Keynote Speakers

Anthony Heymann

Curriculum vitæ

Title: Paradigm shift – from doctor patient to payer patient relationship

Quality indicators are now driving medical care in the community at the expense of individually tailored medical care. In the name of healthcare quality the payers, who might be HMOs or Health Ministries use a “one suit fits all” solution based on epidemiological data.

The danger is that the physician may be pressured to work for the quality indicator and not the patient’s needs resulting in erosion in the physician-patient relationship. The authorities have succeeded in changing physician behavior as can be seen across different health systems. This has been achieved with means as simple as feedback and peer pressure, to the use of financial incentives. The clinical medical record has been the main tool for collecting data but these statistics has been confused with knowledge. The payers think they have the big picture but the critical information is often missing and that is what the patients want. This knowledge is with the family physician who often feels torn between the needs of the patient and the health system.

Each clinic population has its own nuances; each patient has his or her own very specific needs which must be answered. This lecture will illustrate these problems and suggest new strategies to restore the physician patient relationship.

Cyril Höschl

Curriculum vitæ

Title: Placebo scam or a useful tool?

Placebo is a medicament containing no pharmacologically effective substance. Its efficacy is reflected in the brain activity mapped using fMRI. Use of placebo in clinical research is discussed from methodological, ethical and technical perspectives.

First, without placebo-controlled studies the proof of efficacy of a new drug is almost impossible. A direct comparison with placebo is often necessary.

Second, the Helsinki declaration says that benefits, risks, burdens and effectiveness of a new intervention must be tested against already proven intervention. This condition is not met with placebo. This paradox is solved by diminution of the respective wording: The use of placebo, or no treatment, is acceptable in studies where no proven intervention exists or where for methodological reasons its use is necessary.

Third, it is sometimes difficult to ensure blinding the placebo.

Major problem of clinical pharmacology is a significant increase of the placebo effect in recent decades and a fading of a verum - placebo signal. Design of a study, type of institution, patient’s characteristics, rating factors, outcome measure, type of a symptom or a disease, type of medication and dosing schedule, sample size, randomization, cultural context, and qualification of raters may contribute to the observed decrease of the signal.

Interview with Cyril Höschl
Charilaos (Harris) Lygidakis

Curriculum vitæ

Title: Embracing diversity in the digital transformation of primary healthcares

The use of information and communication technologies for health constitutes a strategic ally to the sustainable development goals and attaining universal health coverage through enabling equitable access to high quality and affordable health care services. The omnipresence of mobile devices and sensors, the increasing availability of data and computational power, and the breakthroughs in imaging and genomics, are creating a perfect storm that is bound to transform health care profoundly. At the population level, the coordination of disease control and prevention programmes is facilitated, cost-effective interventions are implemented, and ultimately the quality of life of our communities is enhanced.

EHealth also plays a significant role in the delivery of people-centred and integrated health services, empowers individuals to make informed decisions and self-manage their health needs. For the first time in history, the individual is placed at the centre, has timely and affordable access to data, knowledge and tools, and health care is tailored for his/her diverse background, context and needs.

A second perspective to the digital revolution is how our own discipline is transformed. As technology is a catalyst for sustainable, large scale social change, health care has the opportunity to invest in inter-professional collaboration, and leverage a diverse range of expertise, stakeholders and resources to expand its horizons and tackle old and future challenges.

Interview with Charilaos (Harris) Lygidakis
Amanda Howe

Curriculum vitæ

Title: 'Stand as one' - where do family doctors need to share an identity and a voice?

Separatist forces operating across our world today are a source of anxiety, threat and conflict. Concepts of tribe and nation can be a source of pride but also division. Similarly, professional groups such as WONCA face the challenge of trying to find shared values and means of improving our professional standing and impact, while respecting the diverse settings and backgrounds of our members and patients. This talk will examine the ways in which WONCA develops its shared mission and priorities, while continuing to celebrate our diversity and autonomy.

Wolfgang Mastnak

Curriculum vitæ

Title: Music therapy – add-on-intervention or key treatment?

Music therapy dates back to Ancient Greece and has widespread cultural roots such as in traditional Chinese and ancient Turkish medicine. The vigorous revival of music therapy in the middle of the 20th century went hand in hand with striking phenomenological experiences with music in paediatrics, e.g. in autism spectrum disorders, and in psychiatry. Contemporary music therapy combines artistic approaches, evidence based clinical results, cross-cultural medical theories, and neuropsychological and neurophysiological studies on the multifaceted underlying mechanisms.

In this context, interfaces between the auditory pathway, neuro-cognitive music processing, and neuro-endocrine circuitries play an important role in the music-based modulation of psycho-physiological processes. In addition to that music enhances the neuroplasticity and influences the self-regenerative capacity of the brain. Creative processes and aesthetic experiences interact with the artistic self of patients and involve key structures such as the hippocampus, the insular cortex, the cingulate gyrus, the nucleus accumbens and the medial geniculate body.

These mechanisms allow us to apply music therapy as an operative constituent of complex therapeutic concepts such as in patients with arterial hypertension, in various psychiatric disorders such as depression and schizophrenia, in neurodegenerative diseases such as in Alzheimer’s disease and Parkinsonism, and in perinatal medicine as well as for the support of the neural growth of the foetus. Given the complexity of musical processes, application of music therapy requires interdisciplinary considerations that allow for possible interactions with other therapeutic means and assess eventual contra-indications. Only the estimation of the whole context allows us to speak of an add-on-therapy or a key treatment.

Niek De Wit

Curriculum vitæ

Title: Primary care for the elderly; the essentials of general practice

The population is rapidly ageing, and in 2040 on estimate 25% of the European population will be older than 65 years. Although many elderly will age in good health, physiological limitations, chronic diseases and psychosocial problems may challenge their autonomy with increasing age. Most elderly consider being independant as the core of their quality of life. Therefore preservation of daily functioning is more important than being free of disease. Elderly want to “add life to years, not years to life“. Personal, longitudinal guidance with an integral approach is essential to address the health issues of elderly patients. Evidence based medicine often fails to bring the right answer for the individual elderly patient, as most guidelines focus on younger patients with single diseases. In addition, life perspective changes when people get older, the potential benefit of medical interventions alters and the context of medical decisions changes accordingly. Decisions to abstain from referral or stop medication become as relevant as starting them. For personalised medicine and shared decision making elderly patients need support from a trusted medical professional. Although general practitioners are optimally equipped to fulfill these tasks, future will demand a more proactive role of GPs in elderly care. Early identification of medical and psychosocial problems is required to prevent escalation and functional decline, and eldery will need personal guidance in complex health decisions.

In this lecture the key health challenges of elderly will be discussed in the context of ageing, as well as the approach for general practitioners to adequately address them.