Portuguese Journal of Family Medicine and General Practice
The Portuguese Journal of General and Family Medicine is the official organ of the Portuguese Association of General Family Medicine. It aims to contribute to the development of the specialty of General and Family Medicine and Primary Health Care, through an impartial, rigorous and up-to-date scientific publication. It has been published since 1984 with a bimonthly periodicity.
Associação Portuguesa de Medicina Geral e Familiar
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith. The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
Silva Henriques – Family doctor and ideals
A revista da APMGF tem dedicado este espaço a testemunhar a vida de médicos que contribuem para o nosso legado em Medicina Geral e Familiar, seja pelo seu testemunho de vida, seja na ajuda da construção de conjunto de processos doutrinais, que recriam e renovem o saber instituído e as práticas vigentes. Considero que José Maria Silva Henriques é um deles.
Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
Ciência dos Fatores Humanos: colocando as pessoas no centro dos cuidados de saúde
Para além da consulta de MGF: porque o futuro da saúde começa na comunidade
Pré-Conferência WONCA 2025: um encontro que transforma
Luís Rebelo's legacy: family health and smoking cessation in general and family medicine
Prevalência e preditores de doença renal diabética: um estudo transversal nos cuidados de saúde primários
Introdução: A doença renal diabética (DRD) é uma das principais causas de doença renal em estádio terminal. Os cuidados de saúde primários são fulcrais para o diagnóstico precoce e a gestão da doença. Objetivos: Avaliar a prevalência e a precisão do diagnóstico de DRD. Adicionalmente, identificar potenciais fatores de risco para a DRD e avaliar a prescrição de medicamentos nefroprotetores. Métodos: Estudo transversal numa amostra aleatória de 387 utentes com diabetes tipo 2 num centro de cuidados primários no norte de Portugal. Foram recolhidos dados demográficos e laboratoriais dos doentes, bem como evidências de prescrição de IECA ou ARAII e/ou iSGLT2. O diagnóstico de DRD foi baseado nas guidelines KDIGO 2012. Os códigos ICPC-2 U-99 e U-88 foram considerados adequados para identificar a DRD codificada. Uma regressão logística multivariável foi usada para investigar associações entre a DRD e potenciais fatores de risco como idade, sexo, IMC, hipertensão, dislipidemia, tabagismo e duração, controlo e complicações macrovasculares ou microvasculares da diabetes. Resultados: Foram incluídos 338 utentes, dos quais 58% eram do sexo masculino, com uma idade média (±DP) de 71,4 (±10,2) anos. A prevalência de DRD foi de 42,6% [IC 95%, 37,4-48,0%], com apenas 9,5% devidamente codificada. A maioria dos doentes encontrava-se nos estadios G2 (33,3%), G3a (30,6%) e G3b (14,6%) e, em relação à albuminúria, no estádio A2 (68,8%). Entre os doentes com DRD, 77,1% [69,6-83,2%], 60,4% [52,3-68,0%] e 43,1% [35,3-51,2%] estavam medicados com IECA/ARA, iSGLT2 e ambos, respetivamente. O sexo masculino (OR=1,89), idade avançada (OR=1,08), maior IMC (OR=1,06), complicações macrovasculares da DM (OR=1,90) e dislipidemia (OR=4,95) foram identificados como fatores de risco independentes para a DRD. Conclusões: Este estudo destaca a elevada prevalência e subdiagnóstico da DRD, identificando áreas para melhoria na prática clínica.
WONCA World Conference – Lisbon, September 2025
Gender dysphoria: when no one is paying attention
Introduction: Transgender health remains a challenge for healthcare professionals, given the fast evolution of concepts related to gender roles and sexual identity, with frequent updates to definitions and nomenclature. Also, being a delicate and divisive theme in society, it generates distress, suffering, and stigmatization for people experiencing these processes. Besides, there is often significant inaction by primary health care professionals when addressing these topics, thus failing to identify and help people in distress who are sometimes incapable of asking for help. Case description: A person assigned male at birth, 56 years old, single, unemployed, living with her parents, who financially support her. The patient booked an appointment with the Family Physician, presenting frequent panic attacks. After the clinical interview, the patient revealed that she identifies as a woman, and not with her natal gender. She admitted feeling this way since adolescence, only now having the courage and determination to come out and engage in gender-affirming treatments. A careful clinical history allowed the identification of the distress this person experienced throughout her life, permitting a referral to secondary care facilities and psychological support. Comment: A person suffering from knowing who they are but not knowing how to act or seek help generates severe problems for their biopsychosocial well-being. Primary healthcare workers, being the frontline of healthcare systems, need to be alert to signs of struggle and distress and must be available to actively explore the gender and sexual dimensions of people’s lives. On the other hand, they also have a fundamental role in managing comorbidities and coordinating with secondary health care and other supportive entities, providing personalized and integrated care throughout the transition process.
Livro de Resumos 42º ENMGF 2025 - Troia
Mourning: medical attitudes and a person’s expectations in the general practice/family medicine ambience
Introduction: Grief, a personalized response to the loss of a significant other, often leads to seeking medical consultation. Objective: To evaluate and compare the attitudes to be used by family medicine doctors (m-FM) and the expectations of bereaved individuals. Methods: An exploratory, cross-sectional observational study was conducted on a sample of m-GP, chosen conveniently, and on individuals who have been in mourning for less than a year, applying a specifically designed clinical case and response to similar medical attitudes and expectations in closed multiple-choice and open-ended options. The application process took place after consultation and was also conducted remotely, following an invitation from the m-MGF, by the inclusion criteria. Readability analysis of the text and descriptive and inferential statistics of the data were performed. Results: In a sample of 21 m-MGF, 13 (46.4%) women and n=12 (57.1%) specialists, and from 20 people, n=15 (75.0%) were women. Significant differences were found in the responses of m-MGF and people (p<0.001), with empathetic counseling being the most chosen option by m-MGF, 69.6%, and people, 27.5%. For 91.7% of the specialists, only empathetic counseling was selected, with specialty interns responding with more options (p=0.014). People significantly chose more associations of therapeutic attitudes, 31.7% (n=13), than GPs, 2.4% (n=1, p<0.001). Discussion: The differences found in this unprecedented study, simultaneously academic and practice-oriented, regarding medical attitudes and the expectations of people in the face of a bereavement case, suggest the need for a more comprehensive approach by doctors in managing people in mourning, such as the use of empathy, person-centered medicine, and social prescription. Conclusion: In this sample, despite the same attitudes and expectations, differences were observed between m-MGF and people. Doctors predominantly opted for empathetic counseling (69.6%), while people chose other simultaneous approaches.
Treatment of patients at high risk of osteoporotic fracture in a USF: the importance of FRAX®Port
Introduction: Osteoporosis is a bone disease whose prevalence has been increasing, particularly in elderly females. The main clinical consequence is the fragility fracture, leading to increased morbidity and mortality, and a decreased quality of life for the patient, representing a significant socioeconomic burden. The current challenge is the early identification of individuals at higher risk of fracture who require therapeutic intervention to prevent future fractures. Objectives: To study the beginning of anti-osteoporotic therapy in female patients at high risk of osteoporotic fracture. Methods: A cross-sectional study based on the review of medical records and telephone interviews of 50-year-old and older female patients from a Family Health Unit in the Western Lisbon area. The sample size was calculated using the SurveyMonkey website, and the population sample was randomly selected. Fracture risk was calculated using FRAX®Port. The population was stratified based on fracture risk, and therapy initiation was verified in high-risk patients. Results: A sample of 250 patients was obtained, of which 20.8% (n=52) had a high risk of fracture, 9.2% (n=23) had intermediate fracture risk, and 70% (n=175) had low fracture risk, according to FRAX calculation. Among the patients identified as having a high risk of fracture, 28.8% (n=15) were receiving anti-osteoporotic therapy. Conclusion: It was found that only 28.8% of patients at high risk of fracture were receiving treatment, highlighting the importance of raising awareness among healthcare professionals for the assessment of osteoporotic fracture risk in Family Medicine appointments and implementing a change in the diagnostic and therapeutic approach to osteoporosis.
The future of general and family medicine in Portugal
Like medicine in general, general and family medicine is at an inflection point. Digital transformation, artificial intelligence, and demographic changes require a redefinition of the family doctor's role. Portugal faces urgent challenges: a growing shortage of professionals in the National Health Service, an ageing population, and the need to ensure equity in access to health care. How can we ensure that general and family medicine adapt to this reality without compromising its fundamental principles?
The legacy of Professor Isabel Santos: the people
Professor Isabel Santos determined the direction of the specialty of General and Family Medicine in Portugal. Few people have thought of such drastic changes, so based on the foundations of the specialty: undergraduate and graduate training, continuing education, and research. Her mentoring resulted in hundreds of disciples, including students, interns, specialists, doctoral students, senior researchers, leaders, and those responsible for health organizations and public policies. Due to its direct and indirect action, we now have more doctors in Portugal, especially more family doctors.
Jaime Correia de Sousa: master, leader, and visionary
Honor and challenge! These are two ideas that represent what I feel when writing these words. It is an honor to talk about someone I admire so much. Challenged by the fear that words will become too small to describe the scope of your person and your journey. Jaime Correia de Sousa, as a family doctor, professor, researcher, and visionary, has become an essential figure in General and Family Medicine (GFM) in Portugal, inspiring generations of doctors and other professionals to embrace the values ​​of humanism, dedication, resilience, and empathetic leadership.
Self-assessment of professional satisfaction with general practice consultations: a reflection on the Patient Satisfaction Questionnaire
Introduction: The Portuguese version of the Patient Satisfaction Questionnaire (PSQ-PT) involves the physician's self-assessment perception of their consultation. Objectives: To verify the reliability of the Medical Satisfaction Questionnaire (MSQ) and to validate it convergently with the self-assessment of satisfaction with the consultation in General and Family Medicine. Methods: The PSQ-PT was adapted to QSM and a survey was conducted with QSM, with a lower score indicating a better result, the question "How do you rate your satisfaction with your consultations, in general?", on a scale of 1-10, with 10 being the best, and contextual questions on sex, career category, and type of Health Unit of work, in December 2023 and December 2024, online on specific social media conversation platforms, with a minimum sample size of n=71 responses, without duplicates, in each application. Results: The reliability verified equal results. A sample of n=265 was studied, 67.2% women, 76.6% Specialists, 83.4% in the USF model, n=149 in 2023, and n=116 in 2024. The reliability was 0.675, Cronbach’s alpha, and if an item was excluded, it ranged between [0.634 and 0.685], and the Intraclass Correlation Coefficient was 0.298 [0.161 to 0.420], with a 95% confidence interval. The Kendall correlation between the sum of QSM and satisfaction with the consultations was r=-0.384, p<0.001. Only by sex, the QSM was significantly different, p<0.001, with men scoring 16.3±3.1 and women 18.3±3.1. Discussion: An unprecedented study on a scale of good internal consistency and reliability, which will allow for future improvement in quality by adjusting some of the poorly answered premises. Conclusion: The QSM allows for the evaluation of professional satisfaction with the consultation in general practice, enabling the identification of areas for improvement.
Diabetes in times of a pandemic: the impact of COVID-19 in different Family Health Units across the country
Introduction: Diabetes mellitus (DM) is a chronic disease associated with significant morbidity and mortality, and its management is multifactorial. Evidence remains scarce and contradictory regarding the impact of the COVID-19 pandemic on glycaemic control in people with DM. This study aimed to assess changes in glycated haemoglobin (HbA1c) values in individuals with DM during the COVID-19 pandemic. Methods: Data were extracted from electronic medical records of three patient panels with DM, belonging to three primary care units in the Northern and Central regions of Portugal. HbA1c values from the pre-pandemic period were compared with those recorded during the pandemic. Results: A total of 296 participants were included (51% female): 85 from Unit A, 76 from Unit B, and 135 from Unit C. At baseline, participants had a mean age of 65.8 ± 11.0 years and had been diagnosed with DM for 5.4 ± 3.3 years. Compared with the pre-pandemic period, HbA1c values decreased during the pandemic. An inverse association was identified between HbA1c and age. No significant sex-related differences were observed. Conclusion: This study was pioneering in Portugal in exploring glycaemic control in primary care patients with DM during different COVID-19 pandemic phases. Although statistically significant improvements in HbA1c were observed in some semesters, the magnitude of these changes was small and clinically negligible, aligning with international evidence reporting a neutral effect. Further research is required better to understand the pandemic’s impact on diabetes care.
Sperm vs COVID-19: an unexpected case of male infertility
Introduction: Azoospermia is defined by the complete absence of spermatozoa in the ejaculate, resulting in the impossibility of conceiving with the male partner’s sperm. It is one of the most impactful forms of male infertility for couples. An increase in infertility cases reported after SARS-CoV-2 infection suggests a potential correlation between the virus and impaired spermatogenesis. Case description: A 42-year-old male, living with his wife and daughter, had a SARS-CoV-2 infection in 2022. He had no relevant past medical history or regular medication use. In January 2024, he consulted his family doctor (FD) due to secondary infertility, after 14 months of unsuccessful attempts to conceive, despite normal fertility studies in his wife. A spermogram revealed a complete absence of sperm and immature germ cells. A second analysis at a specialized clinic in March 2024 confirmed azoospermia. He was referred to urology, where further hormonal and ultrasound evaluations in May 2024 showed normal results. A testicular biopsy was suggested but refused by the patient. The couple decided not to pursue additional investigations or assisted reproduction techniques. At the follow-up appointment in July 2024, the FD offered psychological support due to the diagnosis’s potential emotional and social impact. Comment: Considering the patient's clinical history and current literature, SARS-CoV-2 infection appears to be the most plausible cause of his azoospermia. Although the couple has come to terms with the diagnosis, it remains a life-altering condition. This case highlights the critical role of the FD in providing not only clinical guidance but also emotional and psychological support and alternative options tailored to the couple’s preferences and needs. Introduction: Azoospermia is a medical condition defined by the total absence of spermatozoids in the sperm and by the impossibility of conceiving a pregnancy with those spermatozoids, being the type of infertility that affects the couple the most. Because of the increase in infertility cases described after SARS-CoV-2 infection, there seems to be a correlation between infertility and this type of infection.
Perception and valuing of clinical ethics issues by health professionals: an observational study in Administração Regional de Saúde de Lisboa e Vale do Tejo
Introduction: Clinical ethics involves identifying, analyzing, and resolving ethical problems that arise in healthcare practice. This study aimed to describe how health professionals identify and manage clinical ethics issues and to identify which tools and support structures they consider useful. Methods: A cross-sectional, observational study was conducted among health professionals working in primary care in the Administração Regional de Saúde de Lisboa e Vale do Tejo (ARSLVT). A one-stage, stratified, simple cluster random sampling method was used to select a total of 400 professionals. A self-administered questionnaire, previously applied in four European countries, was adapted and pilot-tested for this context. Results: A total of 204 questionnaires were collected. Ninety-six percent of participants reported experience with at least one of seven types of ethical problems described. The most frequently identified issues were caring for adults whose decision-making capacity regarding their health was unknown or impaired (94%), and situations where resource management required professionals to make choices different from those they desired (81%). Only 16% of professionals had used any of the described ethical support resources. The most valued resources for resolving ethical conflicts were those providing help in clarifying ethical issues for themselves and other professionals involved (42%). Conclusion: Ethical problems are an inherent part of the complexity of healthcare, highlighting the need for adequate ethical support in decision-making. However, the low use of such resources among professionals stands out as a key finding. This should be considered when designing organizational models for ethical decision support.
Antimicrobial prescription at the end of life
Infections and febrile episodes are common complications in patients in the terminal phase. The literature shows that about 29% of patients admitted to the hospital are in their last year of life. Although there is no data on the prevalence and impact of infections during this period, European and international studies indicate a high prevalence with a significant impact on quality of life, length of hospitalization, and the use of hospital diagnostic and therapeutic resources, without any benefit or impact on survival or quality of life. These infections also contribute to the emergence of resistant microorganisms. Therefore, the adverse effects associated with the use of antimicrobials should not be neglected. The syndrome of impending death is not always correctly identified, leading to the adoption of disproportionate attitudes and treatments, particularly antimicrobial prescriptions without clear benefit in terms of prognostic impact or quality of life. This could even worsen symptom control, potentially becoming a threat to quality of life due to the symptoms they can cause and the potential for iatrogenesis when care approaches involve attempting to treat it. Given the lack of guidelines for antimicrobial prescriptions for this specific population, it is recommended that both diagnosis and therapeutic decisions be rigorous and carefully considered, prioritizing patient well-being and respecting the advanced care plan. It is recommended that, in defining the therapeutic ceiling, the discussion about the use of antimicrobials be given equal importance to the discussion of other invasive measures. The prescription of antimicrobials in palliative care should, therefore, be an individualized model, shared with the patient and family, resulting from a multidisciplinary decision, and requiring regular reassessment, focusing on symptomatic relief rather than survival. It is essential to promote training in palliative care and the inclusion of end-of-life themes in antimicrobial prescription control programs. The authors believe that research should focus on the approach to infections in end-of-life patients and follow the best available recommendations to ensure person-centered care and preserve dignity and quality of life.
O papel do médico de família no cuidado das famílias monoparentais
Objetivos: Perceber as perspetivas de médicos de família (MF) e de médicos internos de formação específica (MIFE) nos cuidados de saúde a famílias monoparentais. Métodos: Estudo observacional transversal por questionário anónimo, especificamente construído, aplicado online a MF e MIFE entre 28 de dezembro/2023 e 24 de março/2024, recolhendo-se duas variáveis de contexto e as opiniões acerca do “Impacto de viver numa família monoparental” (cinco perguntas) e da “Prática médica em famílias monoparentais” (sete perguntas). Efetuou-se a análise estatística descritiva e inferencial dos dados. Calculou-se como dimensão amostral um n=31. Discussão: A reduzida dimensão da amostra e os diferentes vieses associados à utilização de dados autorreportados foram algumas limitações deste estudo. Não havendo outros trabalhos portugueses nesta temática, o desempenho da função assistencial dos médicos com famílias monoparentais parece depender de conhecimentos e treino a obter em formação médica e desenvolvimento médico contínuos. Conclusão: MF e MIFE consideram importante intervir nas necessidades das famílias monoparentais e não se sentem totalmente preparados para prestar cuidados satisfatórios a estas famílias.
Approach to fears and concerns of type 2 diabetes mellitus patients in consultation: doctor and patient perspectives
Introduction: Type 2 diabetes mellitus is a chronic disease that requires special medical follow-up, which involves understanding the stress of living with it. Objectives: To study the concerns and fears of individuals with type 2 diabetes mellitus (T2DM) and to compare their approach by the general and family medicine physician (GFM) to T2DM expectations. Methods: Multifaceted observational study, qualitative-quantitative, initially interviewing PDM2 and questioning in specific conversation networks to understand concerns and fears. Using Excel, a thematic content analysis was conducted inductively, with all issues resolved by consensus. A similar questionnaire was conducted in MGF in specific conversation networks and to PDM2 in four Family Health Units (USF), PMD2s, and USF conveniently chosen. Results: From interviews with 40 PDM2 52.5% women, 35.0% over 65 years old, and 32.5% under 50 years old, four main themes emerged: fear of complications, stress, concerns about medical care, and worries regarding medication. The second phase, with interviews conducted by the same researcher in 44 PMD2, showed no significant differences in the themes according to the studied sociodemographic variables. For 97.7% of the PDM2, addressing these topics in consultations would improve the control of diabetes. All interviewed PDM2 stated no questioning about the complications/consequences of the disease, stress from T2DM, and concerns related to medical care. For the same questions, 44.3%, 62.5%, and 70.5% of FDs reported not being asked about them. In concerns about medication, 93.2% of the PDM2 expressed not being questioned, and 25.0% of the FDs stated not asking about it. Discussion and Conclusion: The approach in the consultation of FDs regarding the four main themes—concerns about complications, factors of stress/suffering, worries about medical follow-up, and fears regarding medication—has not yet been studied in the Person-Centered Medicine perspective. This approach by GPs could potentially improve the management of PMD2 patients.
Enablement according to communication in the type 2 diabetes mellitus patient
Objectives: To assess the enablement of Person suffering from type 2 diabetes mellitus (PsT2DM), using the Patient Enablement Instrument (PEI), and the doctor communication, evaluated by the Communication Assessment Tool (CAT), according to context variables. Methods: Observational cross-sectional study, as an academic and clinical issue, at the Mondego and Manuel Cunha Family Medicine Units in Coimbra, Central Portugal, in a convenience sample representative of the population, recruited between July and October 2023. PEI and CAT were applied, along with context variables such as age, gender, educational level, monthly income, and type of family. The last three were used to calculate the Socio-economic Deprivation Index (SEDI). Chi-square tests, non-parametric statistics, and correlation analyses were used. Results: A n=110 sample, mostly male (57.3%) and old (65.5% aged ≥65 years), living in company (76.4%), with education (52.7%) and monthly income (62.7%) above the minimum, was studied. The last diabetes appointment occurred three to six months ago for 51.8%, and 51.8% judged their disease not to be controlled. Significant differences were found between age and gender (p=0.027), education level (p=0.001), and income (p=0.002). Spearman correlations between SEDI and PEI were weakly significant and negative (ρ=-0.197, p=0.039); between SEDI and CAT were weak, positive, and not significant (ρ=0.084, p=0.382), and between PEI and CAT were negative, weak, and not significant (ρ=-0.119, p=0.217). Discussion: In a younger male and older female sample, a low level of education and lower income were observed for individuals aged ≥65 years. A higher socioeconomic index was associated with a higher perception of communication quality by the doctor. Higher enablement was noted for lower socio-economic status enablement was. These communication matters are core to health results and well-played by doctors. Conclusion: General practice doctors must be attentive to the socioeconomics of the PsT2DM with whom they communicate.
VoluntariaMente: o impacto do papel social individual na melhoria da saúde mental
Introdução: As patologias de saúde mental estão entre os problemas de saúde mais comuns em todo o mundo, sendo uma causa importante de morbilidade e isolamento social. Este trabalho teve como objetivo implementar um projeto de intervenção com pessoas que sofrem de ansiedade e/ou depressão, com o intuito de melhorar os seus índices de depressão e ansiedade. Métodos: Pacientes de uma Unidade de Saúde Familiar portuguesa, medicados com ansiolíticos e/ou antidepressivos para tratar os seus transtornos de ansiedade e/ou depressão, foram selecionados e integrados num projeto de voluntariado que durou um ano. Os sintomas de ansiedade foram medidos pela Escala de Ansiedade de Hamilton e os índices de depressão foram quantificados pelo Questionário de Saúde do Paciente-9, antes e depois da intervenção. Resultados: Foram selecionados 33 participantes e 25 foram incluídos no projeto. A maioria era mulheres, com mais de 50 anos, tendo realizado uma média de 48 horas de voluntariado. Houve uma redução estatisticamente significativa nos níveis de ansiedade e/ou depressão após a intervenção, independentemente do número de horas de voluntariado realizado. Conclusões: Sugere-se que o trabalho voluntário qualificado e acompanhado pode ajudar a reduzir os índices de ansiedade e depressão.
Migration of an inguinal hernia prosthesis: case report
Introduction: Inguinal hernia is a type of abdominal wall hernia and is the most common surgical condition in primary health care. Local infection and development of seroma or hematoma are common complications, unlike more severe complications such as mesh migration or perforation of adjacent organs. Case description: A 57-year-old male patient with a history of multiple abdominal wall hernia surgeries presented to the health center with pain in the left iliac region and increased flatulence, symptoms that arose after his last laparoscopic hernia repair. A colonoscopy revealed multiple diverticula and a metallic mesh obstructing the colon. A CT scan confirmed the presence of a foreign body and adjacent inflammation. He was referred to general surgery, where the presence of a foreign body in the sigmoid colon was diagnosed, due to probable migration of a hernia mesh, and surgery was scheduled. Due to worsening clinical conditions while awaiting surgery, the patient was admitted and treated for an infection related to the foreign body. After surgery and several cycles of antibiotic therapy, he suffered complications, including a postoperative infection, requiring reoperation. Comment: This case highlights the importance of recognizing hernia mesh migration as a complication of hernia repair, a rare but highly morbid phenomenon, underscoring the need for timely detection and referral. The initial contact with the family doctor was crucial in triggering the diagnosis and the close follow-up of the patient through in-person and telephone consultations, which contributed to managing the emotional response and restoring confidence in the healthcare provided.
The impostor phenomenon and the psychological distress in the general practice / family medicine doctors in Portugal
Objective: To evaluate the impostor phenomenon (IP) in general and family medicine (GP/FM) specialists, according to gender, and years of specialty experience and to ascertain its association with distress or psychological sufferance. Methods: Cross-sectional observational study on a sample of GP/FM specialists, applying a questionnaire in specific conversation social networks with the Clance Impostor Phenomenon Scale (CIPS) and the Patient Health Questionnaire 4 (PHQ-4) questionnaires. Results: In a sample of n=304, significant differences were found for distress by sex, worse in women (p<0.001) and number of years of specialty, with younger practitioners suffering more (50.2%), for professional practice up to five years (27.6%), and 11.1% above 16 years of professional practice (p=0.008). The FI significantly differed for the number of years of specialty practice, with the younger practitioners suffering more (p<0.001). Moderate or severe psychological distress was observed in 21.7% of the sample, with women significantly experiencing more moderate or severe distress, p<0.001. A weak and non-significant positive correlation was found between distress or psychological suffering and FI, r=0.066, p=0.249, in the absolute value of each scale. Discussion: IP was weakly related to psychological suffering but has a negative impact on the individual’s functional status, making it urgent that preventive and even therapeutic measures at both a personal and institutional level are taken. Conclusion: A frequency of 27.6% of GP/FM doctors experienced frequent or intense IP, not significantly different between genders, but significantly lower with increasing years of professional practice. Moderate or severe psychological distress was more common in females and younger GP/FM doctors. A weak non-significant correlation between IP and psychological distress was found.
Rapid antigenic diagnostic test: determinants of use, clinical orientation and economic impact in primary health care
Introduction: Acute tonsillitis is a common reason for seeking medical evaluation in primary health care (PHC) in pediatric age. Although the majority of cases have a viral etiology, 35% are caused by bacteria and, consequently, require antibiotic treatment. The use of rapid antigenic diagnostic tests (RADTs) aids in both diagnosis and the identification of the most common causal agent. Objectives: (1) Assessment of the importance of using RADT in the diagnostic and therapeutic guidance of patients; and (2) estimation of the costs of a large-scale use of RADT and whether this use could result in a reduction in the costs of treating these patients. Methods: An observational, retrospective, and descriptive study was conducted between January 2021 and May 2024 at the ULS of Entre Douro e Vouga units. The sample is made up of pediatric patients diagnosed with acute tonsillitis. The statistical analysis was carried out using SPSS. Results: Eight hundred and thirty-two episodes of acute tonsillitis were analyzed, most of them in FHU-B. In these, RADT was used in 66.1% of cases. The use of RADT contributed to significantly lower antibiotic prescriptions, as well as a reduced need for reevaluation consultations. The age of the clinician, the clinician’s gender, and the type of PHC unit were important factors in both the use of the test and antibiotic prescription. Economically, the implementation of RADT does not increase the cost of the medical procedure and results in a significant reduction in the total cost of the treatment. Conclusion: The use of RADT proves to be a crucial tool in diagnosing and identifying the etiological agent in patients with acute tonsillitis, thereby improving therapeutic guidance and reducing the costs associated with their treatment.
Bisalbuminaemia, a family trait: case report
Introduction: Human serum albumin is the most abundant serum protein in plasma and plays several essential roles. Among the various polymorphisms in its expression is bisalbuminaemia. This phenotype can be hereditary, a relatively rare genetic condition, or transient (secondary). Case description: We present a 4-year-old male child with food selectivity and no abnormalities on physical examination. An analytical assessment revealed iron deficiency anaemia and a protein electrophoresis pattern of bisalbuminaemia, with no other abnormalities. The innate form was presumed to be a genetic cause, and the mother was asked to undergo protein electrophoresis, which showed an identical pattern, corroborating this hypothesis. Iron supplementation was started, and a reassessment confirmed the ferropenic anaemia correction and the bisalbuminaemia pattern’s maintenance. Comment: Hereditary bisalbuminaemia has a low prevalence in the population, however recognising this pattern is particularly important in clinical practice, especially in the context of primary healthcare. Early identification of this benign variant allows the family doctor to guide the patient appropriately, clarifying the genetic and non-pathological nature of the condition and avoiding unnecessary interventions.
The importance of the family approach in family medicine
Introduction: The family approach is a fundamental clinical tool in family medicine. The clinical case presented reinforces the relevance of its use whenever the biomedical model reveals insufficiencies. Case description: M., 44 years old, belonging to a reconstructed family, with a personal history of depressive disorder, had a new depressive episode in the postpartum period. M.’s past traumatic events were preponderant in the etiology and evolution of his current clinical condition. Discussion: Family assessment tools allow identifying factors related to or even at the origin of an individual's dysfunction and empowering users to solve their problems. The family approach should be an integral part of family medicine consultations.