Venezuela Chapter Governor's Newsletter
Israel Montes de Oca, MD, FACP
Governor, Venezuela Chapter
After the last 8 years of magnificent conduct by Dr. Simón Becker, as Governor of the Affiliate Chapter, and Dr. Ramón Soto, as Governor of the Venezuela Chapter, I start as a Governor - for the 2001/2005 period - on behalf of ACP/ASIM as of May, 2001.
It is stimulating to know that work done by Drs Becker and Soto had very important characteristics because they allowed the foundation of our chapter and its ulterior consolidation. ACP/ASIM Venezuela Chapter has currently more than 200 members of different classes (Members, Fellows, Associated, Students) and it must continue to grow thanks to the better knowledge that Venezuelan Medical Community has about our College objectives. Those objectives are to achieve excellence in the practice of Internal Medicine and its subspecialties; to promote continuous medical education through the performance of scientific events that allow physicians, members or non/members of the College, to keep ahead in the knowledge of specialties derived from Internal Medicine; and to encourage an optimal physician-patient relationship, to enforce the highest ethical principles, to strengthen the physician-family interaction, and thus, to obtain a better professional quality for all the College members.
College Governor responsibilities go further than simply representing the ACP/ASIM Institution. Thus, Governor responsibilities have also to do with the fulfillment of the above-mentioned principles, but this is a teamwork to be performed with the contribution and collaboration of all ACP/ASIM Venezuela Chapter Members. For this reason, Governor designation of the Members of different Councils and Committees intend to open a way for Members to provide their experiences on several activities of the Chapter. Those activities will not only include scientific events, where all members would be able to participate, but also a range of different issues that go from administrative to scientific issues.
The activities recommended by the College, voluntaries and service to the community, will give the Chapter the opportunity to go on succeeding, as we did before when we were awarded with several Evergreen Awards. We will inform timely the details as how to develop the above/mentioned activities.
At this time, my best message has not to do with my position but with encouraging you people to provide your ideas and actions that will allow us to grow up to excellence, and service spirit. As Mother Theresa said:
"I was sleeping and dreamt that life was all joy,
I awaked and saw that life is all service
I served and saw that service is joy."
1. A letter was forwarded to all Chapter Members in order to let them know the new governor election and to reinforce Chapter activities in the next years.
2. A communiqué was sent to all Scientific Societies, particularly to Venezuelan Society of Internal Medicine, in order to offer our support as a Chapter and at the same time our willingness to work jointly in Continuous Medical Education.
3. A survey was forwarded to update data on the Members of the Chapter. This survey included the Chart of the Organization on which the development of activities is based, and asked about the topics in scientific events and the Chart level in which the Member would like to participate.
4. Statutes of the Chapter were revised, as they had not been updated for 8 years. Review was done by several steps, 1) Joint revision with the retiring governor (Dr. Ramón Soto) and the incoming governor (Dr. Israel Montes de Oca); 2) Revision with Legal Adviser (Lawyer Irma Lovera De Sola); 3) Revision with the Advisory Council (see the names below). The Council approved the need to perform an Extraordinary Assembly to discuss and approve the statutes. This assembly was performed on June 22, 2001, after being convoked by mail and by a convocation notice in the newspaper. After discussion of some issues, the Assembly approved the final Document, which is now being authenticated by a notary.
5. The Governor appointed a new Advisory Council integrated by the following College Members: Dr. Eduardo Morales (FACP-ASIM), Dr. Ramón Castro (FACP-ASIM), Dr. Mario Patiño (MACP-ASIM) and Dr. Israel Montes de Oca (FACP-ASIM). Dr. Carlos Goldstein was also appointed as Treasurer of the Chapter.
6. In order to meet our needs and increase our activities. A half time secretary (Ms. Lina Carías de Aponte) was engaged for 5 hours a week, and a messenger was hired to be paid by the piece.
Other appointments for different Councils and Committees are being studied and will be published in the next Newsletter.
Internal Medicine and Subspecialties
Eduardo Morales Briceño, MD, FACP
Today Medicine arises several challenges to young generations as a scientific discipline. That which was an art is now settled on the highest quality and sound scientific grounds.
Young doctors recently graduated from our Universities have two major paths before their eyes: clinic sciences and surgical sciences. Both sciences have attractiveness, which differentiate them from each other, and at the same time offer unlimited horizons.
There is no doubt that specialization is a need for modern medicine. Times have already passed when a doctor could know all that was known. Medical knowledge is generated to fast to be entirely assimilated. This rational does not exclude at all the amplitude of criteria or the integral medicine concept. As Professor Carlos Alberto used to point out: "Good specialist is that who declares his/her capabilities in the solution of medical problems limited to certain organs or systems, without losing sight of the ill patient as a whole, and without neglecting patient category as a bio-psycho-social human being. If an specialist does not do that, he/she is not a doctor any more and becomes a technician, who can perform a better or worse job; because he/she has lost nobleness of purposes, loftiness of behavior, and the great possibility to contribute to the humanistic and scientific tradition of profession."
Internal Medicine Specialists ought to be professionals with a comprehensive education, endowed of enough knowledge, both scientific and humanistic, that make them suitable to their community and its socioeconomic situation. This way, they can perform the necessary transformations for community development as a nation. Currently, this aspect is of vital importance for our country, where health decentralization plays an important role in Chapteral and State development and new models of management are being implemented to perform primary, secondary and tertiary prevention maintaining an excellent medical attention to a lesser cost.
It should be of great concern to adequate the training of Internal Medicine Specialists to the current health modalities and to national development plans, in order to improve medical service and decrease population morbidity and mortality.
As Professor Seguin used to mention, "there are immense possibilities in clinical practice for sensitive and thinking men. To be a clinician is to approach our fellow man with no other weapons than knowledge and intelligence; it is to face problems that human beings present before us, making use of our most pure intuition (the basic characteristic of an artist) and our most sharp reasoning (fundamental condition of the science man)". Many times, the success of a clinician does not reside in his/her ability to handle knowledge but in its capability to handle men; this is precisely his/her most noble role and obligation. In addition, a clinician has an immediate and unquestionable sensation of victory few times. This slowness in success takes away from healing much of its dramatism; however, it reverts in personal satisfactions.
Every day that passes, Internal Medicine, just like Surgery , gets restricted while it is divided up by specialization. Nowadays we see subspecialties that originate from specialties. Doctors who restrict their activity to a very limited field can dominate the field better and become experts; however, they must know that they are putting at stake and sacrificing their capacity for a comprehensive understanding and approach to the patient. Subspecialties can arise due to several reasons: (1) technical and scientific advances make doctors to go deeply into certain medical issues to master those advances; (2) it is difficult for a physician to dominate all new knowledge; and (3) the population increase has created the need for professional teamwork in hospitals, according to specialties.
We must be aware that, nowadays, avalanches of knowledge and technology, and scientific advances, mean an important challenge for internal Medicine Specialists. Nevertheless, we are also convinced that life conditions of this professional within demanding and aggressive modern society bear pressure toward superficial and easy solutions. Competitive reality pushes Internal Medicine Specialist, many times dazzled by specialization, towards his/her differentiation within Internal Medicine. However, although specialization is directed toward the achievement of a better efficacy, some specialists are incapable to correlate and integrate factors of different kind that can determine and influence illness. This way, specialists can move away from the universal meaning that embraces all aspects of medical knowledge.
"To serve, the most wonderful word in the language." -- Paul Bourget
8th Annual Meeting of the Venezuela Chapter
From May 30 to June 2, 2001, two very important joint events were held in Porlamar (Margarita Island): The 8th Annual Meeting of the Venezuela Chapter (May 30) and the 2nd Latin American Congress of Internal Medicine (organized by Solami, Latin American Society of Internal Medicine).
Our 8th Meeting was an authentic success not only because of attendance (more than 600 people registered) but also due to its scientific quality. Topics of great interest were developed such as Emergent and Re-emergent Infections in Latin America, Bacterial Resistance, Dengue and Yellow Fever, Hepatitis C, Tuberculosis, AIDS, Cholera, and Human Genome Project. National and foreign guests were prominent professionals, all of them members of ACP-ASIM, and included Drs. Myron S. Cohen, Reed Pyeritz, Raúl Istúriz, Roberto León, Douglas Olivares, Manuel Guzmán, Bernardo Vainrub, and, on behalf of the College Representative Class, Dr. Clicerio González. College Guests also participated in the program of the 2nd Latin American Congress of Internal Medicine (Solami). We had the pleasure to share all the activities with a very special guest for our Chapter, Dr. Johnson III, Former Vice President and Adviser of ACP-ASIM.
Exhibit of the College was organized and attended to by two special representatives, Emily Brooks and Cecilia Castillo. Thanks to the activity Ms. Brook and Ms. Castillo, the image of the College could be projected as a Medical Institution oriented toward Continuous Medical Education; membership was promoted; attendants were informed about College different products, specially those related to published books; and the knowledge of the objectives of the College could be increased through different College documents.
As a Governor, I wish to express our thanks and appreciation to both the speakers of the Scientific Event and the above mentioned representatives.
Drs. Herman Wuani and Tomás Sanabria received the awards "Laureate Award" and "Voluntary and Community Service," respectively.
Considering the important Chapter participation in the development of the 2nd Latin American Congress a diploma was awarded to the College to acknowledge the success reached during the event.
The ACP-ASIM and its Venezuela Chapter collaborated and supported the XXXVIII National Scientific Meeting of Hospital Militar "Dr. Carlos Arvelo" (colloquies) held from June 11 to June 15, 2001.
Venezuela Chapter supported and participated in the event "Treatment in Rheumatology" held during the IV Meeting of Rheumatology of the Specialists Graduated from the Rheumatology Post-graduate Course "Dr. Angel Larralde". The event was held on July 14, 2001, at Centro Médico Guerra Méndez in Valencia.
Forthcoming scientific events:
1) The Chapter will develop a new scientific event "Update for Treatments in Internal Medicine", in conjunction with the Larense Chapter of the Venezuelan Society of Internal Medicine (S.V.M.I.). The event will be held on October 6, at Torre David in Barquisimeto. The speakers will be members of ACP-ASIM and the corresponding Chapter.
2) Three day course titled "Diseases of the Respiratory System". The course will be supported by de Societies of Internal Medicine, Pneumonology, and Chest Surgery, The American College of Chest Diseases and the Venezuela Chapter. The program and the site for the event will be published very soon.
3) The Annual Meeting of the Chapter will be held in May 2002, in Caracas. The subject of the program will be "Role of the Internal Medicine Specialist in Emergency Care, Acute Diseases and Critical Medicine". Special guests, College representatives for the corresponding specialties, a guest of the College Representative (ACP-ASIM) and outstanding Venezuelan specialists will participate in the Meeting. The program is being prepared and organized in conjunction with Dr. José Besso (FACP-ASIM) and patronized by the Venezuelan Society of Internal Medicine, Venezuelan Society of Critical Medicine, and Pan-American and Iberian Society of Critical Medicine. The entire program, guests, date and site will published timely.
Some Thoughts About Medical Certification and Re-certification in Venezuela
Dr. Ramón Soto, MD, FACP
Without objection, doctors need to update their scientific knowledge, skills and aptitudes in the patient health benefit, as scientific medical knowledge is innovated every day by new findings and tendencies.
Certification process in Venezuela has been carried out effectively by the Venezuelan Medical Federation. Certification has been an indispensable requirement for medical practice according to the Law of the Practice of Medicine and Medicine Deontology Code. On the contrary, re-certification process - understood as the mechanism by which a physician credits the updating of his/her professional knowledge, expertise and attitude - has not taken shape despite some scientific societies attempts. In this sense, we lag behind some other nations, not only from the first world but also from the developing world, as Brazil, Mexico and Chile.
That, which we have not been able to perform by our own initiative will have to be done to observe the law. In fact, the Health Organic Law Draft - Title II, Chapter 6, Section V - prepared by the Presidential Commission for Social Security in February, 2001 - which is to be discussed by the Legislative Assembly of the Bolivarian Republic of Venezuela, considerates the following:
Certification and Re-certification of Professionals and Technicians
Article 115. For the practice of all professions and techniques related with the healthcare it will be required to have a title - qualified, certified, and duly acknowledged by the State - to be registered in the Ministry of Health and Social Development, and fulfill the corresponding re-certification process.
Re-certification of Health Care Professionals and Technicians
Article 116. Re-certification is understood as the process by which the Ministry of Health and Social Development accepts the updating of competence and knowledge of the Healthcare Professionals and Technicians. A Commission will be created - constituted by the Ministry of Health and Social Development, the Ministry of Education, Scientific Societies and the corresponding Unions - in order to establish the criteria and mechanisms for re-certification. The Commission will be coordinated by the Ministry of Health and Social Development.
The Commission should establish the norms and regulations that will govern certification and re-certification, including the frequency of re-certification.
Several questions arise with respect to the role that academic, scientific institutions, and the corresponding unions will play in the re-certification process. Those questions keep us in state of expectation. Re-certification process is complex and the previous lack of expertise adds one more difficulty to that complexity. Doctors (the target of re-certification) voices must be listened to for them to put forward their inquietudes and suggestions. On the other hand, we all know that regulation of a law is within the National Executive Power field and this would result in uncertainty about the scope of the law and an in understandable doctors concern.
Within this legislative proposal, we run the risk of going from the situation we now have of "laisez faire, laisez passe" to the other end of an interventionist State. This new situation could lead us to non-equilibrated situations and political interference, which would deform the Hippocratic spirit and could deteriorate healthcare services, qualitatively and quantitatively. Medical Professional - as all human being belonging to world of intelligence - needs room for intellectual creation and for giving his/her science to the humanitarian practice.
All these reflections gain validity with the Law of Partial Reform of the Law that Regulates Health Subsystem, which was recently approved by the Legislative Assembly and published in Official Gazette No. 5,540 (Extraordinary) on June 30, 2001. Article No. 67 is the only article that mentions the topic we are dealing with. This article refers to Institutions that Give Healthcare Services and Professionals of Healthcare Services who Act on Their Own. The article at issue reads: "Institutions that Give Healthcare Services consist of public, private or mixed hospitals, and outpatient clinics, as also healthcare professionals who act on their own in their offices, including the domicile. These establishments must be certified and accredited by the Ministry of Health, and registered in the Superintendence of the Healthcare Subsystem." All other considerations previously referred to in the Project of Organic Law of Health disappear. This new law creates a limbo regarding information on re-certification and more uncertainty about the State resolutions. However, the law is not going to come into force up to January 2002, as for "vacatio legis." Therefore, it could be expected that modifications to extensively define all items related with re-certification were performed in the lapse left.
In addition, it is to be expected that the re-certification program and its implementation are reasonable and practical, without falling into academic or procedure excesses that hinder or invalidate its objectives scope. The program should have clinical relevance and the necessary flexibility to adapt to the characteristics of the different types of medical practice. The program should not be onerous or distract the physician from his/her medicalcare, academic or research obligations. Finally, the re-certification program should be perfectly articulated with a continuous medical education program, which is well conceived and coordinated, practical, inexpensive, accessible and easily assessable.
By way of information, it is convenient to point out that within ACP-ASIM it is currently occurring a fiery controversy about re-certification of American Internal Medicine Specialists. They have formulated serious objections to the re-certification process put forward by the American Board of Internal Medicine (ABIM). Many members of the American College of Physicians call the re-certification process inadequate and expensive. ACP-ASIM Regents Corp has seconded these complains. It has designated a Commission to discuss and negotiate about a 5-item proposal with the ABIM. The proposal gathers the complains and objections of the members, without denying the need for re-certification. The Commission should present a report of its work during the current month of July, so the Regents Corp takes up a definitive position with regard to the new ABIM re-certification program. In view of the strength and prestige of the ACP-ASIM, there is no doubt that ABIM will have to come to an agreement and offer a re-certification program more harmonious with the College lines.
Lets say by de way, that medical re-certification is not mandatory in the United States, by Law. It constitutes a process to which doctors submit voluntarily to keep academic, hospital or other privileges, and to attract a patient population better informed every day about medical business. Re-certification acts as a natural selection mechanism more than as a compulsive and mandatory procedure.
To be raised from Associate to Member and from this to Fellow, ACP-ASIM requires that the physician passes the Board of Internal Medicine. Aspirants from Latin America are dispensed of this requirement because the Credentials Sub-committee accepts as equivalent the certification of a 3 year accredited residency in Internal Medicine, or some of its subspecialties, plus the recommendation of two Fellows of the College ("Proposer" and "Seconde"). However, the Subcommittee has recently agreed - satisfying a Chile and Mexico request - that the Associates who complete their postgraduate residencies and the local programs for certification in Internal Medicine should be raised automatically to Members without presenting the letters from the Fellows. Other Latin American countries will be able to base themselves on this disposition insofar as they implement their own certification and re-certification programs.
MKSAP = 12(Medical Knowledge Self Assessment Program)
Twelve Edition of MKSAP is the most popular program of medical knowledge self-assessment. The program has been completely reorganized and redesigned, and it embraces 13 areas of Internal Medicine and its subspecialties.
Each section consists of a syllabus that updates the most important developments in Internal Medicine, questions and cases, basic interest points and self-assessment tests. MKSAP-12 is available both, as hard copy and as CD-ROM.
To order it call (800) 523-1546 ext. 2600 (9:00 a.m. to 5:00 p.m.) or for more information use the Website: www.acponline.org/catalog/MKSAP
1) Education Department of ACP-ASIM has translated to Spanish two Clinical Skill Teaching Modules. Modules are "Arthrocentesis and Joint Injection" and "Skin Biopsy Techniques." To obtain these modules get in touch with the link person in the Chapter, Ms. Helen Canavan, whose E-mail is: firstname.lastname@example.org
2) Merck-Sharp & Dohme Co. announces the creation of a grant to perform a Cardiovascular Diseases Course at Mount Sinai Medical Center in Miami. The candidate will be selected according to the regulations established in conjunction with ACP-ASIM, in the person of its Governor, and the President of de Venezuelan Society of Internal Medicine.
GIC: Governor Information Center
The Governor Information Center is intended to provide information to all Governors. However, the Chapter receives important news through this Center, which are known as "Hot Topics," whose content can be obtained by means of Alison Dufner (email@example.com) or the College International Website: http://www.acponline.org/college/international/index.html.
For example, information was given on two very interesting aspects of the following issues, in June:
A) Ethics in Medical Practice: Conduct in medical care and environmental changes in healthcare.
B) Re-certification: Talks with ABIM (American Board of Internal Medicine). It is especially interesting for those who wish to take the exam because some changes are announced.
The Governor Information Center printed, in July, several summaries of articles recommended to be published in the Chapter Newsletters.
We have selected the following:
Practical Treatment Center Puts into Circulation New Publications: Practical Treatment Center of the ACP-ASIM has recently put into circulation new publications intended to help the very busy Internist understand a variety of Medical Care Topics. These publications, and many others, are available for members without charge by accessing the Website www.acponline.org/pmc, or by calling the Costumer Service through the telephone number 800-523-1546, ext. 26000.
New publications have the following titles:
1) The Good Business Approach to Medicare Compliance: A Road Map for Internists.
2) Medicare Compliance Action Plan: A Good Business Approach for Smaller Practices.
3) What Internists Need to Know about Medicare Changes for 2001?
Internal Medicine (Physician for Adults) and Subspecialty
Mario J. Patiño Torres, MD
Internal Medicine Professor, Clinic and Medical Therapeutic "B", Luis Razetti School of Medicine, Hospital Universitario de Caracas (HUC), Universidad Central de Venezuela (UCV).
Academic and practical conception of Internal Medicine stems from German Medical School, which introduced the integrality concept and provided the new specialty, Internal Medicine, with Doctrine characteristics. During the first half of 20th century, subspecialty practice led Internal Medicine to be seen as a discipline aggregate, and not as an integrative discipline. This twisted conception obliged to revalorization and revival of the "Generalist Internal Medicine" as a legitimate discipline specialized in adult diagnosis and treatment. The ALMA ATA declaration (1978) adds more to this motivation for generality and establishes the priority of resources for primary care.
In Venezuela, Clinical Medicine originated and developed with the name of Medical Clinic up to 1949, when the concept of the Internal Medicine practice is introduced. Then, the Clinical Medicine was assimilated by the Internal Medicine Specialty. A great number of clinicians gathered in Medical Schools, located in Hospital Vargas and Hospital Universitario de Caracas, and they gestated a movement that propitiated Internal Medicine as an Holistic and Integrative discipline, the base of all medical specialties. This movement culminated with the foundation of the Venezuelan Society of Internal Medicine on April 18, 1956, and the start of the "Specialty Postgraduate Courses in 1959. More than 40 years of enormous teaching, scientific, academic, administrative, informative, organizational and union work have elapsed since then, with more than 2500 Internists being formed in the Universities. In those more than forty decades, the concept and rational has been generated to orient official organisms and University Postgraduate Courses on what should be the basis for curriculum designs and medical practice new tendencies, in which Generalist Internist has a fundamental role.
Usually, sub-specialists do not take up the responsibility of patients who do not come within their particular fields. This results in patients being cared for by several specialists with different approaches that some times are contradictory. This attempt to provide medical care with sub- or super-specialists brought about the so-called "Health Paradox;" the population was unsatisfied due to fragmented, depersonalized and excessively technicalized attention and additionally, health care cost went up.
However, scientific-technical revolution in the last 50 years has remodeled technique but not clinic. That what has become obsolete are the former techniques, but not the clinic. If there is any medical specialty that should keep defending the clinical method to assess the healthy and the ill adult, it is Internal Medicine. The image of the Generalist Internist is - and will always be - that of the clinician par excellence, the highly capacitated physician who can generalize through all fields of Internal Medicine, and who is recognized as a consultant by all other specialties.
The rational for persistence and pertinence of Internal Medicine is the following:
- Internal Medicine has served as the conscience of medical profession.
- Generalist Internists are able to cover a high range of adult care, from primary attention to tertiary attention.
- Generalist Internists serve as a link between patient and other sub-specialists.
- Internal Medicine is the specialty which has been submitted to more changes among all specialties, and the specialty which has adapted the best.
Internal Medicine mission within the health system consists of:
- Harmonic Integration of knowledge and skills;
- Synthesis, understood as promotion of the adult as a unique and indivisible bio-psycho-social being;
- Coordination, as a service mission of horizontal organization;
- Cooperation within an ethical relation, with scientific rigor, to favor the better care of the adult, and with a credible and qualified function of education and research;
- Specificity to approach medical, social and psychological care of the adult as a subject, and not as an object of the care.
Finally, new millennium Internal Medicine is called to develop the clinic, theoretically and practically, for the clinic to be kept alive and contribute the medicine of the future. It is necessary for this that we, Generalist Internists, get adapted to changes. We must define what must last, so that all the other can change, without losing the basic principles of the clinic and clearly differentiating that which is science from that which is technique. We should get more deeply involved in action, prevention and promotion, and recognize that the first line of action is not at the hospital ward but at the health primary care level, without abandoning our major mission in hospitals and Universities.
We must convey the vision of the integral aspect of clinical medicine and society to the rest of our colleges and students; this vision results in the capacity to achieve a better clinic in every time and place. It is still necessary a general theory that explains the health/disease process in a person, group and society. Internal Medicine contribution to this must be decisive; the tools provided by clinical epidemiology, and, even better, the clinical decision model that represents Medicine Based on Evidence, if correctly used, allow reaching those purposes.
Despite recognition of the scope of the challenge we face - as it is to guard the essence itself of the clinic in a unstable and changing environment - we trust that the best of human being will succeed to continue moving forward through this path into the new era, for the good of every body.
Voluntary and Community Service Project
The Chapter - by means of its Governor and the Committee for Voluntary and Community Service to be designated very soon - will implement a project, which will consist of a first phase of free primary medical care for the needy. This project will be implemented in conjunction with some charitable institutions or in some voluntary colleagues offices.
We will further inform about this project in the next Newsletter.
How to Contact Us
Governor: Israel Montes de Oca
- Home: Avenida las Acacias, Edf. Albarregas 71, La Florida. Caracas, Venezuela.
- Office: Centro Médico de San Bernardino, Anexo B, 2° piso-C. San Bernardino. Caracas Venezuela.
- Mailing Address:
- In Caracas: Apartado Postal N° 1126 Caracas 1010a - Venezuela.
- In Miami: 4405 N.W. 73rd Ave Suite N° 30-837 Miami Fl. 33166-6400
- Phone Number:
- Home: 058 (212) 781-2992
- Office: 058 (212) 551-5442
- University: 058 (212) 662-8202
- Cellular: (014) 303-1005
This Informative Bulletin of Venezuela Chapter (ACP-ASIM) has been edited in Spanish and English, thanks to the cooperation of Merck Sharp & Dohm of Venezuela Laboratories.