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Objective: To understand the perceptions that doctors and patients have about their relationships and how the current conditions of the General System of Social Security in Health (GSSSH) influence their relationship., Materials and Methods: The collection and analysis of information was based on the saturation principle proposed by qualitative research, through direct observation and semi-structured interviews applied to 17 patients and 15 physicians during the exercise of their roles, in the waiting and consultation environment within the selected healthcare institutions. The interviews recorded, transcribed and analyzed under five precepts of the Grounded Theory of Corbin and Strauss. The sample design was theoretical for convenience., Results: Health system conditions on the doctor's doing, abuse of the right by some patients, the perception of uneven quality between health care promotion entities, communication failures in the Doctor-Patient Relationships, loss of prestige of the general doctors, perception of disbelief towards young doctors, among other identified perceptions, hint that changes in the GSSSH contribute to the construction of current Doctor-Patient Relationships., Conclusions: It is essential that the actors of the GSSSH propose interventions that reinforce the communicative and psychosocial capacities in the doctors from their formative processes, as well as the provision of the GSSSH to provide conditions that allow the doctor to develop a health care focused on the patient.

Introduction and Objectives: The medicine development demonstrates that the traditional bioethical medical care model is not the most adequate. On the other hand, the person-centered clinical method has been winning more space in the medical practice, since it is a humanized method of care that allows best results. In pediatrics, the patient-centered care works a little bit different, since it requires not only the physician-patient relation, but also the integration of the physician-family-patient relation. Thus, the patient-centered care in the pediatric area is understudied, as well as little practiced. In this context, this review has the objective to exposure the actual scenario of the patient-centered care in pediatrics., Materials and Methods: This is a scoping review carried out from the standards of Jonna Briggs Institute (JBI). The database PubMed, Science Direct and BVS were used to search studies between 2012 until 2024. The research was performed with the descriptors "Medicine", "Shared DecisionMaking", "Pediatrics", "Physician-PatientRelations" and "Patient-CenteredCare"., Results: The research identified 27,272 articles, along with 79 met the criteria and were included. Each article was analyzed and allocated in the four pillars of the patient-centered care, which was described and related with the pediatric clinic., Conclusions: The patient-centered care brings benefits to medical care, especially in the pediatric area. Among them, stands out the increased adherence to treatment, the lowest rates of medical errors, the greater integration of the interprofessional team, the more individual and patient-sensitive investigation, as well as the respect of beliefs and desires, making the results obtained better., (Copyright © 2024 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Radiological contrast media play an essential role in radiology departments by facilitating more precise and detailed images. It is important to note that for radiologists the use of these contrast agents implies several legal responsibilities and ethical considerations towards patients. This article will explore the main issues related to responsibility and complication management for radiologists, referring physicians and other related professionals, as well as issues around informed consent, contraindications for their use and the benefit-risk balance assessed when deciding if a contrast-enhanced test should be carried out. In addition, we will address the crucial role of the radiologist in effective communication with patients and in obtaining informed consent. This research relates to Spanish legislation in the context of medical practice., (Copyright © 2024 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To analyze the relationship between administrative burden and intrinsic motivation and between administrative burden and professional well-being among family and community medicine physicians. To analyze the extent to which attention to three basic needs (autonomy, sense of competence and relationship capacity) that one of the main motivation theories identifies as a generator of intrinsic motivation compensates for the negative effect of the administrative burden. To compare management models., Method: Data from a survey (542 valid questionnaires) carried out through the Catalan Society of Family and Community Medicine are used. Data analysis is based on multiple regression and ANOVA techniques., Results: The perception of administrative burden and "red tape" are clearly demotivating and reduce job satisfaction. On the contrary, individual autonomy, networking opportunities between professionals and performance feedback are motivating and feed the perception of professional well-being. The EBA (Association Based Entity) model presents results above the ICS (Catalan Health Institute) and OSI (Integrated Health Organizations) models both in controlling the negative effect of administrative burden and in the management of basic psychological needs., Conclusions: The motivation and professional well-being of primary care physicians would benefit from reforms that limit the administrative burden of some procedures and red tape. At the primary health center level, greater attention to individual autonomy, improving relatedness between professionals and the sense of competence based on better information on individual performance can offset the negative effects of the administrative burden., (Copyright © 2023 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: In some areas of the world, breast milk is seen as a potential source of child diarrhoea. While this belief has been explored in African and Southeast Asian countries, it remains vastly understudied in Latin American contexts. We investigate socio-cultural factors contributing to breastfeeding cessation in rural high-altitude populations of the Peruvian Andes. The role of socio- cultural factors in the local explanatory model of child diarrhoea, and whether these perceptions were integrated in the local healthcare system were assessed., Methods: Within the framework of a randomised controlled trial, we conducted semi-structured interviews with 40 mothers and 15 health personnel from local healthcare centres involved in the trial., Results: Cultural beliefs on breastfeeding cessation included the perception that breast milk turned into "blood" after six months and that breastfeeding caused child diarrhoea. We identified eight local types of child diarrhoea, and women linked six of them with breastfeeding practices. "Infection" was the only diarrhoea mothers linked to hygiene and the germ disease concept and perceived as treatable through drug therapy. Women believed that other types of diarrhoea could not be treated within the formal healthcare sector. Interviews with health personnel revealed no protocol for, or consensus about, the integration of the local explanatory model of child diarrhoea in local healthcare and service provision., Conclusions: The local explanatory model in rural Andean Peru connected breastfeeding with child diarrhoeas. Cultural beliefs regarding diarrhoea management may increase home treatments, even in cases of severe diarrhoeal episodes. Future national breastfeeding support programmes should promote peer-counselling approaches to reduce negative attitudes towards breastfeeding and health practitioners. Local explanatory models should be incorporated into provincial and regional strategies for child diarrhoea management to promote equity in health and improve provider-patient relationships., (© 2021. The Author(s).)

Objective: To analyse the frequency of complaints due to the refusal of Primary Care Physicians to indicate a diagnostic test, treatment, or referral requested by a patient., Methods: Observational, retrospective study was conducted by analysing the complaints filed in a Primary Care Area during the years 2016, 2017, and 2018., Results: A total of 378 complaints were included. Of these, 30 (8%) were justified in the refusal by the doctors to a request of the patient (28 addressed to general practitioners and 2 to paediatricians). The most frequent related to the request was for a treatment (18 [60%]) followed by the request for diagnostic tests (9 [30%]). While the total number of claims increased by 151%, the relative weight of the claims for not responding to a patient's request was reduced (2016, 8/70, 11.4%; 2017, 11/132, 8.3%; and 2018, 11/176, 6.3%). No professional liability claims were filed., Conclusions: Complaints for rejecting patient requests increased slightly, but tends to decrease their relative weight when considering the volume of complaints., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

Objective: To determine the offer of preventive activities by resident physicians of family medicine in the Primary Care consultations and the relation with their communication habilities., Design: A descriptive multicentre study assessing medical consultations video recording., Location: Eight Primary Healthcare centres in Jaen (Andalucia)., Participants: Seventy-three resident physicians (4th year) filmed and observed with patients., Principal Measurements: Offer of preventive activities (according to the Spanish Program of Preventive Activities and Health Promotion -PAPPS-). Doctor, patient and consultation characteristics. Peer-review of the communication between physicians and patients, using a CICAA scale. A descriptive, bivariate, logistic regression analysis was performed., Results: Two hundred and sixty interviews were evaluated (duration 8.5±4.0min) of 73 residents (50.7% women, mean age 32.9±7.7 years, 79% urban environment). The patient is more frequently a woman (60%) who comes alone (72%) due to acute processes (80%) and with 2.1±1.0 demands. Preventive activities are offered in 47% (duration less than one minute) of primary (70%) and secondary (59%) prevention, offered through advice (72%) or screening (52%) and focused on the cardiovascular area (52%) and lifestyles (53%). Eighty percent related to the patient's reason for consultation. Communication skills 41% improvable, 26% adequate, 23% excellent. The offer of preventive activities is related to the duration of the consultation (OR=1.1, 95% CI 1.01; 1.16) and communication skills (OR=1.03, 95% CI 1.01; 1.10)., Conclusions: Preventive activities are carried out in almost half of the consultations, although focused on advice and screening and linked to the patient's demand. Consultation time and communication skills favor a greater preventive offer., (Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style., Design: Cross-sectional multicentre study., Location: Primary Healthcare Centres in Andalusia, Spain., Participants: A total of 119 tutors and family medicine physician residents., Principal Measurements: Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care., Results: The mean duration of consultations was 8.8min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37±4.19min vs 7.54±2.98min; p=0.001), and when there was joint decision-making (9.79±3.96min vs 7.73±3.42min: p=0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r 2 =0.32). There was no correlation between physician or patient gender, or problem type., Conclusion: A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Objective: To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented., Material and Methods: A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators., Results: More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors., Conclusions: The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient., (Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: To determine the communicative profiles of family physicians and the characteristics associated with an improved level of communication with the patient., Design: A descriptive multicentre study., Location: Primary Healthcare Centres in Almeria, Granada, Jaen and Huelva., Participants: 119 family physicians (tutors and 4th year resident physicians) filmed and observed with patients., Principal Measurements: Demographic and professional characteristics. Analysis of the communication between physicians and patients, using a CICAA (Connect, Identify, Understand, Agree and Assist, in English) scale. A descriptive, bivariate, multiple linear regression analysis was performed., Results: There were 436 valid interviews. Almost 100% of physicians were polite and friendly, facilitating a dialogue with the patient and allowing them to express their doubts. However, few physicians attempted to explore the state of mind of the patient, or enquire about their family situation or any important stressful events, nor did they ask open questions. Furthermore, few physicians summarised the information gathered. The mean score was 21.43±5.91 points (maximum 58). There were no differences in the total score between gender, city, or type of centre. The linear regression verified that the highest scores were obtained from tutors (B: 2.98), from the duration of the consultations (B: 0.63), and from the age of the professionals (B: -0.1)., Conclusion: Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

The presence of an adult accompanying the patient in the consulting room is a significant fact that deserves the attention of the physician. Some types of companions and their presence in the consultation have been described and may improve communication, patient management, and participatory decision making, achieving greater patient satisfaction. Consultations with companion are generally longer, and patients accompanied are often elderly, women, less educated, and with poorer physical and mental health. But it is not known exactly what is the significance of a consultation with a companion. It may be a semiological fact to keep in mind for the family diagnosis, or it may be the risks of their presence, the influence of medication, or the importance of the doctors themselves that are the cause of the presence of a companion. Different communication skills must be achieved during the interview with the companion in the consultation, rather than with the patient alone., (Copyright © 2014. Publicado por Elsevier España, S.L.U.)

This project supports the initiative promoted by the Spanish National Health System to provide informational materials, in printed or interactive format, to encourage public participation in decision making and healthcare. We present the newly created PyDEsalud.com, a web platform aimed at people with chronic diseases with a high socioeconomic impact, such as breast cancer, depression, and diabetes. This platform uses scientific methodology and contains three information service modules (Patients' experiences, Shared decision making, and Research needs), aimed at promoting health education for patients and families., (Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.)

Over 2200 new cases of breast cancer are diagnosed annually in Cuba, and a decade ago I became one of them. Late in 2000, I underwent breast cancer surgery at the National Oncology and Radiology Institute in the Cuban capital. My experience-both with the disease and as a sociologist at the University of Havana studying gender relations-serves as the basis for the following essay. The article characterizes today's Cuban women, particularly those of us with or at risk of breast cancer, and describes my own and others' responses to our disease. My aim is to provide insights useful to the physicians, nurses, engineers, physicists, technicians, and service and administrative workers in Cuba's health services who interact with us, whose increased awareness will make us feel more deeply understood and respected. In this context, I also reflect on the Cuban media's portrayal of cancer, with recommendations for dismantling the biases of fatalism and even pity often conveyed.