{"id":13288,"date":"2019-10-25T05:01:09","date_gmt":"2019-10-25T04:01:09","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2019\/10\/WMA-70th-President-Inaugural-Speech-Final-Version.pdf"},"modified":"2019-10-25T05:01:09","modified_gmt":"2019-10-25T04:01:09","slug":"wma-70th-president-inaugural-speech-final-version-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/noticias-y-prensa\/speeches-talks-interviews\/wma-70th-president-inaugural-speech-final-version-2\/","title":{"rendered":"WMA 70th President Inaugural Speech Final Version"},"author":17,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

WMA 70th President Inaugural Speech Final Version<\/a><\/p>\n

1
\nDr. Miguel R. Jorge, World Medical Association 70th
\nPresident
\nInaugural Speech, 25th of October 2019
\nDear Colleagues and Friends,
\nLadies and Gentlemen,
\nThank you for your presence and enduring support to the
\nWorld Medical Association. It means a lot to the physicians
\nwe represent and, at this particular ceremony, it also means
\na lot to me.
\nThose of you familiar with the World Medical Association
\nknow that our constituent members include one hundred
\nand twelve national medical associations. I am here today
\nbeing inaugurated as the World Medical Association\u2019s 70th
\nPresident not by myself but representing not just my
\ncolleagues from the Brazilian Medical Association but
\nmillions of physicians who practice in every corner of the
\nglobe.
\n2
\nMy home country, Brazil, is amongst the 10th biggest
\neconomies but is also amongst the 20th most unequal
\ncountries in the world. And we know that wealth
\ninequalities within a country impact social determinants of
\nhealth and consequently the health status of its population.
\nIt is not uncommon to see, in unequal countries, two
\nrealities for medical care: one with first world quality for
\nthose who have more and the other of little quality \u2013 if any
\n\u2013 for the underprivileged.
\nThe World Medical Association\u2019s Declaration of Geneva
\nstates in its opening remarks that physicians pledge to
\ndedicate their lives to the service of humanity and have the
\nhealth and well being of their patients as their first
\nconsideration. We, as physicians, practice our commitment
\nto these principles not just when attending to our patients
\nbut also when we join our medical associations in their
\nmultiple activities, aiming, at the end, to raise the health
\nstatus and quality of life of the population we serve.
\n3
\nThere are many and different factors influencing the
\nphysicians\u2019 role to promote the health and quality of life of
\nothers, such as a good and continuous medical education,
\nadequate resources and conditions for work – particularly
\nenough time with each patient, a balanced professional and
\nsocial life, and – equally important \u2013 to take care of their
\nown physical and mental health.
\nAs a psychiatrist, I was planning to emphasize during my
\nPresidential term that there never will be health without
\nmental health. But I was challenged by myself to broaden
\nmy concerns, and remind and highlight to my fellow
\nphysicians one essential component of the practice of
\nMedicine: the great value of the physician-patient
\nrelationship.
\nIt is usually recognized that most of those who are looking
\nto enter medical school, do so saying they want to help
\npeople in their suffering related to illness. But studies from
\ndifferent countries show that medical students usually are
\n4
\nless sensitive to the patient\u2019s needs as a person when
\nfinishing than they are when entering medical school.
\nWhat happened in between? One possible reason is that
\nstudents, during their medical education, are more and
\nmore exposed to the biological nature of illnesses than to
\nthe social environment surrounding their patients and the
\ndevelopment of diseases. They also are not adequately
\ntaught to take into consideration the emotional aspects of
\nthose they are assisting.
\nTo those who are being trained to be a medical doctor,
\nbiology is an arena where they feel more secure and
\ncomfortable to act than they do when feeling incapable of
\ndealing with people\u2019s social and psychological issues.
\nBesides that, the physicians-to-be were developing
\ndefences against their own suffering when facing different
\nforms of pain in their patients. Physical pain, emotional
\npain, social pain. And these defences reduce their
\nsensibility to others\u2019 needs.
\n5
\nA good physician needs to be able to put him\/herself in the
\nplace of their patients, trying to feel as they feel, in order to
\nbetter understand their needs and plan to provide what they
\nneed more. But it is not a simple task to put him\/herself in
\nthe place of a patient and – at the same time – to avoid
\nfeeling as helpless as the patient would be. In medical care,
\nit is as essential to have empathy as it is to be able to
\nexamine the patient from the outside.
\nA colleague from my Department in the Federal University
\nof S\u00e3o Paulo, Dr. Julio Noto (personal communication),
\nreported to me that once he heard from one of his Medical
\nPsychology students: \u201cHow can I talk to the patient if there
\nis nothing that I can do for him due to his condition?\u201d Noto
\nconsiders that teaching Medical Psychology to medical
\nstudents sometimes is similar to teaching someone \u201cto do
\nnothing\u201d. There, doing nothing can correspond to cathartic
\nlistening, emotional continence, expectant attitude, and
\neven the use of countertransference in the physician-patient
\nrelationship. A brilliant Brazilian novelist from the later
\n6
\n19th and early 20th centuries, Machado de Assis, once
\nwrote: \u201d\u2026there are things we say better being quiet…\u201d
\nWe all hear that Medicine is both science and art but, in the
\nlast decades, the practice of Medicine is more and more
\nreflecting an emphasis just on its scientific nature. A
\ncompetent physician is not a good mechanic of the human
\nbody but someone who equally combines technical
\nexcellency with being close to their patients, respecting
\ntheir dignity, and showing them empathy and compassion.
\nEvidence-based guidelines containing standards of care are
\nreally of great importance. They allow the organization of a
\nfragmented physician-patient care model, as different
\nphysicians assisting the same patient at different times can
\napply the same objective scientific knowledge. But an
\ninteresting study published in 2016 by Lauren Diamond-
\nBrown suggested that goals of standardization cannot
\nrationalize all aspects of medical practice, and policy
\nmakers must not forget the function of a positive physician-
\npatient relationship. We have to recognize the importance
\n7
\nof evidence-based medical practice while not forgetting
\nthat the decision-making process of care also involves
\nimportant subjective aspects.
\nEric Cassel (2012), in his book The Nature of Healing: The
\nModern Practice of Medicine, states that \u201cRespect for
\npersons has helped move the idea of persons and
\nknowledge about them to a more central position in
\nmedicine. From this it follows that healers and other
\nclinicians should know as much about persons as they
\nknow about their pathophysiology.\u201d According to him,
\nalmost nothing about people is unaffected by sickness.
\nConcepts like this one have led to a shift of models of care
\nfrom a disease-specific model to patient-centered
\ncollaborative care. Results from reviews of the literature
\nconducted in 2000 by Mead and Brown and repeated in
\n2019 by Langberg et al. described five dimensions of a
\npatient-centered care: sharing power and responsibility,
\ntherapeutic alliance, patient-as-person, coordinated care,
\nand a biopsychosocial perspective.
\n8
\nEmanuel and Emanuel (1992) considered \u2013 before the
\ncurrent digital era – that the role of physicians varies, in
\ndifferent models of physician-patient relationship, from a
\nguardian to a counsellor or advisor, from a friend or a
\nteacher to a technical expert. Nevertheless, ethical
\nconsiderations about the rights of persons and the
\nwidespread access to information brought by the Internet to
\nall, have a major impact on the physician-patient
\nrelationship. Medical expertise continues to rely on the
\nphysicians\u2019 knowledge, but the decision-making process
\nand adoption of a treatment plan now need to include and
\nrespect the patients\u2019 preferred choices.
\nTaking just diagnostic imaging and individual genetic
\ntailoring for the treatment of cancers as examples of the
\nsophisticated progress experienced by Medicine in the last
\nfew decades, as well the development of telemedicine, the
\nuse of artificial intelligence and particularly of social
\nmedia, we \u2013 physicians \u2013 have to learn how to use these
\ntools for improving the physician-patient relationship and
\n9
\nnot allow them to move us from a focus on the patients
\nthemselves or to create more difficulties in our
\ncommunication with them.
\nAnother interesting study, from Hitchsock et al. (2005),
\ninvolving primary care patients with multimorbidity,
\nshowed that participants were willing to use technology for
\nmonitoring or educational purposes if it did not preclude
\nhuman contact. When listening to patients\u2019 expectations,
\nhumaneness appears as equally or even more important
\nthan medical competence. So, a recommendation of major
\nimportance is that physicians must be focused on building
\ntrust and a strong therapeutic alliance early during the first
\nvisit of a patient.
\nLast November, the European Council of Medical Orders
\nsupported and adhered to an initiative by the Forum of the
\nMedical Profession of Spain and the Portuguese Medical
\nAssociation to defend and strengthen the physician-patient
\nrelationship by requesting its recognition by UNESCO as
\nan Intangible Cultural Heritage of Humanity. That proposal
\n10
\nconsiders the physician-patient relationship a fundamental
\ncomponent of health care that can be threatened by
\npolitical, social, or economic risks, and technological and
\ncommunication changes, which makes it necessary to
\nprotect and enhance the fundamental elements of that
\nrelationship.
\nPhysicians working under difficult circumstances such as
\nthose in Africa, Latin America and Asia, often cannot do
\nwhat they consider to be the best plan of action due to the
\nscarcity of different resources. But they can accomplish at
\nleast partially their mission if they give a little more time
\nand show empathy and attention to their patients. I am sure
\nthat we can always do better for all if we keep in mind the
\nreason why we chose to be physicians earlier in our lives:
\nto help those who are suffering due to their compromised
\nhealth.
\nFinally, I would like to say something about my
\nbackground and this moment. My four grandparents arrived
\nin Brazil in 1912, after fleeing a difficult situation they
\n11
\nwere facing in their mountain villages of Lebanon. My
\nparents were born in a small city in the interior of the
\ncountry and my father became a merchant in his adult life.
\nWhen I was studying Medicine, his wish was to see me as a
\ngeneral surgeon practicing and making my life even in a
\ndeeper part of Brazil, where everything was still waiting to
\nbe built.
\nBut, according to some of my colleagues at the medical
\nschool, I \u2013 in a way – declined to be a \u201creal\u201d physician by
\nchoosing to become a psychiatrist. And, in the eyes of
\nmany, the worst part of all: rather than focusing on a money
\ndriven path, I chose to follow an academic career and, early
\nin my professional life, I engaged in lifelong actions for
\nenhancing the quality of medical care provided particularly
\nto those that are more in need.
\nAfter so many years, being here today, becoming the 70th
\nPresident of the World Medical Association was not
\nsomething I ever dreamed of. It gives me great joy and
\nhappiness, even though has not been possible to have some
\n12
\nof my family members with me at this moment. But, I want
\nto specially thank them for their continuous and enduring
\nsupport.
\nI am sure that there are times when many of you \u2013 like me
\nnow \u2013 are participating in professional activities that divert
\nyou from the company of your family. This is a kind of side
\neffect of being a physician but \u2013 remember \u2013 as I said
\nbefore, a balanced professional and social life is essential
\nfor taking care of others.
\nSo, once again, on behalf of millions of physicians
\nworldwide and of those they serve, I want to recognize
\nyour efforts and dedication, ultimately aiming to provide
\nbetter health to all.
\nThank you!
\n13
\nBefore I close this Ceremonial Session of the General
\nAssembly of the World Medical Association, I give the
\nmicrophone to the Secretary General for some
\nannouncements.
\nOn behalf of the World Medical Association, I would like
\nto thank you for honouring us with your presence here
\ntoday.
\nI now declare this Ceremonial Session closed and invite
\nyou all for a short cocktail provided by the Brazilian
\nMedical Association just outside this room. Thank you!<\/p>\n"},"caption":{"rendered":"

WMA 70th President Inaugural Speech Final Version 1 Dr. Miguel R. Jorge, World Medical Association 70th President Inaugural Speech, 25th of October 2019 Dear Colleagues and Friends, Ladies and Gentlemen, Thank you for your presence and enduring support to the World Medical Association. It means a lot to the physicians we represent and, at this […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":13299,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2019\/10\/WMA-70th-President-Inaugural-Speech-Final-Version.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/13288"}],"collection":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=13288"}]}}