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      "titulo" => "S&#237;ndrome de hipersensibilidad a los anticonvulsivos&#58; reporte de un caso"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">One of the most important and complex processes of transforming medical activity began to develop in the second half of the 20th century&#46; This change involves what is currently known as &#8220;shared decision making&#8221; &#40;SDM&#41;&#46; For centuries&#44; it was the physician&#39;s prerogative to define the health problem and decide for the patient &#40;and&#47;or the relatives&#44; or even in the face of what other health professionals or society sectors believed&#41; what the most appropriate course of action to solve the problem would be&#46; This attitude has commonly been called medical paternalism and was&#44; in its time&#44; seen as correct from the epistemological &#40;the physician is the one who knows the most about health and disease&#41;&#44; the ethical &#40;the physician&#39;s intention is always good&#41; and the moral point of view &#40;society bestows this prerogative to the doctors&#41;&#46; However&#44; just as with other aspects of health and disease&#44; the historical moment is decisive when interpreting the events that affect human beings and when organising the transactions among the various sectors of society&#46; This transformation has been attributed to erosion of confidence in medicine as a profession&#44; in addition to ever-greater doubts as to the integrity of the institutions&#44; organisations and systems that provide health services&#46; In turn&#44; this situation has been linked to multiple factors&#44; among which the following stand out&#58; a&#41; nowadays&#44; individuals confront traditional authority in numerous fields and in medicine people now consider not only the expert&#39;s knowledge to be important&#44; but also their own experience as a valid and necessary element for making decisions&#59; b&#41; there is a tendency to consider that doctors put their own interests above those of their patients&#59; c&#41; the increasingly widespread vision that patient access and participation are restricted by economic interests of both pharmaceutical firms as well as the many stakeholders in the health systems &#40;for example&#44; medical carriers and health promotion companies&#44; among others&#41;&#59; d&#41; the unrealistic expectations transmitted to society &#40;stemming from the idea of ever-increasing medical progress as a type of happily inevitable destiny&#41; that medicine offers and guarantees progressively more and better results in its interventions&#59; and e&#41; the practical&#44; ethical and conceptual difficulties derived from shifting the emphasis from cure &#40;related to acute disease&#41; towards emphasis on management &#40;involving chronic disease&#41;&#46; In this new context&#44; SDM is being strengthened&#59; SDM&#44; that is defined as the involvement of the patients in the decisions that concern them with respect to diagnosis&#44; prevention&#44; treatment and rehabilitation&#46; Such joint decision making is a significant source of reflection&#44; doubts and problems as to its conception and implementation in psychiatry&#46; As Villagr&#225;n et al indicate&#44; modern psychiatrists find themselves divided between &#8220;unjustifiably side-stepping the autonomy of the patients to safeguard their welfare&#44; and unjustifiable respect for their autonomy at the cost of that welfare&#8221;&#46; This balance is undoubtedly difficult and depends on our conceptual open-mindedness&#44; our communication with the patients&#44; our competence and possibilities of assessing the patient&#39;s capacity when it becomes time to make a specific decision&#44; and&#44; finally&#44; the assessment of the risk &#40;for the patients themselves and for third parties&#41; that accompany the disease&#46; The good news is that empirical studies tend to support SDM as an effective&#44; safe and ethical way to reach decisions&#44; capable of being implemented even with patients that suffer from severe&#44; persistent mental illnesses&#46; However&#44; we should ask ourselves whether in Colombia we psychiatrists have&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0010" class="elsevierStylePara elsevierViewall">space &#40;both during training and in carrying out the profession&#41; to think about SDM and acquire the skills for its implementation</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">a social and health system setting favourable to SDM</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">a legal and ethical setting that backs the doctor and the patient in making decisions jointly&#46;</p></li></ul></p><p id="par0025" class="elsevierStylePara elsevierViewall">The invitation is thus to reflect and try to create the possibilities so that our profession&#44; without having to sacrifice some of its basic principles&#44; can adapt to the new models of relationship and help for patients and society&#46;</p></span>"
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