ReferateEchipa care se ocupă de îngrijirea pacientei cu DPP esteformată din: medicul de familie, psihiatru, psiholog, asistentsocial, nursă.Sunt importante respectarea tratamentului recomandat demedic şi prezentarea la vizitele de control.Este importantă implicarea familiei în susţinerea pacienteicu DPP.Scala de depresie postnatală din Edinburgh a fostconstruită pentru a ajuta medicii să determine dacă mamasuferă de o depresie postpartum.Instrucţiuni:Cum te simţi? Alege răspunsul care este cel mai apropiatde cum te-ai simţit în ultimele 7 zile - nu numai cum te simţiastăzi.1. Am putut să râd şi să văd partea distractivă a lucrurilor.a. Da, tot timpulb. Da, în cea mai mare parte a timpuluic. Nu prea desd. Deloc2. Am putut să privesc viitorul cu bucurie.a. La fel de mult ca întotdeaunab. Mai degrabă mai puţină decât de obiceic. Cu siguranţă mai puţină decât eram obişnuităd. Deloc3. * Mi-am făcut reproşuri în plus când lucrurile aumers prost.a. Da, majoritatea timpuluib. Da, uneoric. Nu prea desd. Nu, niciodată4. Am fost îngrijorată sau am fost neliniştită fărămotive întemeiate.a. Nu, delocb. Rar, câteodatăc. Da, câteodatăd. Da, foarte des5. * Mi-a fost frică sau am intrat în panică fără motivebine definite.a. Da, destul de multb. Da, câteodatăc. Nu, nu prea multd. Nu, deloc6. * Lucrurile m-au depăşit.a. Da, majoritatea timpului n-am fost capabilă săcooperez delocb. Da, câteodată n-am cooperat ca de obiceic. Nu, majoritatea timpului am cooperat binişord. Nu, am cooperat ca întotdeauna7. * Am fost aşa de nefericită că am avut dificultăţide somn.a. Da, majoritatea timpuluib. Da, câteodatăc. Nu prea desd. Nu, deloc8. * Am fost tristă sau m-am simţit mizerabil.a. Da, majoritatea timpuluib. Da, destul de desc. Nu prea desd. Nu, deloc9. * Am fost aşa de nefericită că am plâns.a. Da, majoritatea timpuluib. Da, destul de desc. Numai ocazionald. Nu, niciodată10. * Am avut gânduri să-mi fac rău mie.a. Da, destul de desb. Câteodatăc. Cu greu aş putea ziced. NiciodatăPunctajul:Răspunsurile au punctaj de 0, 1, 2 şi 3 în concordanţă cucreşterea severităţii simptomelor. Afirmaţiile marcate custeluţă (*) sunt punctate în ordine inversă (i.e. 3, 2, 1 și 0).Punctajul final este calculat prin adunarea fiecărui punctajde la cele 10 afirmaţii.Un punctaj > 10 indică probabilitatea unei depresii, dar nuşi severitatea ei.Atenţie la întrebarea 10, care reflectăgândurile suicidale!Surse:Cox JL, Holden JM, Sagovsky R.: Detection of postnataldepression. Development of the 10-item Edinburgh PostnatalDepression ScaleBr J Psychiatry. 1987 Jun;150:782-6.http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf* articolul prezentat a fost publicat la pagina pacientului in“Jurnalul medicului de familie”, dorindu-se a fi un materialpentru pacient, care se poate da gravidei/lăuzei în cursulconsultaţiei, spre documentare. Publicăm articolul cu acordulautoarei datorită conţinutului de larg înteres pe care-lreprezintă şi pentru medicii de familie.Buletinul Asociaţiei Balint, vol. xii., nr. 45, Martie <strong>2010</strong>11
Referate„WriTinG PREscripTIOns IS EASY...”:FRAnz KAFKA AND His COunTRY DOCTOR- John Salinsky, general practitioner, London, UKABSTRACT‘Writing prescriptions is easy…’ This sub-theme of theCongress derives from a rueful reflection in FranzKafka’s short story A country doctor. In this story, a nightcall from hell vividly illustrates the not-so-easy partof the doctor’s life. But what would happen if Kafka’sunfortunate GP presented his ‘case’ in a Balint group?And is Kafka offering himself as a suitable case fortreatment?During my early days as a family doctor over 30 years agoI kept coming across a quotation from a story by Franz Kafkacalled A country doctor. The quotation was:To write prescriptions is easy but to come to an understandingwith people is hard.It was originally used as the epigraph to one of the earlybooks written by Michael Balint and his group in London.The book was called Treatment or Diagnosis: a study of repeatprescriptions in general practice and it is still worthreading. But the quotation kept cropping up in lectures andarticles. This was in the 1970s when general practice was reinventedas a speciality in its own right. Far from being inferiorto the hospital specialists, we GPs felt that we could providea personal service to patients that no other doctor couldoffer. And Kafka’s words seemed to encapsulate everythingwe stood for. Our mission was - and is - not just to scribbleon the pad but to connect with our patients as humanbeings. To reach out to them with empathy, compassion andcontinuity. Everyone I spoke to seemed to know the quotationbut, strangely, no one had read the story. Years later,when I finally read it myself, I was astonished by its powerand its strange dream like quality. Not only was it a wonderfulpiece of writing, but the author seemed to have such anintimate knowledge of what it felt like to be a doctor. Had heever studied medicine? I didn’t think so. And being by Kafka12Buletinul Asociaţiei Balint, vol. xii., nr. 45, Martie <strong>2010</strong>the story must have all sorts of other meaning as well that Imight not have figured out. When I telephoned an old friendwho is an English professor, he told me that it wasn’t reallyabout doctors at all. But I was not entirely convinced. I becameobsessed with the story. I read about it. I wrote aboutit. I gave seminars to trainee GPs about it. And I tried to learnas much as I could about Franz Kafka. He was born inPrague in 1883 into the minority Jewish community in Praguewho were German speaking. Although Kafka was fluentin Czech as well, he wrote only in German. He worked as alawyer in the state workers’ insurance agency in Prague anddid his writing at night. He was not very well known in hislife time but, since his death, he has become one of the mostfamous, most written about and most perplexing authors ofthe twentieth century. He was a very troubled person, fullof anxieties and psychosomatic symptoms. His name hasbecome associated in the word Kafkaesque with the idea ofa world in which a small insignificant person struggles desperatelywith an unfeeling bureaucracy. He also had a greatsense of humour. Franz Kafka died at the age of 40, havingwritten three unfinished, unpublished novels, together withletters, diaries and lots of short stories some of which werepublished in his lifetime. One of these was A Country Doctor(Ein Landarzt).At this point, I should tell you something about the story.Or maybe refresh your memories if you already know it.The story begins in the first person. The country doctoris speaking:I was in great perplexity; I had to start on an urgent journey;a seriously ill patient was waiting for me in a villageten miles off; a thick blizzard of snow filled all the spacesbetween him and me. I had a gig, a light open carriage withbig wheels, exactly right for our country roads; muffled infurs, my bag of instruments in my hand, I was in the courtyardall ready for the journey; but there was no horse tobe had, no horse.We learn that the doctor’s horse has died in the night andhe has been unable to borrow one in spite of the efforts of hisservant girl Rose. Then the story takes a magical ordream like turn. Out of an old pigsty emerge two splendidhorses and a groom who seems to be in charge of them.Problem solved? Yes and no. The groom turns out to be ademonic character who is intent on raping poor little Rose.The doctor finds himself being carried away in the open carriageby the furiously galloping horses and unable to protectRose from the groom. As in a dream, the gig arrives at thepatient’s village almost instantaneously and the doctor hasto concentrate on his work, despite the agonies of his private life.
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