[The Chilean Health Care System: the task ahead].

The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%.

[The ALANAM statement on public health policy].

The ALANAM (Association of Latin American National Academies of Medicine) statement on public health policy, issued following its 19th Congress, held October 28–30, 2010, in Santiago, Chile, declares that cardiovascular diseases, cancer, accidents and violence are the leading causes of death in the region, while in several of its member nations, emergent and re-emergent infectious diseases, malnutrition, and mother-child illnesses remain prevalent. The statement calls attention to the lack of functioning water supply and sewage systems in many villages and rural areas. After describing the social causes of the present state of public health in Latin America (poverty levels reaching upwards of 44% of the total population, or some 110 million people), it calls on governments, first, to spare no efforts in the task of eradicating extreme poverty in the short-term, and poverty in the long-term.

[Keynote address to the 19th congress of ALANAM].

In his keynote address to the international seminar of the ALANAM (Association of Latin American National Academies of Medicine), held October 28-30, 2010, in Santiago, Chile, Dr. Alejandro Goic, President of the Chilean Academy of Medicine, discussed the state of health and of medical and health research in Latin American countries. He called attention to the fact that the National Academies of Medicine are learned and honorific institutions whose main function is to reflect on, and foster, medical practice, medical education, and public health.

[Biographical notes on Professor Hernan Alessandri, M.D].

Hernán Alessandri, a renowned Chilean medical educator, was born in Santiago in 1900. He received his medical degree at the University of Chile in 1923. When in 1927 his father, then President of Chile, was sent into exile, he used the opportunity to deepen his medical knowledge in France and Germany.

[The diagnosis of death].

This paper undertakes an analysis of the scientific criteria used in the diagnosis of death and underscores the importance of intellectual rigor in the definition of medical concepts, particularly regarding such a critical issue as the diagnosis of death. Under the cardiorespiratory criterion, death is defined as "the irreversible cessation of the functioning of an organism as a whole", and the tests used to confirm this criterion (negative life-signs) are sensitive and specific. In this case, cadaverous phenomena appear immediately following the diagnosis of death.

[The ethics of health care organization].

Health care organization is not only a technical issue. Ethics gives meaning to the medical profession's declared intent of preserving the health and life of the people while honoring their intelligence, dignity and intimacy. It also induces physicians to apply their knowledge, intellect and skills for the benefit of the patient.

[Decentralization of health care and medical teaching: the Chilean experience].

In Chile there has been a close interaction between medical teaching and health care. In 1943, the University of Chile School of Medicine (founded in 1833) created Chairs in several public hospitals. The University of Chile School of Public Health (founded in 1943) played a key role in the creation in 1952 of a centralized National Health Service (NHS).

[The University of Chile School of medicine : 170 years serving the country].

The first course on Medical Sciences in Chile was inaugurated in 1833, being its director William C Blest, MD, an Irish physician graduated in Edinburgh University. Therefore, Dr. Blest can be considered the founder of Chilean formal medical education.

[Seminar about medical training in Chile in the current time].

The Chilean Academy of Medicine is concerned about the significant increment in the number of Medical Schools in Chile, from six in 1981 to 16 in 2002. All these Schools were invited to participate in a seminar about medical training. Eleven Schools are private and 5 are public (3 private Schools are subsidized by the state).

[Proliferation of medical schools in latin America. Causes and consequences].

Significant changes in university education have occurred in Latin America, caused by the strategic importance that it has on economical and social development. The educational system expanded and science, technology and informatics, experienced an important development. The eighties were characterized by a reduction in government expenditures, a more efficient use of resources, an increase in the number and variety of universities and university students.

[The Revista Médica the Chile and medical education].

With this issue, Revista Médica de Chile will have been published uninterruptedly, for 130 years. Formal medical education had an early development since Chile became independent from Spain (1817). The first Medical Sciences Course was organized in 1833 by the Irish physician William C Blest.

[Sources of error in clinical practice].

The clinical setting is everything that contact us with the patient's reality, including physical, instrumental and laboratory exploration, and we use it for diagnostic and treatment purposes. Diagnosis is the synthesis by which physicians conclude an elaborated analysis of subjective and objective data, obtained by physical exam and technology. This procedure involves data collection about the patient and his disease, the results of various tests and laboratory findings, the interpretation of the data and a diagnostic summary.

[Pedro Laín Entralgo, physician and humanist].

This speech of the president of the Chilean Academy of Medicine, Dr Alejandro Goic, is a tribute to the memory of the Spanish physician, scholar, historian, writer and intellectual Dr. Pedro Laín Entralgo, who died in Madrid on June 4, 2001, at the age of 93. On that occasion, the Spanish newspaper "El Pais" defined him as the last humanist.

[Quality control in Medicine. Position of the Chilean Academy of Medicine].

In the last two decades, important changes in medical training and care have occurred in Chile. The number of medical schools has been doubled, exceeding the national availability of professors and qualified training fields. The quality assessment and accreditation of medical training and care is insufficient in Chile.

[It is time to think about patient's rights. An introduction].

The underlying purpose of the Hippocratic oath and most medical ethics codes dictated during the twentieth century, is patient protection. Nowadays, however, clients of health services do not conform themselves with ethical declarations of the medical profession but demand that the rights that arise from those declarations, become legal instruments that force professionals, health authorities and governments to satisfy their health needs and respect their individual rights. Probably this is a consequence of the depersonalization of medical care, the weakening of ethical bases of physician-patient relationship and the emergence of new economical and social philosophies.

[Trends in current medicine].

Predicting the future of medicine is daring. One can speculate about some of its future traits at the most. The spectacular progress in biological sciences has nurtured the hope that medicine will be able to dominate all ailments, improve the quality of life and longevity.

[Claudio Costa Casaretto M.D. (1914-1999) in Revista Medica de Chile].

The work of Dr. Claudio Costa Casaretto covers a broad field in the history of Medicine in Chile. He contributed with the historical aspects in the Centennial issue of Revista Médica de Chile in July, 1972.

[Availability of physicians in Chile and its medium-term projection. 5 years later].

According to a prospective study performed in 1993, Chile had 14,400 active physicians (excluding those over 70 years of age) and a physician/inhabitant ratio of 1:960. The estimated projection for 1998 was of 16,244 physicians and a ratio of 1:921. However, during the present decade, the number of medical schools in Chile has duplicated, increasing by 38.

[The Hippocratic Oath].

The impact of Hippocratic Oath on medical practice is universally recognized. However, some physicians raise questions about its validity and few medical schools use it in graduation ceremonies. It is postulated that this oath does not harmonize with present bioethical concepts and that the principles of beneficence, lack of harm, autonomy and justice, elaborated by Anglo-Saxon philosophers, would do so.

[The care of the terminally ill patient].

Drs. Alejandro Goic (internist), Ramón Florenzano (psychiatrist), Bernardino Piñera (physician and Catholic Bishop), Sergio Valdés (internist) and Rodolfo Armas (internist) participated in a round table about the care of the terminally ill, during a Postgraduate Course organized by the Chilean Society of Gastroenterology. After a general introduction, participants discussed the psychological aspects of terminally ill patients, about the sense of death from a Christian anthropological perspective, the terminally ill in intensive care units and finally about the education of medical students in this frequently neglected aspect of medical practice.

[Bioethics in contemporary medicine].

Bioethics arose in a delicate social and political moment in the United States of America. With time, it has become a social and perhaps political movement. Its scope is wider and different than that of medical ethics.

[Revista Médica de Chile: a long and beautiful educational task].

Revista Médica de Chile is one of the oldest medical journals in the world. Since its foundation in 1972, it had an educational character. Its successive editors and members of editorial committees have been distinguished clinicians, investigators and teachers.