Staff from Nossa Senhora da Conceição Hospital
Hospital Medicine’s Emergence in Brazil
The implementation of hospital medicine, especially those aspects that involve more than just having a general medicine physician dealing with inpatient care, is brand new in Brazil. So far, the U.S. hospitalist model of care is unfamiliar to most Brazilian medical doctors and healthcare managers. Some institutions have hired hospitalists to be part of rapid response teams, neglecting the more specialized dimension of this new model of care; they are not aware of this title’s real meaning. There is a long way to go until the hospitalist is seen as a specialist, and we hope all our efforts will earn this new specialty official recognition in Brazil.
Our group is based in the Brazilian state of Rio Grande do Sul, mainly in Porto Alegre, its capital. Most of our time is dedicated to inpatient care, and we started our movement after studying the model of care delineated by Wachter and Lee.7-9 In 2005, we formed a local association called GEAMH (Grupo de Estudos e Atualização em Medicina Hospitalar) to promote the understanding and diffusion of hospitalist principles, integrated by the professors and former and current residents of a large local internal medicine residence program from the Internal Medicine Department of Nossa Senhora da Conceição Hospital (HNSC).
We have created a Web site (www.medicinahospitalar.com.br) where you can find history, news, and information about hospital medicine fellowships in the United States, as well as online hospital medicine continuing education. As you can see, we are spreading SHM’s ideas.
The third year of the HNSC Internal Medicine Residence Program (R3) focused on hospital medicine was developed in 2005. We believe this to be the first initiative of its kind in Brazil. HNSC is part of Conceição Hospital Group, which is composed of four hospital units and is one of the biggest public hospital networks in Brazil.
The Internal Medicine Residence Program started at HNSC in 1968. The department itself has more than 100 hospital beds. Medical residents’ activities all take place in the hospital, and there are nine professors: Eduardo Fernandes, Guilherme Barcellos, Janete Brauner, José Luiz F. Soares, Nelson Roessler, Paulo Almeida, Paulo Ricardo Cardoso, Sergio Dedavid, and Sergio Prezzi. We would like to make special mention of our colleagues Eduardo Fernandes, current head of HNSC Internal Medicine Medical Residence Program, and Sergio Prezzi, the R3 coordinator.
Table 2. Philanthropic Hospitals5 Conditions: A hospital is considered philanthropic if at least 60% of its admissions are SUS patients or if it spends 5% to 20% of its income on health-related activities.
Advantages: Special reimbursement from state or city administrations and significant federal tax deductions.
The HNSC Internal Medicine Service is well known for graduating internists skilled in hospital practices, mainly because the program is run by professors who specialize in that area. The R3 is a one-year training program. Our goal is to train physicians to provide outstanding and comprehensive inpatient care. Through supervised training, our residents are able to treat common hospital illnesses; we are also training them in consultative medicine and in the clinical management of surgical patients. Other areas of medical residents’ education include medical ethics, end-of-life care, inpatient nutritional support, risk management, rational use of drugs, and technology and evidence-based medicine.
Our third-year residents have the opportunity to try bone marrow biopsy, pleural biopsy, and thorax draining—all of which are usually handled by other medical specialists. In general, residents also have many opportunities to learn about and practice endotracheal intubations, ventilator management, central vein access, and many other procedures.