Risk communication: ethics, psychology, law

When communicating with a patient, a doctor is within a certain cultural practice (science-based medicine and state health care system), falling outside the limits of which is not legal. However, a broader understanding of medicine as a cultural phenomenon with a focus on health also requires a more varied perspective on patient care. The patient’s problem can be more complex than looking at it from science- and evidence-based point of view. Therefore, in risk communication as an element of work with adherence or as part of signing informed consent, different ways are needed to consider a patient’s situation. An ethical and psychological perspective on clinical interactions allows for a more holistic view of the disease

The components of clinical interaction ethics

Ethical norms are traditionally inseparable from medical work as such and are an unconditional part of the general idea of medicine and doctorhood. However, the structure of medical ethics is ambiguous and complex. It includes the ways in which ethically loaded decisions are made, the categories of ethically loaded decisions themselves and the good/bad dichotomy, as well as cultural context that defines these categories. The psychological component also plays a role: mental state of a patient, a doctor, as well as verbal and nonverbal communication. Finally, the legal framework is imperatively introduced into the doctor-patient relationship, setting norms regardless of the nuances of interpersonal interaction. This article discusses the most important and explicit components of an ethical relationship in helping, and also proposes as a universal solution the ethics of virtue neither as an instrumental, but an essential approach

When the body does not collaborate: pharmacological treatment of obesity

The paper presents the modern evidence on pharmacological treatment of patients with obesity and comorbidities, who try to modify their lifestyle, but are unsuccessful due to metabolic disturbances. The main and recently discovered additional effects of orlistat are discussed

ANGIOTENSIN RECEPTOR ANTAGONISTS: GOING WITH THE TIMES

This literature review focuses on the angiotensin II receptor antagonists as one of the new and promising classes of antihypertensive medications. Apart from their antihypertensive activity, these agents possess a number of other beneficial effects. The results of multiple studies, including large multi-centre clinical trials, are presented for olmesartan, an angiotensin receptor antagonist with additional beneficial properties

Humanitarian competencies of a doctor (cardiologist)

The article reveals the features of working with the patient as a social and psychological subject, who, in addition to somatic pathology, has an experience of the disease situation. Psychosocial risk factors for cardiovascular (and more generally non-infectious) pathology, as well as social well-being as a component of positive health, are considered as elements of a doctor-patient relationship. Work with a person requires from a doctor competency that differs from working with pathology at a biological level. Perhaps, the time has come to single out “biomedical doctors” and “medical doctors” in clinical medicine, of which the first ones are not required humanitarian competencies. Since non-infectious pathology largely includes psychosomatic features, and mental processes are filled with an experience of social reality, the clinician must have skills of human sciences to work with them. This is especially important in view of the physician’s power as an ambassador of medicine and health. The following competencies are discussed: internal work skills, situational search and interpretation, communicative and ethical competence, development of positive health

Arterial hypertension and coronary heart disease: the place of angiotensin II receptor antagonists

The paper considers arterial hypertension and coronary heart disease as pathologies which share multiple pathogenetic mechanisms. The role of angiotensin II receptor antagonists (ARA) in the effective treatment of these diseases and in prevention of their complications is discussed. The modern views on ARA and their indications are presented

STROKE PREVENTION OPPORTUNITIES FOR CARDIOLOGISTS: COMPLEX MANAGEMENT OF ARTERIAL HYPERTENSION (ROLE OF CALCIUM ANTAGONISTS)

The paper focuses on the important issue of cardio-cerebral interactions, cardiac comorbidities, and the need for complex therapeutic approaches. While stroke is traditionally regarded as a neurologic problem, cardiologists play an important role in its prevention, via modification of multiple risk factors. One of the key preventive measures is arterial hypertension treatment. New calcium channel blockers are a promising group of modern antihypertensive medications

Arterial hypertension treatment with a calcium channel blocker and an ACE inhibitor. Benefits of combination therapy

The paper emphases the need for dual antihypertensive therapy and describes itsbenefits, such as synergetic hypotensive action and other beneficial effects. One ofthe pathogenetically justified variants of combination therapy – a third-generationdihydropyridine calcium channel antagonist and an angiotensin-converting enzymeinhibitor – is discussed in more detail

PATIENT-CENTERED MEDICINE. A NEW REALITY

The literary analysis is presented to underline the importance and controversy of the meaning of patient-centered medicine, which attracts  more and more researchers and practitioners. The origins of this concept are reviewed, its further directions as a novel generalized  physician  approach to a human  with opportunity  to launch positive dynamics  on all levels from somatic  to social  and  cultural.  A  range  of questions is taken,  and  the  pathways  sketched towards  conceptualization   and evidence base for practical implementation of patient-centered paradigm

Sociocultural factors in the cardiovascular continuum

The article shows biosocial relationships as elements of pathological changes of cardiovascular pathology — first at the functional, then at the morphological level. The ability to interact with the semantic, symbolic reality is the competence of a doctor, which allows helping people at the level of a person’s social identity. It is shown that in addition to the evidence-based (essentially biological) aspects of contact with a patient, there are sociocultural aspects. They are fundamentally different, since at the cultural level reproducibility and reproducibility are impossible. In this way psychological part is only the moment of the transition of the biological into the social, and vice versa. This approach returns to medical care its original meaning — working with a person in its entirety, which corresponds to WHO definition of health