To perform the diagnosis he applies cognition tests involving dates, seasons and car models, with questions asked in a persistent, but gentle way. The person is not only a person, but a corporal person 17 , says Julian Marias, quoted by Miranda. We are also our body and therefore we find ourselves limited in time and space. The temporal dimension of the human being is its central feature. Man struggles with time, tries to leave it behind, to be above it - the first way to try to overcome it is to keep memories of the past, and the second is to wish to convert the present into something permanent In this sense, the preservation of the autonomy for the health of the elderly, by stimulating the constant reconstruction of the memory, is of extreme importance.
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According to a recent scientific Discovery, exercising can contribute to a brain that resists better to the phisycal shrinkage, in addition to stimulating cognitive flexibility. Mija Jeong-hie Yun , a year-old lady, lives in the countryside of South Korea, where she raises her teenage grandson. On a visit to the doctor, she complains of tingling in her right arm and of constant forgetfulness. The doctor prescribes light exercises for the muscles and requests tests.
In addition to completing her pension working as a caretaker of a middle class gentleman who had suffered a stroke, she enrolls in a course of poetry and goes on to attend poetry reading and karaokes. These activities contribute to maintain a productive routine, essential for brain plasticity.
Weuve et al. Thus, in suggesting the practice of exercises for a year-old woman, the doctor contributed not only to increase her blood flow, but also to the appearance of new vessels and new brain cells 21 , providing a holistic improvement of the condition. The doctor-patient relationship, although only briefly in the film, is an example of the attentive look of the physician towards the elderly patient. It was the valorization of one of the less important complaints of Mija that led to the correct diagnosis of the disease. Muriel Donnelly Maggie Smith is one of seven seniors featured in the film.
Grumpy, the former housekeeper appears lying on the stretcher of a hospital corridor, refusing to be attended by a black doctor and asking the nurse to be looked after by an English doctor. The nurse provides the English doctor who, to her surprise, has Indian ancestry. He suggests, then, surgery with placement of prosthesis in femoral head executed in pilot project outsourced in hospital in India.
The film does not explain why the character needs this surgery. However, one of the main diagnostic hypotheses, in the absence of reference to falls and due to the fact that Muriel is moving in a wheelchair, is osteoarthritis, a disease marked by cartilage degeneration and surrounding structures, pain and progressive loss of joint mobility.
This disease predominantly affects the women, and its incidence rate increases with age, with the hip being frequently affected. Osteoarthritis can arise for a variety of reasons endocrine, metabolic, congenital, traumatic , according to Coimbra et al. In selected cases, the treatment involves surgical procedures, such as the hip replacement surgery that Muriel underwent. Another point to be discussed is the prejudicial character of Muriel. This negative attitude that human beings manifest in relation to others may appear in several domains. Among them are race, religion, profession, sex, age, region, political affiliation, education, socioeconomic status.
To color prejudice it is added the ethnic issue. This is because, for centuries, England maintained a subaltern relation of the Indians in relation to their Imperialism. Violet Weston Meryl Streep , a compulsive smoker, is a cancer patient, using polypharmacy, including opioids. The doctor-elderly patient relationship is demonstrated in a conflictive way: the family, especially the eldest daughter, Barbara Julia Roberts , presents difficulties in understanding and accepting the amount of prescription drugs prescribed to treat anxiety disorder, panic syndrome and pain of her mother.
The polypharmacy concomitant consumption of five or more drugs is an increasingly common practice among the elderly. This phenomenon occurs due to the progressive increase of life expectancy in the national and world scenario, together with the prevalence of chronic diseases, the medicalization present in the training of doctors and the power of the pharmaceutical industry, according to Silveira, Dalastra and Pagotto The repercussions of its use, especially in the elderly, include a greater number of adverse reactions and drug interactions due to altered pharmacokinetics 27 , It reflects a common aspect experienced among family members and physicians of elderly patients: the denial and indignation of family members in the face of diagnoses of their loved ones with bad prognosis.
The feeling of impotence and the restructuring of the family nucleus to care for the frail elderly are the main factors of estrangement at the beginning of this process. It is worth mentioning that not only children, grandchildren and spouses need professional guidance to better manage the new reality, but also the elderly patient must work a new stage in his life, in which he is incapacitated to perform daily activities that he used to do before The humanized view of the doctors-elderly patient relationship is productive for both patients and physicians, and must be practiced in line with bioethical and personal professional aspects and other cultural, scientific and historical issues can directly influence this relationship Duarte 31 says: Certain cultural experiences, associated to a certain way of watching movies, end up interacting in the production of knowledge, identities, beliefs and worldviews of a large contingent of social actors.
In the context of the use of films to work concepts related to medical education - especially in the fields of bioethics and ethics - the narratives presented on the screen are important tools, since they bring experiences full of emotion, capable of awakening reflections on life and reality 3. It also stimulates thinking about relationships with patients and their illnesses, including important emotional responses.
This ratifies the idea put forward by Cezar 3 that the cinema allows the student to incorporate concepts into his cognitive repertoire, developing his power of critical analysis 3. Often, patients have expressed dissatisfaction with the cold and inhuman way in which they are treated by some health professionals, who take an alienated and reductionist stance. This is because they prioritize the treatment of diseases, not patients, and ignore the complex biopsychosocial dimension of illness.
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The exclusively technical character in the training of health sciences professionals gave preference to innovative educational practices that transcend the incorporation of knowledge necessary to understand the health-disease process These practices consider the holistic approach of the patient to be relevant, and it is in this scenario that different perspectives regarding the care and the doctor-elderly patient relationship deserve special mention.
Although the number of studies in the literature on elder care has increased in recent years, few studies have been able to synthesize the plurality found in this relationship This happens because it allows to visualize the case reported and opens space for discussions that are of extreme importance both for the student of medicine and for the doctor in the exercise of his profession.
The doctor-elderly patient relationship in cinema: visions of care
Balint M. Rev Fr Sociol. Cezar PHN. J Pneumol. Conselho Federal de Medicina. Rev Assoc Med Bras. Brandt LJ. On the value of an old dress code in the new millennium. Arch Intern Med [Internet]. Rio de Janeiro: Atheneu; Blasco PG. Porto CC. Arq Bras Cardiol [Internet]. Miranda LFJR. Rev Med Minas Gerais.
Muakad IB. Anfetaminas e drogas derivadas. Ann Fam Med. Maldonato M. Total daily physical activity and the risk of AD and cognitive decline in older adults.
Whose life is it anyway? And bringing out the dead
Reynolds G. How exercise could lead to a better brain. N Y Times Mag [Internet].
Physical activity, including walking, and cognitive function in older women. Osteoartrite artrose : tratamento. Rev Bras Reumatol. Munanga K. Preconceito de cor: diversas formas, um mesmo objetivo. Rev Antropol. Arrighi G. Rio de Janeiro: Contraponto; Pettigrew J, Richardson B. A social history of tea. London: The National Trust; Rev Bras Epidemiol. Secoli SR.
The Picture of Health: Medical Ethics and the Movies
Rev Bras Enferm. Cuidando de idosos altamente dependentes na comunidade: um estudo sobre cuidadores familiares principais. Duarte R. Cad Antropol Imagem. Mariana de Oliveira Lobo and Fernanda Caroline Moura Garcez participated in the research of scientific literature and review of the manuscript in all stages.
The Picture of Health: Medical Ethics and the Movies
All autors colaborated in the selection of films and in the preparation and initial review of the manuscript. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Services on Demand Journal. Research The doctor-elderly patient relationship in cinema: visions of care. Abstract This article aims to describe different views of care through the doctor-elderly patient relationship as addressed in feature films. Method This is an exploratory study in which research was carried out using national and international filmography, looking for feature films that showed scenes that portrayed the doctor-elderly patient relationship in different ways.
Results and discussion Ten films that exposed didactically the doctor-elderly patient relationship were analyzed, they are presented in a chronological order below. This will allow students to learn more about the historical and social context of the issues at stake. The course will cover the following biomedical issues - the problems around defining death, ethical issues in transplantation, ethical issues in enhancing humans by genetic manipulation, moral dilemmas bout ending of life.
During the course students will watch movies and the topics addressed in the movies will be discussed in practical classes. Discussion: Ethics issues in brain death and organ transplantation. Preparing for practical classes Short pages on essay on the topic chosen by a student at the end of the course. During the course the students will acquire deeper understanding of some of the most important issues in the contemporary bioethics. Students will be able to analyze and discuss the current issues in bioethics with reference to the historical context of the problems and the way they are perceived in popular culture.
Students should be able to analyze, evaluate un critically discuss various bioethical issues. They should be able to formulate their own point of view and support it by arguments.
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