUREOFETHICALTHEORY§ ETHICSASPHILOSOPHYTodiscussthenatureofmoralprinciplesandnorms§ ETHICSASSOCIALSCIENCEToexplainthehistoricalprocessesofmoralizationofsociety§ ETHICSASSOCIALTECHNOLOGY:ToperformtheeffectivemoralizationofSocietyandPersons.
(OrtizP,1994,1997,2004)
(PeralesA,2018)
FIVEDWELLINGSTOBECOMEAMORALPERSONALITY:1. Biological(motherswomb)AtBirth2.Nuclearfamily.Basichumanlearning3.Theschool-Formaleducation4. Theuniversityandotherhumaninstitutions(Ethicsconsolidationofpersonality)
5.Societyandcultureingeneral
Ethos=habit,custom,….dwelling
EACHHUMANSUBJECTSHOULDBECOMEAMORALPERSONALITYMAXIMALVALUESDOCTORSHOULDPERFORMONBEHALFOFHISPATIENTTorespectihisdignity,topromoteSolidarityTorespecthisautonomy,topromoteLibertyTorespecthisintegrity,topromoteJustice.
(OrtizP,1994,1997,2004)
IMPACTOFPERSONCENTEREDMEDICINEINLATINAMERICA
Althoughstilltooearlytotalkaboutspecificresultssometendenciescanbeobserved:1.OnMedicaleducation(JuanEnriqueMezzich)2.OntheconsiderationofthestudentasaPerson§ OnStudent´smentalhealth§ Onmoraldevelopmentandneedofethicsteaching
UNIVERSITYSTUDENTSMENTALHEALTH
EPIDEMIOLOGICALSTUDYONUNDERGRADUATESTUDENTSSANMARCOSUNIVERSITY,2015.TOTALPOPULATION:24000SAMPLE:1819(7.5%)MALE:56.4%MEANAGE:21y..Range:16-56y.o.
STUDY YEAR WISHTODIE
SUICIDALIDEATION
SUICIDALPLAN
SUICIDALATTEMPT
SANMARCOSUNIVERSITY 2015 35 22,4 17,7 11,1
MENTALHEALTHNATIONALSURVEY(ADULTS)
2012
23,4
8,9
3,5
2,8
MENTALHEALTHNATIONALSURVEY(ADOLESCENTS)
2012
25,9
11,04,9
3.6
PeralesA,etalAnalesdelaFac.Med,2018.
SUICIDALBEHAVIORSANMARCOSUNIVERSITYUNDERGRADUATESANDPERUVIANGENERALPOPULATION.COMPARATIVELIFEPREVALENCES
SAN MARCOS UNIVERSITY STUDENTS´ MENTAL HEALTH (A, Perales y col, 2013-2014)
MEDI-CINE%
NURSING%
OBSTETRICS%
MED.THECNOL
%
NUTRITION%
MENTALHEALTHSURVEYLIMA,2002
ADOLESCENTSADULTS%%
SUICIDALATTEMPT
4 10.2 8.3 7.6 9.4 3.65.2
HOMICIDALIDEATION
12.7 7.6 6.9 11 13.9 3.24.6
DISSOCIALBEHAVIOR
19.2 26.9 21.7 18.6 27.5 9.915.4
PROBLEMSWITHALCOHOL
7.3 4.2 3.1 4.7 5.2 S,d,
ONMORALDEVELOPMENTANDETHICALTRAINING:TOWARDSANEDUCATIONCENTEREDONTHESTUDENT´S
NEEDSASAPERSON.
Suicidalattemptanddissocialbehaviorlifeprevalencesarehigherinthetheundergraduatethaningeneralpopulation.Onthisaccount,teachingofethicsshouldbeplannedfortwogroupsofstudentswithdifferentneeds:1)Thosewithoutmentalhealthpathologywhocanbenefitfromregularcurricularstrategy;and,2)Thosewhohavingmentalhealthproblemsandindicatorsofsocialbehaviordifficulties,should,besides,behelpedwithstrategiesorientedtosupporttheirmoraldevelopment.
Thiseducationalchallengeshouldbetheuniversity´sresponsibilityintheXXIcenturyunderthequestion¿Whatdoweneed,healthprofessionalswhoknowethicsorwhobehaveethically?
ACKNOWLEDGMENTS
• ToTheInternationalCollegeofPersonCenteredMedicine• ToThePaulTournierAssociation• TothefamilyofPaulTournier• ToDr.HansRudolfPfeifer
• TOTHEMEMORYOFDR.PAULTOURNIER