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