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SERVICE

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Total focus on private medical consultations in the specialty of Psychiatry.

Pleasure in sharing knowledge intensively, so that clients (patients and companions) develop the ability to understand the rationale and meaning of diagnosis and treatment.

Our clinic seeks to give a touch of refinement and elegance to the tireless ideal of delivering top-level medical consultations in bio-based Clinical Psychiatry and Psychopharmacology for adults and the elderly.

That is our goal. We know it is impossible to achieve that without much endeavor and persistence.

In his career, Dr. Petrus Raulino has:

• Solid experience in private service. More than 1,500 patients privately seen in his private medical office.

• Solid experience in psychiatric care with complex medical issues. More than 800 psychiatric consultations held in general hospital (similar to private consultations, but in emergency rooms, wards or ICU’s of general hospital).

• More than 15 years of experience in Psychiatry.

• More than 20 years of experience in Medicine.

The use of e-mails and social networks do not have the features of medical consultations. The interaction by these tools does not have the same invested time and richness of details of a medical consultation.

Accordingly, they should not be considered as means for the practice of Medicine, although they are useful tools.

In medical consultations, contact with the patient is direct, individual and in-depth.

By contrast, the use of e-mails and acting on social networks are mass interaction activities (with many people at the same time). Especially for reference professionals.

Consequently, for the use of e-mails and social networks, Dr. Petrus Raulino has a very trustworthy team for giving support in the front lines of these activities. Very often, a person from this team, and not Dr. Petrus Raulino, will answer to interactions through these media.

This team is directly supervised by him, always following Dr.’s guidelines and respecting the professional rules of secrecy and privacy. But in no case communication by e-mails and social networks replaces face to face medical appointments.

Organizing in this way, Dr. Petrus Raulino frees up his time to do what he does best: commit himself to delivering medical consultations and continually updating his expertise.

Code of conduct on medical prescriptions:

Dr. Petrus Raulino, as a psychiatrist, is a knowledge professional. His delivery is the knowledge through medical consultation. His relationship with the patients is grounded by knowledge, not by medical prescription. The vast majority of patients understand this.

As a general conduct, Dr. Petrus Raulino does not prescribe outside medical appointments.

To give a prescription, the doctor must update the balance of benefits versus side effects of the medication, as well as the treatment planning, and provide guidance. The face to face medical consultation is the appropriate setting to meet these objectives.

In other words, the medical prescription must necessarily have “ballast” in the validated knowledge in an updated consultation. The medical prescription must be understood as a consequence of the consultation, not as an end in itself.

Every medical prescription is given for a specific period until the following medical consultation.

The deadline for clinical follow-up reassessment in a new medical appointment is defined at the end of each medical consultation. At that moment, the client (patient or companion) must speak up if he or she has a different demand other than the stipulated deadline. Thus, it is possible to clarify doubts about the deadline.

Dr. Petrus Raulino also cannot make prescriptions through phone call orders, as these orders are analogous to self-medication (because they are unilateral and have not gone through the validation process by medical consultation to adjust or maintain the use of the medication).

Requesting prescription renewal without passing through medical consultation is bad for the patient and the doctor.

For the patient, it is flirting with self-medication. People who ask for automatic prescription renewal without medical consultation, often by convenience of a phone call, seem to ignore that drugs can be responsible for deaths or serious complications, especially if improperly taken by self-medication.

Self-medication is associated with an idea of practicality, agility and “self-care”, which can be in many instances dangerous. Ingesting a drug presupposes a clinical diagnosis that is strictly within the purview of the physician. Otherwise, it can trigger a series of problems, such as the worsening of pre-existing diseases or interaction with other medications, causing side effects that are often disastrous.

For the doctor, the practice of filling a prescription without a face to face medical consultation is constrained by his Code of Medical Ethics, which prohibits the physician from prescribing treatment or other procedures without direct examination of the patient. The doctor who does so can be obliged to respond for ethical infraction to the council.

The practice of filling prescriptions without direct examination of the patient can put the patient’s life at risk. This is so true that Cremesp (Sao Paulo Regional Council of Medicine) condemns it. “The danger of prescribing medications without evaluating the patient is to increase the complications of the condition. Although apparently simple, the act of renew the prescription implies that the doctor agrees with [the continuation of the medicine and] its indication. If the person presents complications due to a certain practice, the professional [who gave the prescription without evaluating the patient] is [the main] responsible for the prescription ”, said Antônio Augusto Dall’Agnol Modesto, a member of the Technical Chamber of Family Medicine of the Cremesp, in a signed article on bioethics. And he goes further: “Obliging doctors to automatically renew prescriptions and order exams without the patient’s decent assessment, besides being unethical, is also not the appropriate conduct”.

The Medical Code of Ethic itself establishes that “the doctor is prohibited from prescribing treatments and other procedures without direct examination of the patient” (2020, p. 28, article 37). Therefore, it highlights the value of the face to face medical consultation for adequate treatment safety.

The Code of Medical Ethic also reinforces that “it is forbidden for the doctor to fill a medical document without having performed a professional act [that is, medical consultation] that justifies it” (2020, p. 37, article 80).

For all these reasons, Dr. Petrus Raulino does not prescribe outside medical appointments.

Due to global emergency of pandemic Covid-19, the Federal Council of Medicine and the Brazilian Psychiatric Association recognized exceptionally the practice of Telemedicine as long as the battle to fight spread of Covid-19 continues.

Telemedicine is the practice of medicine through interactive and remote technologies largely based on the internet.

Telemedicine focused on Psychiatry, also called Telepsychiatry, is a viable practice that is exceptionally approved as a strategy to assist patients and their families during the pandemic.

Telemedicine (including Telepsychiatry) takes place via videoconferences, phone calls or cell phone applications. These means should offer the same degree of privacy and confidentiality as face to face medical consultations. However, clients (patients and companions) must know there are limitations and risks related to the computational universe and the internet.

Telepsychiatry care is not mandatory, but optional for the psychiatrist – if he considers that it is safe for the person who will undergo this type of care – and for people who feel comfortable and helped by this type of care.

For remote assistance (remote or online consultations), clients (patients and companions) should be aware that:

– distance (or online) medical service has limitations, such as the impossibility of a complete physical examination, although it is possible to carry out inspection;

– the online medical consultation is strictly delimited and does not guarantee the right to be attended indefinitely or to have the doctor available at other times not previously agreed by any means;

– the online medical consultation is for one individual, who must be in a quiet place which provides confidentiality concerning the consultation;

– the client (patient or companion) is not allowed to use the image or audio of the medical consultation without the express permission of the Dr. Petrus Raulino;

– for the good use and analysis made by the doctor, client (patient or companion) must inform ALL possible data, NOT omitting any information about its signs and symptoms;

– the accuracy of the information provided by the client (patient or companion) is even more necessary due to the absence of a face to face clinical evaluation by the doctor;

– the patient may be invited to take photos of parts of his or her body, depending on the clinical complaint, and the images could be filed in his or her medical record (for example in case of an adverse skin reaction due to the use of medication prescribed by the psychiatrist);

– complementary exams may be necessary for a better diagnosis;

– the patient may be referred to a health service, according to the doctor’s assessment;

– there may be any technical impossibility to carry out the medical consultation, such as the instability of the internet connection, and, in this case, doctor’s appointment must be rescheduled, on the day and times agreed by both parties;

– the use of e-mail or SMS as a means of communication and sending information may be necessary and the client (patient or companion) must guard against vulnerabilities of the system of choice regarding the confidentiality of information, and must be aware of such vulnerabilities, assuming the resulting risks;

– the delivery of physical material referring to tests request, medical reports or medical certificates to a bearer authorized by the client (patient or legal responsible) may be necessary, observing the need to protect all information, according to the General Data Protection Law and other legal and ethical regulations;

– in case there is a need to prescribe some controlled drugs, it will not be possible to send them electronically, due to ANVISA’s specific determination on this matter.