Arquivos de Tag: Anatomia Humana

Not Only SURGEONS

Not Only Surgeons

SURGERY, A NOBLE PROFESSION

Surgery is, indeed, one of the noblest of professions. Here is how Dictionary defines the word noble: 1) possessing outstanding qualities such as eminence, dignity; 2) having power of transmitting by inheritance; 3) indicating superiority or commanding excellence of mind, character, or high ideals or morals. These three attributes befit the profession of surgery. Over centuries, the surgical profession has set the standards of ethical and humane practice. Surgeons have made magnificent contributions in education, clinical care, and science. Their landmark accomplishments in surgical science and innovations in operative technique have revolutionized surgical care, saved countless lives, and significantly improved longevity and the quality of human life. Generations of surgeons have developed their craft and passed it on to succeeding generations, as they have to me and to each one of you, to take into the future.

Beyond its scientific and technical contributions, surgery is uniquely fulfilling as a profession. It has disciplined itself over the centuries and dedicated its practice to the best welfare of all human beings. In return, it has been accorded the respect of society, of other professions, and of policy makers. Its conservative stance has served it well and has been the reason for its constancy and consistency. At the beginning of the 21st century, however, profound changes are taking place at all levels and at a dizzying pace, providing both challenges and opportunities to the surgical profession. These changes are occurring on a global level, on the national level, in science and technology, in healthcare, and in surgical education and practice.

To retain its leadership position in innovation and its attractiveness as a career choice for students, surgery must evolve with the times. It is my belief that surgery needs to introduce changes to create new priorities in clinical practice, education, and research; to increase the morale and prestige of surgeons; and to preserve general surgery as a profession. I am reminded of a Chinese aphorism that says, “You cannot prevent the birds of unhappiness from flying over your head, but you can prevent them from building a nest in your hair.”

ADVANCES IN SCIENCE

The coalescence of major advances in science and technology made the end of the 20th century unique in human history. Notable among the achievements are the development of microchips and miniaturization, which fueled the explosion in information technology. The structure of the human genome is nearly completely elucidated, ushering in the genomic era in which genetic information will be used to predict, on an individual basis, susceptibility to disease and responsiveness to drug therapy. The field of nanotechnology allows scientists to work at a resolution of less than one nanometer, the size of the atom. By comparison, the DNA molecule is 2.5 nanometers.

In the last 50 years, biomedical research became increasingly reductionist, turning physiologists and anatomists into molecular biologists. As a result, two basic science fields—integrative physiology and gross anatomy—now have a lower standing in medical education and surgical science than they once did. Surgery and surgical departments can and possibly should claim these fields, but the window of opportunity is narrow. Research is now moving back from discipline-based reductionist science to multidisciplinary science of complexity, in which biomedical scientists work side by side with engineers, mathematicians, and bioinformatists. The ability of high-speed computers to quickly process tens of millions of pieces of data now allows for data-driven rather than hypothesis-based research. This collaboration among different disciplines has already been successful.

TRANSFORMATION OF HEALTHCARE SYSTEM

During the past 75 years, we have seen the entire healthcare system undergo a profound transformation. In the 1930s and for a considerable period thereafter, medical practice was fee-for-service, the doctor–patient relationship was strong, and the physician perceived himself or herself as being responsible nearly exclusively to his or her individual patients. The texture of medical practice started to change when the federal government became involved in the provision of healthcare in 1965. The committee on “Crossing the Quality Chasm” identified six key attributes of the 21st-century healthcare system. It must be:

  1. Safe, avoiding injuries to patients;
  2. Effective, providing services based on scientific knowledge;
  3. Patient-oriented, respectful of and responsive to individual patients’ needs, values, and preferences;
  4. Timely, reducing waits, eliminating harmful delays for both care receiver and caregiver;
  5. Efficient, avoiding wasted equipment, supplies, ideas, and energy;
  6. Equitable, providing equal care across genders, ethnicities, geographic locations, and socioeconomic strata;

No one knows at present what this 21st-century healthcare system will look like. While care in the old system was reactive, in the new system it will be proactive. The “find it, fix it” approach of the old system will be replaced by a “predict it, prevent it, and if you cannot prevent it, fix it” approach. Sporadic intervention, provided only when patients present with illness, will give way to a system in which physicians and other healthcare providers plan 1-, 5-, and 10-year care programs for each patient. Care will be more interactive, with patients taking a more important role in their own care. The technology-oriented system will become a system that provides graded intervention. Delivery systems will not be fractionated but integrated. Even more importantly, care will not be based simply on experience and clinical impression but on evidence of proven outcome measures. If the old system was cost-insensitive, the new system will be cost-sensitive.

SURGICAL PRACTICE

There are many reasons for the declining interest in general surgery, some of which parallel reasons for the drop in medical school applicants in general. One problem specific to surgery is that medical students are given less and less exposure to surgery, due to the shortening of required surgical rotations. Most important, however, is their perception that the life of the surgical resident is stressful, the work hours too long, and the time for personal and family needs inadequate. The workload of the surgical resident over the years has increased significantly both in amount and intensity, without concomitant increase in the number of residents and at a time when hospitals have significantly reduced the support personnel on the surgical ward and in the operating rooms. Students graduating with debts close to $100,000 simply find the years of training in surgery too long, followed by uncertain practice income after graduation.

From several recent studies, lifestyle is the critical and most pressing issue in surgical residency. Some studies have also shown that the best students tend to select specialties that provide controllable lifestyles, such as radiology, dermatology, and ophthalmology. We have a problem not only in the declining number of students applying for surgical training but also in the declining quality of those who do apply. In a preliminary survey of 153 responding general surgery programs, we found that attrition (i.e., categorical residents leaving the training programs) occurred at a rate of 13% to 19% in the last 5 years. In 2001, 46% of those leaving general surgery training programs cited lifestyle as the major reason.

Unless these trends are reversed, general surgery as a specialty is threatened, and a future shortage of general surgeons is inevitable. I know that the Council of the American Surgical Association is most concerned about the crisis in general surgery. We must do a better job of communicating to students and residents that the practice of surgery is as rewarding as ever and full of opportunities in this new era. Innovations in minimal access and computer-assisted surgery and simulation technology provide exciting new possibilities in surgical training. We must also look very carefully at the demands of surgical residency and improve the life of residents without compromising their surgical experience. Unless we deal with work hours and quality of life issues, we are likely to see continuing decline in the interest of medical students in surgical training.

CONCLUSIONS

In conclusion, the noble profession of surgery must rise to meet numerous challenges as the world in which it operates continues to undergo profound change. These challenges represent opportunities for the profession to develop an international perspective and a global outreach and to address the growing needs of an aging population undergoing major demographic and workforce shifts. The leadership of American surgery has a unique role to play in the formulation of a new healthcare system for the 21st century. This task will require commitment to quality of care and patient safety, and it will depend on harnessing the trust and support of the American public. Advances in science and technology—particularly in minimal access surgery, robotics, and simulation technology—provide unprecedented opportunity for surgeons to continue to make landmark contributions that will improve surgical care and the human condition. I believe it is also crucially important that we train surgeon-scientists who will keep surgery at the cutting edge in the genomic and bioinformatics era. Ours is a noble profession imbued with eminence, dignity, high ideals, and ethical values. It has a rich and proud heritage… and I quote, “The highest intellects, like the tops of mountains, are the first to catch and reflect the dawn.”

Source: Lecture from Haile T. Debas, MD (UCSF School of Medicine, San Francisco, California) Presented at the 122nd Annual Meeting of the American Surgical Association, April 25, 2002, The Homestead, Hot Springs, Virginia.

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Ao Cadáver DESCONHECIDO

Hic locus est ubi mors gaudet succurrere vitae

“É este o lugar onde a morte se alegra de socorrer a vida”

Égide do respeito ao Cadáver no estudo da Anatomia Humana*.

A utilização do cadáver representa uma tríplice lição educativa:

  1. Instrutiva/Informativa: como meio de conhecimento da organização do corpo humano, procedendo ao estudo no vivo;
  2. Normativa/Disciplinadora: através do seu caráter metodológico e de precisão técnica da linguagem;
  3. Estético/Moral: pela natureza do material de estudo, o cadáver, e pelo método primeiro de aprendizado, a dissecção, que é experiência e trabalho repousante na contemplação da beleza e harmonia de construção do organismo humano.

Contudo e essencialmente, porém, lição de ética e de humildade, porque:

  1. Não é o cadáver, doado ou indigente, fato isolado da comunidade, mas seu reflexo, dela provindo. O cadáver que é o meio de aprendizado para adequada assistência do vivo, assim portanto tão importante para a sociedade como o é o paciente;
  2. Esses corpos sem vida são vivificados de forma reiteradas pelo calor da juventude estudiosa através do sentimento de gratidão; O cadáver, antes de tudo “um irmão em Humanidade, se entrega despojadamente ao conhecimento que proporciona aos futuros profissionais, de maneira anônima oriunda do jogo do acaso da vida;
  3. O cadáver anônimo ao receber este título – cadáver desconhecido – e assim ultrapassar o limite estreito de um nome e, despersonalizado, distribui elementos para o bem coletivo, sem ter conhecimento quer antes, durante ou depois de sua imolação, do seu destino a um tempo sublime e sagrado;
  4. O Cadáver desconhecido tudo oferece ao conhecimento sem nada haver recebido daquele que o estuda, que dá sem saber que dá e por isso, sem conhecer recompensa da gratidão e sem sentimento do valor  da sua dádiva generosa, na mais nobre expressão de poderosa caridade universal;
  5. O cadáver que dissecado, desmembrado, simboliza outra forma de crucificação para o bem comum e marca o sentido profundamente humano da Medicina;

Portanto o nosso material de estudo transcende pois ao simples valor de meio e objeto de aprendizado; e nos fala em linguagem universal que nos educa na humildade da limitação humana. Eis porque na austeridade do ambiente do Laboratório de Anatomia a atitude física, mental e verbal do aluno deve ser de sobriedade, respeito, meditação e elevada compostura, manuseando as peças anatômicas com o mais profundo sentimento de respeito e carinho.

Nulla Medicina Sine Anatomia

“Ao curvar-te sobre o cadáver desconhecido…

lembra-te que este corpo nasceu do amor de duas almas; cresceu embalado pela fé e esperança daquela que em seu seio o agasalhou, sorriu e fitou os mesmos sonhos das crianças e dos jovens; por certo amou, foi amado e também acalentou um amanhã feliz. Seu nome só Deus o sabe e agora nesta fria lousa, o destino inexorável deu-lhe o poder e a grandeza de servir a humanidade numa última missão, ENSINAR.

Ó irmão ignoto que tivestes a morada do espirito, o seu corpo, perturbado em seu repouso imutável por nossas mãos ávidas de saber, apresentamos a ti o nosso respeito permanente e infindo AGRADECIMENTO.”

*Adaptação do texto original “Aula Inaugural”

Professor Renato Locchi (1896-1978) / Emérito de Anatomia Humana da Escola Paulista de Medicina.

História da Anatomia Humana

Atualmente, o conhecimento da anatomia se junta a um universo de outros conhecimentos que, não menos importantes, vão se somando e contribuindo de forma muito rápida para o desenvolvimento científico, para a melhoria da qualidade de vida e para a maior longevidade do ser humano. A anatomia e a medicina são ciências distintas, porém não há como separar a história de ambas. Estão ligadas intimamente e por muito tempo sendo que, na antiguidade, foram tratadas como uma só história. Ana, em partes; tome, cortar. O termo anatomia, de origem grega, significa “cortar em partes”. Antigamente referia-se ao ato de explorar as estruturas do corpo humano por uso de instrumentos cortantes como anatomizar, hoje substituído pela palavra dissecar. E foi a dissecção de cadáveres humanos que serviu como método de estudo para o entendimento da estrutura e função do corpo humano durante vários séculos. Devido ao incessante trabalho de centenas de anatomistas dedicados ao aprendizado e evolução do conhecimento acerca do corpo humano, e suas de funções, é que hoje nós, estudantes, podemos aprender e familiarizar com os termos anatômicos utilizados para designar cada estrutura dessa engenhosa “máquina” que é o ser humano. Grande parte dos termos que compõe a linguagem anatômica é de procedência grega ou latina. Latim era a língua do império romano, época em que o interesse nas descrições científicas foi cultivado. No passado, a anatomia humana era acadêmica, ciência puramente descritiva, interessada principalmente em identificar e dar nomes às estruturas do corpo. Embora a dissecção e descrição formem a base da anatomia, a importância desta, hoje, está em sua abordagem funcional e nas aplicações clínicas, de forma a entender o desempenho físico e a saúde do corpo.

Fundamentos Históricos da Anatomia Humana

Ebook: Princípios da Anatomia Topográfica

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Os conceitos fundamentais da Anatomia Topográfica Humana através do estudo das regiões anatômicas com maior relevância Médico-Cirúrgica. Agora com amplo material multimídia disponibilizado através de acesso on-line dentro do livro e com isso creditamos que este trabalho será útil como mais uma ferramenta didática na preparação profissional dos estudantes de Medicina.

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