Accepted abstracts: Unconference sessions

 

IGNITE PRESENTATIONS

 

Title: Complementary and Alternative Therapies: strategies we can no longer ignore.

Proponents: Inês Antunes, Ana Cláudia Monteiro Pereira, Ana Margarida Gomes, Ana Rute Marques, Mafalda Lemos Caldas.

Keywords: Complementary therapies, alternative therapies; primary care.

Abstract: Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard medical care, such as natural products and mind and body practices. CAM is considered the fastest growing area in health care today and it is estimated that 50% of primary care patients use at least one complementary therapy.

Although CAM therapies are popular, many patients are not comfortable discussing them with their doctors, and many physicians are uncomfortable with the topic as well. This communication gap represents an important opportunity for family physicians. Discussing CAM can lead not only to new insights into illness and health, but also to enhanced patient communication, satisfaction and quality of care.

Some primary care clinics already offer complementary therapies as part of their care and some family doctors have training in specific CAM therapies. As family doctors we can incorporate CAM into our practice by engaging in education, collecting key tools and reliable resources, considering new care models and learning how to identify patients who will profit the most with these therapies.

 

Title: Having a vegetarian/vegan diet during pregnancy and breastfeeding: what do we need to know?

Proponents: Ana Rute Marques, Ana Cláudia Monteiro Pereira, Ana Margarida Gomes, Ines Antunes, Mafalda Lemos Caldas.

Keywords: Vegetarian; vegan; pregnancy; breastfeeding; nutrition.

Abstract: Pregnancy and breastfeeding are unique situations. During these periods, the adoption of a healthy lifestyle and a diversified and balanced diet are of extreme importance for the health and wellbeing of mother and child, as well as for the future adult. Each day, an increasing number of people choose to follow a vegetarian or vegan diet for the most varied reasons (socioeconomic, environmental, animal rights,...).

As Family Doctors, we should aim for a strong and trustful relationship with our patients, finding common ground fields and helping with their lifestyle options. However, this can be a very demanding task, as we need to be well informed in a huge variety of issues in order to be able to help our patients.

Moreover, regarding dietary habits and choices, in our country and specially in primary care, the access to nutritionists or dieticians is almost absent, even though a nutritional assessment and counselling is recommended for many patients. Again, we need to be prepared in order to fill in these gaps.

We bring the topic of vegetarian and vegan diets during pregnancy and breastfeeding to discussion because the vegetarian/vegan population is growing in our practice and we noticed a lot of misconceptions and lack of information amongst physicians.

In this ignite session, we will convey information about: vegetarian/vegan diets, food sources of the most important nutrients, deficits of nutrients in vegetarian diets, supplements that can be needed and how to manage vegetarian/vegan patients.

 

Title: Palliative Care and Sexuality: Giving life to a relationship.

Proponents: João Ribeiro.

Keywords: palliative medicine.

Abstract: Palliative Medicine is often mistakenly associated with terminally ill patients. Congestive heart failure (CHF), chronic obstructive pulmonary disease and other diseases with complex symptoms control can be criteria to act as a Palliative Medicine. As a consequence of this wrong conception, health professionals many times forget to access the patient’s concerns about other subjects that can be important for their quality of life, like sex and sexuality, and the impact that this changes can have either in patient’s life as in his/her partner. In our Primary Care Unit, we initiate a Palliative Medicine consultation where all of this questions can be discussed. In this session, we propose to share a case where man and wife were being consulted as Palliative patients, as he has CHF NYHA IV (New York Heart Association grade IV/IV) with chronic dyspnea and she was receiving chemotherapy for estrogen receptor positive breast cancer. Were asked their concerns about sex life and how to deal with their physical and emotional problems.

 

Title: ACTIVE STEPS: New steps for health.

Proponents: Mariana Moura Relvas, Rosário Pires, Margarida Pereira, Tatiana Pinto, Alice Jeri, Daniela Silva, Maria João Ribeiro, Clara Ferreira, Mário Gomes.

Keywords: exercise; cardiovascular disease; healthy eating.

Abstract: Cardiovascular disease represents an important public health challenge and is a major cause of chronic morbidity and mortality throughout the world, with an estimated global mortality of 30% in 2013. There are several risk factors identified, such as elevated blood pressure, dyslipidemia, smoking, inadequate dietary habits, overweight/obesity, sedentarism, diabetes type 2 and excessive stress. The beneficial effects of physical activity are numerous, particularly in the reduction of cardiovascular risk. The international recommendations indicate that being sufficiently active in the adult age (18-64 years old) refers to at least 150 minutes per week of moderate intensity activity (30 minutes per day, 5 days a week), or 60-75 minutes per week of vigorous intensity aerobic activity (20-25 minutes per day, 3 days a week), or equivalent. The recommendations to adults are also applicable to the elderly (>=65 years old). With this project we pretend to sensitize the patients of our Health Units, who have cardiovascular risk factors, to the importance of exercise in the management of these, including promoting moderate physical activity, at leisure times, through collective walks; stimulating the continued practice of different intensity physical activities, through motivational strategies, like oral intervention or in the actions mentioned above; enhancing the knowledge about healthy eating and physical activity and its impact on the health and well-being. With these actions, our intent is to promote the control of cardiovascular risk factors and increase overall health of our patients.

 

Title: Young Doctors Antimicrobial Resistance Network - A new special interest group.

Proponents: Kasper Lorenz Johansen, Ana Lúcia Gomes Costa.

Keywords: antimicrobial resistance; antibiotics.

Abstract: In 2014, the World Health Organization published their first global report on antibiotic resistance, predicting the coming of the “post antibiotic era” unless serious measures are taken to halt the emerging resistance trends globally. Infections with multiresistant bacteria are difficult to treat and could lead to prolonged illness, hospital stays, or increased mortality. Given this imminent public health threat, there is an imperative not only to increase public awareness, but also to promote appropriate antibiotic use among doctors. In 2016 a few GP trainees set out to create a network for European GP’s (first fives), GP trainees and medical students with a special interest in rational antibiotic usage in general practice. The aim of the Network is to highlight the impact of antibiotic resistance; to generate research; and to create a platform for the exchange of knowledge, ideas and strategies in order to formulate viable solutions to the challenges posed by antibiotic resistance. Topics include: patient education, appropriate prescribing patterns; quality improving tools; audits and research projects and public awareness. Through this network, GPs commit to becoming active partners in forging a solution to the global problem of antibiotic resistance.

 

Title: HIV Pre-Exposure Prophylaxis - whose business is it?

Proponents: Carla Rodrigues, Andreia Silva, Ana Filipa Vilaça, Helena Marques, Sara Rita, Ana Beatriz Figueiredo.

Keywords: PrEP; HIV; primary care.

Abstract: HIV Pre-exposure prophylaxis (PrEP) substantially decreases HIV infection risk and brings a new possibility and tool on the long fight of HIV eradication. PrEP has been slowly accepted in some some European countries and the European AIDS Clinical Society published its first guidelines on PrEP in 2015, bringing this controversial theme into the spotlight. But meanwhile governments and health ministers discuss its use for each country, what should GP’s know about this subject? Is this something to be prescribed on a primary care level or a secondary care degree? PrEP is a subject that can also interfere with our own moral beliefs and many doctors are divided on accepting or rejecting this option. On one hand, PrEP has the ability to reduce the numbers of infected individuals. On the other hand, it is expensive and comes with risks and possible discrimination. One of the most controversial fear related to PrEP is the risk compensation that can arise from the alleged safety associated with PrEP, allowing patients to engage in riskier behaviours without using protection. Is this a real fear to be taken into account? All of these questions should be discussed and the reality of each country must be part of the equation. Our aim is to increase awareness for this new topic and shortly portray the reality of PrEP worldwide.

 

Title: Through the mouth dies the fish! A proposal of oral health care integration in the General Practice appointment.

Proponents: João Toscano Alves, Carlota Veiga de Macedo, Hugo Pissarra, Maria Teresa Costa.

Keywords: Oral Health; oral pathologies; examination of oral health; precocious referencing.

Abstract: The global approach of the General Practitioner (GP) using the person centered method of consultation doesn't usually integrate the evaluation of the oral health. This floss is essentially due to the lack of knowledge established since the university medical education and to the depreciation of the importance of oral health in systemic health. The GP, when is able to invest its appointment time investigating oral pathologies, the most of the times he acts as a mere referencer, many times unnecessary and others postponed or inadequately. We propose, in a simple, methodical and delineated way, the GP to carry through an examination of oral health, not relinquishing important pathologies and promoting a precocious referencing and/or treatments. We suggest an attached proposal of examination of the oral cavity carried out through the family doctor, with access to illustrative images, spending very little time of the consultation and with very low costs. In this way the GP would be able to identify the more frequent or urgent oral pathologies, in a precociously way, for prevention and precocious intervention of the oral cancer; as well as identifying the more frequent benign pathologies and learn to deal with them in the consultation in General Practice, preventing the unnecessary referrals to the differentiated professionals.

 

Title: An ICPC-based educational project.

Proponents: Jacopo Demurtas,Gabriella Pesolillo, Stefano Celotto, Alberto Vaona, Ferdinando Petrazzuoli, Marc Jamoulle

Keywords: education; job description; core curriculum; ICPC

Abstract: The last job description of the Italian family doctor is a document from 1992. So far nobody has seriously tried to update that document considering the innovations and the implementation of family medicine and the shift in the doctor status and competences. The job description should be the base for a Core Curriculum which encompasses the different fields of family medicine.

We would like to share and discuss an educational project based on the International Classification of Primary Care (ICPC), in which, starting from the various anatomical chapters of the classification, we will define together the competences of new family doctors with the methodological strategy to achieve those competencies. Moreover, since teaching in General Practice also involves professional topics and patient-related ones besides the usual clinical subjects, we would like to explore the tools already available to us (such as Q-Codes or PERi) to better assess the managerial and academic side of Family Medicine and the issues related to patient context, such as continuity and accessibility of care.

Educational resources on this topic: WONCA International Classification Committee (external link); ICPC training modules (external link)HETOP (external link) (free registrations grants access to ICPC in 21 languages). 

 

Title: The Gen-Equip Project.

Proponents: Ana Sequeira.

Keywords: genetics; primary Care; education.

Abstract: Equipping European primary care health professionals to deal with Genetics is the basis of the Gen-Equip project.

This is an innovative project, consisting of an online, free, continuing medical education program in Genetics, using clinical relevant tools, hoping to improve care for our patients with genetic conditions or concerns.

 

Title: The SISCOS Project - Italian Society for the Development of Competencies of Healthcare Professionals.

Proponents: Jacopo Demurtas, Stefano Celotto, Gabriella Pesolillo, Alberto Vaona

Keywords: education.

Abstract: In 2015 we established a new Scientific Association named SISCOS (Italian Society for the Development of Competencies of Healthcare Professionals), whose main target is Family Medicine, which brought us to define a part of SISCOS just for Family Medicine, called SiscoMed. Therefore, we built a platform which provides different services and opportunities to Italian Family Doctors. The Aim of this Ignite session is to share the project with you and get feedback for further implementation. What is missing? What would you do differently? What are the possible strategies that need implementation?

 

 

SPECIAL SESSIONS

 

Title: What's the Right Thing to Do? Tom & Lukas' Corner on Ethical Issues.

Proponents: Tom Axelrod, Lukas Heschl.

Keywords: ethics; dilemma; decision making.

Abstract: In primary care we encounter almost every day ethical issues, and even a simple routine bureaucratic action may hold a big dilemma. In this session we would like to explore, discuss and analyze everyday ethical issues and questions, but there is also a place for "big" questions in terms of public health and health policy - depends on the attendees' preferences.

The discussion will be guided using a 4 stages tool developed by Dr. Rhona Knight (a GP and member of the RCGP Ethics Committee). The 4 stages are:

1. Identify the ethical matters and dimensions of the consultation

2. Identify the relevant facts

3. Explore the relevant values

4. Decide a justifiable way forward with the patient.

In addition, we will share our experience from our practices.

Question and dilemmas can stem from real clinical cases (better) but may also be raised as hypothetical thoughts.

The facilitators may enrich and challenge the discussion by suggesting a different look at the question - from the patient's or the physician's position, from the public health system, the regulator and even the insurer points of view.

At the end of the session facilitators will summarize the issues raised up and emphasizing practical applications in light of the relevant values.

 

Title: The migrants, the refugees and the crisis of Europe: Are we all equally human?

Proponents: Yusianmar Mariani, Sara Rigon, Özden Gökdemir, Elena Klusova, Ana Nunes Barata, Nina Monteiro, Fabrizio Cossutta.

Keywords: migrants; refugees; human rights.

Abstract: More than a million migrants and refugees crossed into Europe in 2015, sparking a crisis as countries struggled to cope with the phenomenon at many levels from infrastructures to politics. As health professionals we do what we can for the people who make it to Europe, the lucky ones who after a long and extremely dangerous journey, are not sent back, but they are given a chance to be treated as human beings again. What happens to the unseen ones? “Are we all equally human?” as the great Philosopher and refugee herself, Hannah Arendt said? What’s our role in this crisis? We are doctors but we are also European Citizens. We would like to open a discussion on this crisis as well as the way the EU respond to it.

 

Title: A 21st century Hamlet: to care or to consume?

Proponents: Jan-Jakob Delanoye.

Keywords: economization; neoliberalism; consumerism; ethics.

Abstract: In the past few decades, both the language, the organization and the public profiling of health care has been influenced by words, patterns and publicity techniques related to the predominant economic logic of our time. The striving for efficiency, the birth of so called ‘care brokers’, the vision of the patient as a consumer, ... : in parts of Europe it seems to become more and more common. Nevertheless, one could wonder if the values of caring and the laws of finance aren’t contradictory. As such, a neoliberal approach to health care might turn out to be incompatible with the wants and needs of citizens all over the world. To care or to consume, that is the question for the generations to come. The aim is to have a vivid discussion among the attendees. During the event,  the facilitator will both introduce the questions and summarize the most important arguments, in order to bring the session in the final minutes to a conclusion.

 

Title: ASPIRE Global Leaders Collaborative Eureka Session.

Proponents: Candan Kendir, Tugba Onat, Maria João Nobre, Claire Thomas, Job Metsemakers, Jose Castellanos.

Keywords: leadership; young doctors; primary care.

Abstract: Background & Aim: The World Organization of Family Doctors (WONCA) recently published that “leadership training has a direct impact on the ability of physicians to make continual system improvements.” Within this goal in mind, the ASPIRE Global Leader Program has been developed. It is a global leadership program aimed at increasing leadership abilities, international collaboration and engagement in Young Doctors Movements. This special session will be facilitated by Anna Stavdal (President of WONCA Europe) and Job Metsemakers (WONCA World Executive Member-at-Large 2016-18 & WONCA World Honorary Treasurer & Immediate Past President of WONCA Europe). The aim of this session is to discuss the lacks and needs of young doctors as leaders of primary care and create a strategy document for further organizations of our program. In the end of the special session, we will create a curriculum for ASPIRE Global Leaders Program workshop to improve the related leadership skills of the young doctors.

 

Title: Web-based reporting in primary care: structured and evidenced-based.

Proponents: Stefan Heinmueller                                                     

Keywords: web-based; online; evidence; evidence-based,guideline; guidelines; primary care; general practice; documentation; reporting, structured.

Abstract: Background: Digital documentation of patients' medical informations (i. e. history, test results, diagnoses, medication etc.), which has become standard in western primary care practices, offers great possibilities for improvement (e. g. reduction of medical errors, lower GP-workload, closer adherence to clinical guidelines, better interprofessional cooperation etc.) and subsequently higher-quality patient care. However, several challenges prevent these potential improvements from being used. These include among others deficient software functionality, a vast amount of software providers and a poor inter-software-compatibility.

Objective: To discuss with fellow junior doctors the idea of a web-based reporting tool for primary care doctors, which comprises all the above mentioned improvements and can be used additionally to any existing documentation software.

 

Title: VdGM SIG Research Special Session: What makes us do research?

Proponents: Vanja Lazić, Ana Luísa Neves, Patrick O'Donnell, Gabriella Pesolillo, Gaetano Lops, Luís Monteiro, Katarzyna Nessler, Rosy Tsopra, Sarah Moore.

Keywords: research; general practice; motivation; early career.

Abstract: Starting out with research in the field of General Practice is hard and not many early career GPs choose to do it. Motivation, opportunity, mentoring and support of peers are some of the factors that might influence a young GPs decision to pursue the elusive path of primary care research.

VdGM Special Interest Group on Research aims to help GPs make their first steps in research as well as to provide support to active early career researchers. We have several suggestions for how to achieve this:

1. Organizing conference sessions promoting GP research as a goal for early career GPs, thus providing motivation and networking opportunities.

2. Showcasing collaborative research projects of the group and providing opportunities for interested GPs to do engage in research.

3. Developing an early career GP researcher networking website, where members can post their project ideas and search for partners,

therefore enhancing networking and collaboration.

4. Offering research support to young GPs. Operative and communication strategy has to be developed to find the best means of support that would reach all in need. Support group could proactively reach to users of networking website.

5. Finally, the group will collaborate with EGPRN to provide education and a strong foundation in research methodology and to aid the transition to senior researcher.

In this session, the group will discuss motivation of early career GPs to do research and address ways to help them do research.

 

 

WORKSHOPS

 

Title: Derma for dummies - dermatological challenges in Primary Health Care.

Proponents: Elena Klusova, Rocío García-Gutiérrez Gómez, Sara Correia, Manuel Soto, Adrian Castellote.

Keywords: dermatology; primary health care; dermoscopy; image, collection.

Abstract: Introduction: Primary care doctors are frequently exposed to dermatological challenges. Skills in recognition of common dermatological disease is imperative for effective management and insufficient knowledge is a frequent cause or delayed or missed diagnosis.

Objectives:

1. Challenge our GPs with interesting clinical cases and generate dialogue and debate.

2. Inform and educate with a summary of the most common dermatological consultations in Family Medicine

3. Hands-on skills training in dermoscopy in collaboration with the Primary care dermatology society (PCDS)

4. Foster collaboration between young GPs and the Primary Care dermatology society

Methods:

Part 1: divide participants into teams and undertake a clinical case base quiz. Debate and discuss responses

Part 2: interspersed with the quiz responses we will summarise the common presentations of skin pathology in primary care and important considerations to aid diagnosis

Part 3: in collaboration with colleagues from the PCDS discover and practice the hands-on skill of dermoscopy.

Conclusions: In our daily routine, we have to pass through several dermatological cases, each one tougher than the one before. As family doctors, we have to deal with uncertainty all the time, but if we train ourselves we can improve our clinical eye, and reduce the number of derivations to other specialists and help our patients in a more effective way.

                      

Title: A bomb exploded. Are you ready to help?

Proponents: Miriam Rey Seoane, Rabee Kazan, Anna Fernandez Ortiz.

Keywords: mass casualty incidents; triage; prehospital care.

Abstract: Mass Casualty Incidents, incidents that involve more patients than the local resources can handle (terrorist attack, train crash...), can happen everywhere. A special Management System is needed there, in order to give properly prehospital assistance and correct evacuation, which is important to reduce mortality.

Most of the health care professionals are not well prepared in this area. In this Workshop GPs will learn how the scenario is controlled and how the assistance area should be organised (security, post-disaster medical care, evacuation...). Also we will practice the fundamentals of the START triage and its criteria.

Facilitators:                                    

- Miriam Rey Seoane: GP in an Emergency Primary Care setting in Barcelona.

- Rabee Kaza: 4th Year trainee-GP in Barcelona                                                  

- Anna Fernández Ortiz: 3rd Year trainee-GP in Barcelona.

Methods:

Combination of theory (use of slides to introduce the basic knowledge of Mass Casualty Systems) and skill training (use of START in practical cases with Mass Casualty Victims, role playing in a terrorist attack with bomb scenario or similar).

Conclusion: Indulging in Emergency Care and in Catastrophe Medicine could be a new focal point in the new European reality. How to start a triage and how to manage the chaos is basic knowledge physicians nowadays must have.

 

Title: Myths in nutrition: everything we have been led to believe.

Proponents: Marta Barbado Villalba, Andrea María Artime Artime, Verónica Rodríguez Fernández, Elena Klusova.

Keywords: myths; nutrition; food; scientific evidence.

Abstract: How many times a day should we eat? Do we have to eat less fat to lose weight? Is a glass of wine good for the heart? Are ̈diet ̈ products healthy? Is cholesterol so dangerous? Is the vegan diet safe? Should we eat more natural food?

Everybody talks about nutrition and food... And that's why myths are so common among all people in general and healthcare professionals in particular, usually by contradicting what science says.

We propose a nutrition workshop about exploring different food myths using "gaming" learning techniques. These techniques are a teaching strategy that aim to make learning more attractive and stimulating through play. A dynamic team based board game activity will be applied; a mix of Trivia and the ̈Duck duck Goose Game ̈. Participants will be challenged by different important questions about nutrition. The objective is to expand knowledge about nutrition, with a focus on scientific evidence. They will be encouraged through small debates to enrich the nutritional knowledge applicable in the family medicine consultation.

                                              

Title: Telemedicine: a powerful tool we must learn to use.

Proponents: Ana Cláudia Monteiro Pereira, Ana Margarida Gomes, Ana Rute Marques, Ines Antunes, Mafalda Lemos Caldas.

Keywords: telemedicine; asynchronous appointments; group discussion.

Abstract: As technology grows and time seems to never be enough, it’s important for family doctors to manage alternative ways to facilitate access to health services.

We are young residents in Family Medicine in Camarate, just outside Lisbon. Our population is very poor and multicultural, with many migrants and young people. Sometimes, it ́s not easy for them to reach us and they can feel lost in our healthcare system. Since our practice is already highly dependent on technologies, why not use it on behalf of our patients?

Over the last few years, several initiatives and programmes were implemented on Telemedicine or ehealthcare. In Portugal, Telemedicine is contemplated in no 8445/2014 dispatch from de 30th of July and a National Center of “TeleSaúde” was implemented, with regional coordinators and internal promoters. To facilitate contact with patients is one of the advantages of Telemedicine, for instance when hospital appointments multiply and patients are too busy to have close encounters with their family doctor. Yet, Telemedicine can never replace face-to-face appointments and it must be used according to each individual situation. Despite it being a tempting tool, several issues remain to be solved. For instance, some softwares still don’t allow for Telemedicine to be considered as a type of appointment neither consider synchronous and asynchronous appointments. Also, we cannot allocate our time for this type of practice.

We bring Telemedicine to this hands-on workshop to create discussion on this hot topic: What’s the best way to use it on behalf of our patients? How many hours of should we dedicate to Telemedicine? How is it done in other countries?

The participants of the workshop will be divided into five groups, where each author will give a short introduction and lead the discussion. Each group will focus on one of the following themes:

1. What are the major advantages of adopting Telemedicine?                                         

2. What are the main dangers of replacing regular appointments?                                   

3. Which types of appointments are best suited for being done remotely?

4. How much time should be dedicated to asynchronous appointments?                        

5. Will the future of Medicine include Telemedicine or is it an utopia?

At the end, the main findings and recommendations will be shared and discussed with all the workshop participants.

 

Title: Brave New World: Creating a vision for the future of Family Medicine.

Proponents: Claire Thomas, Anna Stavdal

Keywords: family medicine; future proofing; creative thinking.                                                  

Abstract: Introduction: The young doctors of today will be charged with shaping the future of our profession. We will need to learn to navigate the emerging demographic, social, economic and technological trends to "future proof" family medicine and the delivery of accessible primary care for all. This workshop, facilitated by the Presidents of VdGM and WONCA Europe, will engage young doctors in thinking critically about the challenges we face and applying creative problem solving techniques to build a vision for the future of family medicine. We aim for it to inspire and signpost participants to how they can become more involved with the world of family medicine outside the consultation.

Methodology: We will open with an interactive exploration of the current challenges in family medicine: one at a time we will introduce an "issue" from the current landscape of GP/FM and key challenges that face us as a profession ie aging population, population increase, resource stretching, advancing technology and role of GP in face of this etc. Participants will be asked to move across a horizontal line in the room to rate on a scale of 1-10 how worried they are about this issue. This will be used as a tool to trigger facilitated discussion and debate.

Participants will then be divided into 3 small groups: 1) Local 2) National 3) International.

Each group will nominate a facilitator and a scribe. The groups will be asked to examine their "level" of family medicine by applying creative problem solving methods, such as "De Bono's 6 thinking hats" and "Disney's Imagineering". Facilitators will be given questions to help guide discussion i.e. What are the current pressures and forces at play? What is the young GPs role in responding to those forces? What goals do you set for the future of GP? What strengths and weaknesses, threats and opportunities are there in realising those goals?

Results: Groups will be asked to summarise and present their work by succinctly identifying core goals/activities for successfully developing the future of family medicine at their "level". These will be collated together as a "Vision for the future of family medicine" after the workshop and disseminated appropriately.

Conclusion: To close the session participants will be signposted to how they can become more engaged in the future of FM through VdGM, WONCA and other associated networks. Each participant will be asked to set 3 SMART actions they will take forward following this workshop.

 

Title: ASPIRE Global Leaders Program Workshop: How to facilitate a team in difficult situations?

Proponents: Candan Kendir, Claire Thomas, Job Metsemakers, Jose Castellanos.

Keywords: leadership; facilitation; difficulties.

Abstract: Background & Aim: The World Organization of Family Doctors (WONCA) recently published that “leadership training has a direct impact on the ability of physicians to make continual system improvements.” Within this goal in mind, the ASPIRE Global Leader Program has been developed. It is a global leadership program aimed at increasing leadership abilities, international collaboration and engagement in Young Doctors Movements.The aim of this workshop is to improve the facilitation skills of the participants within a team that consists of people that have mixed type of personalities.

Method: In the beginning, there will be a warm up; introduction of the facilitators, the ASPIRE program and outline of the workshop. After that, 10 minutes of presentation will be done about handling difficult situations in managing a team. Thereafter the participants will be asked to divide into three groups (max 10 people in each) and one pre-prepared scenario will be given to each group. It is expected to have max 30 people in the workshop. According to scenario, everyone will have one role and one facilitator within the group will be asked to handle the difficult situation of the team for 20 minutes. After group role-plays, feedbacks of the participants about their own difficulties will be got individually and management of difficulties will be discussed with the facilitators of the workshop for 45 minutes. In the last 10 minutes, there will be wrap up and feedbacks about the workshops and suggestions for future activities of ASPIRE.

Conclusion: In the end of the workshop, we expect participants to gain/improve their facilitation skills in management of a team.

 

Title: The legacy of Intimate Partner Violence. Heterosexual and Gay (LGBTQ) communities. New challenges for the family doctor.

Proponents: Elena Klusova, Ula Chetty, Sara Conde-Valvís Fraga, Fabrizio Cossutta, Hagit Dascal Weichendler, Özden Gökdemir, Raquel Gomez Bravo, Yusianmar Mariani, Nina Monteiro, Maria João Nobre, Ana Nunes Barata, Lodewijk Pas, Christopher Patrick Reichel, Sara Rigon, Claire Thomas.

Keywords: intimate partner violence; domestic violence; communication methods, total; primary health care.

Abstract: The “classic” gender violence of the heterosexual couples has left a painful legacy to the LGBT community. Recent researches show that rates of IPV in LGBT are similar to or higher than the rates found for heterosexual women. Though hardly worked, it seems to be that existing approach programs turn out to be incomplete and insufficient to address this problem in heterosexual women, being practically unknown in sexual minorities. The greater part of health professionals seems to have a vague and unclear knowledge of many basic LGBTQ+ concepts and specific health needs (social isolation, substance abuse, eating disorders, intimate partner violence, cancer prevention, etc...) The reality is that most of nowadays family physicians are not conscious nor trained to identify no manage the differences in professional help need between sexual minorities and heterosexual patients.

The main objective of this workshop is to raise awareness of the characteristics and specific needs for the LGBTQ related to partner violence, contrasting them with those of the heterosexual couples and so to work specifically on communication skills. We want the participants, on one hand, to exercise how for the approach the aspects of sexual orientation and on the other, how to handle with family violence in homo and heterosexual couples.

This WS is a joint work of two special interest groups of VdGM Europe, Family Violence and Equally different.

We would like to start making the WS-topic review through the quiz, analyzing the initial knowledge/understanding of the differences between the Gender-Based Violence and Intimate Partner Violence in LGBTQ couples based on an understanding of the peculiarities and specific needs of the both types of the partner violence victims. We intend to organize the "Know and Win" contest, during which we will give the correct answers and explanations of the discussed issues, to provide a lively and animated learning. After this interactive theoretical part, we will exercise different scenarios of IPV LGBT and GBV victims in the FD consultancy for working directly on communication skills with this delicate patients and situations. In the end, will be given a list of practical suggestions for a family violence problem conscious, gender neutral and LGBTQ friendly practice.                                

We will provide the listeners with the links to specific pages of literature sources of great interest and reliability.

 

Title: Making Genetics easy – GP consultation survival kit.

Proponents: Ana Sequeira, Vera Araújo.

Keywords: genetics; family history; inheritance patterns; red flags.

Abstract: Introduction: At least 10% of consultations in primary care are related to a genetic problem. Furthermore, it is expected of General Practitioners (GPs) to being able to identify patients at risk of a genetic condition, to contribute to medical management of such patients and to communicate adequate genetic information to patients. However, studies show that GPs lack knowledge of genetics and genetic testing relevant for daily practice and lack confidence in dealing with genetic related conditions. Thus, we thought to be relevant proposing a skill-building workshop on Genetics, addressing basic principles, but relevant for GPs daily practice.

Objectives: Attending this workshop will enable participants to learn how to proper take a family history to detect possible genetic conditions, understand inheritance patterns of genetic diseases through genogram analysis and know red-flags that should prompt further evaluation.

Methods: The two presenters, who will develop the workshop, are GP residents with training in Genetics. After a brief introduction of the participants (10 minutes), taking of family history will be done by active method using role-playing technique (30 minutes). The genogram rules will be presented using the expository method (5 minutes). Then, participants will form small groups for problem-solving activities – genogram analysis for inheritance patterns, active method (30 minutes). Red flags will be addressed along the workshop, but will be summarized, using the expository method (5 minutes). Finally, we consider a formal period for questions and/or comments in the end (10 minutes).

The contents of this workshop include family history, genogram, autosomal dominant dominant conditions, autosomal recessive conditions, X-linked conditions and red flags.

Discussion: Understanding the basis of adequate family history taking, genogram and inheritance patterns plays a pivotal role in GPs daily practice. And will be an important step in improving care for patients with genetic conditions.

Additionally, useful pocket-tools will be provided to the attendees on red flags and genogram representation, as well as showing online resources for continuing medical education, so that participants will be able to learn more after the workshop.

 

Title: Providing primary care to multicultural communities - the challenge of overcoming health inequalities in migrant populations.

Proponents: Cristiano Marta Figueiredo, Ana Cebola, João Sousa, Martino Gliozzi, Ricardo Antunes, Sara Antunes, Sofia Correia Pinto, Tânia Bonifácio, Tatiana Consciência, Tiago Lopes, José Lima.

Keywords: migrant care; international health; health literacy; health policy.

Abstract: Why is it relevant? As a consequence of globalization, doctors are confronted with a growing vulnerable migrant population and refugees, which have diverse epidemiological profiles and endemicity of disease. Moreover, migrants present specific health problems, health needs and cultural health beliefs and practices.When delivering primary care, specific skills are required to deal with language and cultural barriers besides mixed somatic and psychosocial presentation of symptoms, the administrative complexity and often financial constraints and bad work conditions that this population usually tackles with.

Who are we? We are a team of family doctors working in Lisbon and providing care to a multicultural community. About 30% of our patients have other nationality than the Portuguese, being mainly from Bangladesh, Nepal, Brazil, India and China. We are developing a pilot project in order to improve the integration of the Bangladeshi immigrants into the Portuguese National Health Service named bengalisboa Community Health Project. We are acting to be a model practice in migrant health care in Portugal, contradicting the poor performance of Portugal in health policies for immigrants stated by the MIPEX 2015.

What do we want to achieve? Raise the awareness about the specific health needs of migrants. Find solutions for the specific health needs of migrants. Provide resources for the family doctor to improve his capacity to respond to the specific health needs of migrants. Create a network of junior family doctors working with multicultural communities in order to share best practices between European countries - the beginning of a VdGM’s Special Interest Group: Migrant Care, International Health & Travel Medicine.

How do we want to achieve it? Facilitate a group discussion about the perceived specific health needs of migrants living in the participant’s countries. Brief talk about the evidence regarding the specific health needs of migrants. Facilitate a group discussion about the solutions found in the participants’ countries to minimize the health inequities and improve health care to migrants. Brief talk about the best evidence-based strategies to decrease the cultural and language barriers faced by migrants when accessing health services. Share resources to improve the family doctor’s capacity to respond to the specific health needs of migrants. Collect the contacts of the interested participants to take part in the new VdGM’s Special Interest Group.

 

Title: Management of the infertile couple.

Proponents: Filipa Rafael, Ana Beatriz Figueiredo, Nuno Ramos.

Keywords: female infertility; male infertility; initial study; medically assisted procreation.

Abstract: Introduction: The prevalence of couples with infertility has been increasing, being a frequent reason to go to the general and family doctor consultation. The recent development in the knowledge and techniques regarding this topic has allowed an increasingly efficient response to these couples. Couples benefit from the correct and prompt diagnosis, since time fights against them for the resolution of their family project.

Objectives: In this workshop, we intend to review the essential aspects to study infertile couple with the objective of training all physicians with the knowledge and skills necessary for the best approach and orientation of these patients.

Discussion: In a practical way, the following topics will be reviewed: physiology of the menstrual cycle and fertilization, the main causes of anovulation and azoospermia; sexual dysfunction and male Infertility; the first approach to complementary analytical and imaging tests and how to increase fecundity.The workshop will include a multidisciplinary approach, with the participation of professionals from general and family medicine, gynecology and urology, as well as psychology.

Conclusion: It is intended that a useful discussion will arise for all the included professionals, alerting to the subfertile and infertile couples existing in the consultation. In this way, allowing the earlier diagnosis that will eventually be of extreme importance in the success rate of medically assisted procreation.

 

Title: How do you satisfy your patient?

Proponents: Rianne van Vliet, Maike Eppens, Nadia Tuomi.

Keywords: communication skills.

Abstract: In this workshop facilitators will focus on patient’s expectations of a doctor visit. Why does the patient comes to you and what does he wants? Is it medication, reassurance or maybe a referral? Or is it something else? What questions can you use to explore patients ideas and concerns? What are (non-) verbal clues and hints? How do you structure this within the short consultation time you have?

We will talk and practise consultation techniques to effectively meet your patient’s needs. If you as a doctor connect with your patient’s concerns and idea’s, your patient will be more satisfied. And if the patient is satisfied, so are you as a doctor as well, right?

 

Title: The medical actuality in recreational drugs. Skill-building workshop of the training of the approach to the patient intoxicated by recreational drugs.

Proponents: Elena Klusova, Rocío García-Gutiérrez Gómez, Sara Correia, Kelly Patricia Baldeon Cuenca, Manuel Soto, Raquel De León Contreras, Cristina González Ruiz, Alba Gomez Zahino, Claire Thomas.

Keywords: Drugs, Recreational; Substance-Related Disorders; Organic Mental Disorders, Substance Induced; Substance Use Disorders; Toxicity; Diagnosis; Algorithms; Emergency Treatment; Life Support Care.

Abstract: Since 1960-s drug abuse-consequences started to form a significant public health issue. An increasing number of cases of life-threatening drug intoxication by so-called recreational "club drugs" have shaken the planet in the last 15 years, and the use of chemical-submission psychoactive substances have recently acquired a new dimension owing to the atrocity of sexual crimes associated with drug use(DFSA).

For this, we believe it is imperative that physicians know the symptoms and signs of alarm of these pathologies, to improve their early recognition, to prevent a consecutive severe neurotoxic damage and to achieve the possibility of survival of these patients by providing an early and correct treatment.

We present a Skill-building WS with a unique opportunity to exercise clinical-diagnostic thinking in the actual scenarios of overdoses by recreational drugs currently more popular in the European territory. We have the exclusive knowledge acquired in the emergency services of the main Ibiza ́s and Madrid ́s hospitals and the “061” service of the advanced life support of Balearic Islands.

Structure:

-Shocking ice-breaking video of the dangerous effects of recreational drugs popular now in Europe                                       

-Brushstrokes about the importance of approaching recreational drugs-addiction or its ‘sporadic and compulsive consumption for the short and long-term mental health, explained by a group Psychiatrist. 

-Presention of: a.the two main theories of classification of “design drugs”, which will help us to understand the physiopathological mechanisms of drug ́s-action and facilitate the diagnosis and treatment in real situations; b.The list of illicit drugs, currently used for recreational purposes, the serious intoxication by which is attended currently in the medical services in Europe; c.The warning signs, essential to distinguish in intoxicated patient and the algorithms of the immediate diagnostic orientation; d. With the example of a real-case-video will hold the joint work of diagnostic evaluation and main lines of the therapeutic approach.

-In the main block of the WS, the teams of participants will have the videos of intoxicated by substances relevant to daily practice and must face the challenge of: diagnostic evaluation of the patient; decision making; organization of the human team (nursing, witnesses, security agents, police); election of means of approach; and finally, the pharmacological and non-pharmacological treatment of the patient.

-Take-away messages.

 

Title: Choosing wisely in the Emergency Room.

Proponents: Rafael Beijinho do Rosário, Ayose Perez, Augusto Saldana, Magdalena Canals, Rosario Bosch.

Keywords: emergency medicine; choosing wisely; evidence based medicine
Abstract: Background: The use of unnecessary tests and treatments contributes to health care waste (overutilization, overuse, overtreatment). Three years ago the Spanish Society of Family and Community Medicine (semFYC) set up an action called “Not to do” and commissioned expert panel to identify some of such items on day-to-day GP consultation. The list was narrowed over a modified Delphi process. The top 15 tests and treatments were provided with Grading of Recommendation, Assessment, Development and Evaluation (GRADE) literature summaries. Afterwards it commissioned another expert panel of 15 GPs to produce a paper on Emergency Medicine with the same procedure (link).

Aim of the Workshop: Share 15 recommendations of the document “Do not do in the emergency room” (choosing wisely); provide scientific evidence or absence in usual practices in emergency services.                                                      

Methods: Through the resolution of interactive clinical cases delegates will review the recommendations of the paper. The chair will bring about clinical cases in day-to-day situation, prior to clinical decision a question will be asked followed by the delegates voting "Do" or "Do Not". After each question a debate will be held and the literature supporting final decision will be provided.

Results and Conclusions: Making clinical decisions with a poor level of evidence is common in our daily practice. Papers such as the one produced by semFYC is a landmark in family practice towards efficiency and efficiency because they are based on evidence-based medicine.

 

Title: S.W.O.T Analysis for primary care doctors and workers.

Proponents: Tugba Onat, Süheyla Atalay, Alexandra Tsipou, Ilyas Erken.

Keywords: primary care; SWOT.

Abstract: Background: The S.W.O.T Analysis is a classic diagnostic tool that looks at the four elements: Strengths, Weaknesses, Opportunities and Threats. When developing strategic plans for the future, every organization needs to understand what it's internal strengths and weaknesses are, and what opportunities and threats are in the environment. Understanding these four elements creates an effective foundation for planning and we can use this method in our daily practice to improve our quality. A S.W.O.T analysis in a clinic, college or other health care establishment can be a simple and yet effective tool for ensuring that all appropriate factors are considered.

Strengths - factors that are likely to have a positive effect on (or be an enabler to) achieving the clinic’s objectives.

Weaknesses - factors that are likely to have a negative effect on (or be a barrier to) achieving the clinic’s objectives.

Opportunities - external factors that are likely to have a positive effect on achieving or exceeding the clinic’s objectives, or goals not previously considered.

Threats - external factors and conditions that are likely to have a negative effect on achieving the clinic’s objectives, or making the objective redundant or unachievable.

This workshop engages participants' thinking, allows the sharing of different perspectives and viewpoints, and educates everyone involved to create a common ground about the elements and the necessary future planning.

Methods: Participants will be divided in four groups, each assigned one of the four elements of the S.W.O.T Analysis. We will give the group 15 minutes to list information on. Every person writes down each of his or the group’s ideas with a black marker on a post-it note and puts it on the flip-over and can discuss among each other and exchange or improve existing ideas or experiences. Last part will be to recognise the workshop datas and talk for 15 minutes about datas, ‘What is currently being done or has been done?’ -‘What still needs to be done?’

Goals: To create a clear picture of the four elements needed in an effective future-oriented planning process, to engage participants thinking about strategic themes and to distill as a team the meaning of information that is generated, to developed the main strategic actions for the future in primary care practice.

 

Title: More than just drugs in your prescription. If the health problems are BIOPSYCHOSOCIAL, the solutions must be... 

Proponents: Kelly Patricia Baldeon Cuenca, Elena Klusova, Sara Correia, Adrian Castellote, Sara López Puche, Flávia Fernandes Neves, Lucía Gutiérrez García.

Keywords: community; empowerment; interdisciplinary communication.

Abstract: Introduction: Community medicine consists of the care based on the patient, family and/or its ́ immediate environment as a conditioner of health status and not on the disease itself.The health problem shows to be a BIOPSYCHOSOCIAL one, connecting the “biological”medical illness in a direct or indirect way with all the complexity of the social and psychological setting of the patient.It is important the interplay between epigenome, social and biographical contexts, development of individual abilities, stress management, sense of internal coherence and behavioral development.

The limited time of the patient care and the high healthcare burden and organizational pressure in the current European Health Systems, makes doctors to reduce their intervention to just a pharmacological treatment, tending to forget or misspend all the resources, that the community can offer. Frequently we forget how working together with the multidisciplinary teams can benefit all the involved.

Structure:                                   

Part 1: We are going to offer a brief test clinical-case on the health situation of one of the media personalities, assessing the options of their multidisciplinary solutions that the audience can propose (such as therapy advice of sleep hygiene care, mindfulness, nocturnal meditation).                                                 

Part 2: We will tell the participants about the most interesting projects of community health programs currently developed in our country.                                                  

Part 3: The participants will form several groups, which will represent multidisciplinary teams, we are going to ask the participants to try to solve the clinical cases initially raised as medical ones, avoiding pharmacological measures and big economic investments.

Part 4: Now is the time for the participants to tell us what they are doing in their countries: how do you help your patients apart from issuing the drugs prescriptions? what projects do you carry out in your community? Open to dialogue and debate.

Part 5: take-away messages resume.                

Conclusion: Our primary goal as physicians and community members should be: to achieve the perspective of equity in solving health problems, to learn to look for “causes-of-cause” or cause-based approaches, and to potentiate an individual and group empowerment. We need to design associative strategies, promote health, increase the quality of life and social welfare, enhance the capacity of individuals and groups to address their own problems, demands and needs, it is a continuous process with a beginning but without an end.

 

Title: Unpuzzling type 2 antihyperglycemic drugs. Matching the sweetest pill with the right patient.

Proponents: Sara Correia, Helena Alonso-Valencia.

Keywords: diabetes; antihyperglycemic drugs; combination therapy.

Abstract: Diabetes is a complex, chronic illness requiring continuous medical care. That being said, the role of the general practitioner is one of utmost importance, as we are the ones who monitor the evolution of the disease, get to tailor the antidiabetic treatment and adjust it according to specific patient phenotypes and needs, thus optimizing the best combination.

According to recently compiled data, around 422 million people live with diabetes worldwide, and an estimated 193 million people have undiagnosed diabetes. Having all this in mind, we believe that the better the knowledge, the straighter the control and the lesser the negative outcomes, and so we decided to create this workshop to brush-up everyone’s skills and unpuzzle type 2 antihyperglycemic drugs.

When entering the room, each participant will be randomly assigned to a group colour, in a way that we will form a total of four groups. By doing this, we hope to break the pre-established friend/country sets, and promote the dialogue with different colleagues. After a short introduction and welcoming words, we will start with a 15 minutes presentation, reviewing the main antihyperglycemic drugs and combinations used nowadays having in mind different types of patient profiles. After this, we will assign each group a clinical case. They should debate it among themselves (for about 10 mints) and, afterwards, each group will share the answer with the rest of the participants and we can have an open debate about their options and different opinions. At the end of the workshop, we will provide our attendees some extra material to take home which sums up the activity and hopefully will help them in their daily practice.

 

Title: Spirometry Made Easy.

Proponents: Pedro Fonte, Claudia Vicente.

Keywords: respiratory function; chronic lung diseases; obstruction; restriction.                                                       

Abstract: Objective measurement of respiratory function is a fundamental requirement in the diagnosis of many chronic lung diseases. It is important to be able to distinguish between obstructive and restricted lung disease, and often this is not possible to determine from history and physical examination. In addition it is sometimes impossible to distinguish between asthma and COPD without objective respiratory function testing. Spirometry has often been in the “too hard” basket for many in General Practice, but high quality technique is achievable and accurate interpretation is possible for “on site” diagnosis and appropriate treatment.

GRESP, the Portuguese Primary Care Respiratory Group, presents this interactive workshop. After a short presentation, open discussion among participants will be led by a team of practising family physicians with a special interest in respiratory diseases and with experience of education and investigation in this field. The session will be applicable to General Practitioners and Allied Primary Care Health Professionals. It will be pragmatic and concise. The main issues to be covered at the workshop will be: clinical vignettes and discussion of diagnosis, with a short theoretical introduction on pulmonary function and physiology; correct techniques achieve accurate results; interpretation of spirometry; tips traps and tricks in achieving accurate assessment.

 

Title: Intermediate care for youngs GPs. From Lecce to Porto.

Proponents: Simone Cernesi, Jacopo Demurtas, Stefano Celotto, Alice Serafini, Gabriella Pesolillo, Francesca Mele, Alessandra Boni, Giulia Cusmano.

Keywords: intermediate care.

Abstract: Background: The definition of Intermediate Care (IC) is not clear yet. We think it's important to analyze it from the point of view of General Practitioners (GPs). Although it can actually be considered one of the possible options when dealing with aging from a global perspective, many questions remain open, such as: What does Intermediate Care really mean for GPs? Is it considered as just a riddle? Can we provide a different perspective? Why is IC marginalized in General Practice?

Purpose: To generate hands-on solutions to increase awareness and involvement of young GPs in the innovation of intermediate care (IC), especially in regard to an international perspective.

Method: classroom contract (5 min); Presentation and Ice Breaking games (10 min). We have planned three different tasks, that can be developed either simultaneously or in sequence. First Task (15 min): Investigate the meaning of Intermediate care from the participants' point of view and design a conceptual map on a flip chart; Second Task (20 min): "Cognitive Autopsy", which consists of an effort to identify similarities and differences between Family Medicine, Palliative Care and Intermediate Care; Third Task (25 min): highlight the barriers that junior GPs face when approaching Intermediate care.

Conclusions: This workshop could also be a great opportunity to: 1) Share and collect different GP experiences and give voice and visibility to them, 2) discuss our IC "Decalogue", first presented in Wonca Prague 2017 (what we need, what we can improve) and also promoted in the Wonca Working Group, 3) Spread the best take-home messages on social media and also make our WS traceable and open for future ongoing discussion.

 

Title: Shifting boundaries, international opinions of euthanasia?

Proponents: Rianne van Vliet, Maike Eppens.

Keywords: euthanasia.

Abstract: In this workshop we want to pay attention to what euthanasia entails in the Netherlands. We will talk about the guidelines and the role of the GP in this.

In the Netherlands, patients can choose euthanasia when they are in the terminal phase. In the Netherlands,147,000 people die each year, of which 6,760 (4.6%) die through euthanasia or suicide aid. The number of patients who die through euthanasia grows each year. With the growing population of elderly people it is important to think about what our beliefs are of euthanasia.

In this workshop we will compare the different views between the countries. We will discuss the pros and cons of euthanasia and talk about the grey boundaries as euthanasia in patients with dementia or psychiatric diseases. Also, we want to talk about the impact for us as a GP. Our aim is to inform, discuss and learn from each other.

 

Title: Doctor, can I have a safe home birth experience?

Proponents: Irene Pizarro Sanz, Lucía Gutiérrez Garcí, Rocío García-Gutiérrez Gómez, Alberto Sanchez Bernal.

Keywords: home childbirth; delivery, obstetric; birth injuries; general practitioners; midwifery; evidence-based practice.

Abstract: Introduction: It is emerging among women around Europe a request for a birth labor more human, without setting aside the safety and potential medical care that this process requires. As members of the Community Health, it is in our hands to move closer to this demand by being informed of the alternative options that exist in our working area. All of it, in order to inform and support women throughout the process in the assessed decision each one makes.

Objectives: To share scientific evidence involving planned home birth as an alternative option that women may demand, as well as creating a common space to share experiences in different countries and discussion about this topic.

Methodology: Since this workshop’s fundamental aim is to learn and share experiences, our main tool will be open debate. Using diverse audiovisual resources, we will expose topics related to pregnancy and birth outside the hospital so that participants can offer their personal opinions, experiences and improvement ideas. Some of the addressed topics will be:

- Patients’ and professionals’ growing doubts and concerns about traditional hospitalary care. Rising patients empowerment about their health decisions. Obstetric violence.

- Alternative options practiced in different countries and scenarios (urban, rural, low resources areas...). Group and multidisciplinary work: nurses, midwives, family doctors, GyOb and their roles in pregnancy and birth.

- Evidence-based data: morbility and mortality differences between hospitalary versus home births. A final space will be offered for participants to express their conclusions.

Conclusions: We can not neglect the fact that some changes are happening in the way patients, health professionals, and society experience the process of pregnancy and birth. Expectations and claims are changing, and so must do our clinical practice so there is a continuity in trust and good patient-doctor relationship. We aim to learn and share practical knowledge and tools to improve the way we face patients new demands and expectations maintaining evidence-based counseling.