Tag Archives: Brasil

Marcelo_Garcia_imageDr Marcelo Garcia Kolling is a GP and primary care academic in Curitiba, Brazil

As Brazil prepared for the FIFA World Cup, its people were conflicted between football and needs of the country.   We have always called ourselves the Soccer’s Country (although we did not invent it, do not have the wealthiest national championship and, as is now clear, do not have the best team), Brazil is currently struggling to develop in other important areas as we strive to improve public services, whether in education, safety and health. In recent years its people have gone on the streets to call for the end of the military government and for direct elections. We fought for a Universal Health System and have tried to implement it for the past 30 years.

“Every Brazilian is a soccer coach” we say. Soccer is the topic of conversation in in every bar, and every media outlet, newspaper and blog is full of analysis of the game, its system and tactics. Everyone can name the iconic past soccer players or coaches, with Pele, Garrincha, Ademir da Ghia, and we had Tele Santana and Zagallo, with, more recently, Ronaldo, Rivaldo, and Ronaldinho Gaúcho.

But in the past two years, people have been concerned with other issues. Massive popular demonstrations ask how public money is spent and question tax exemptions in our essentially poor and uneven country. For primary care physicians, it is clear that, while everyone has the answers for our soccer team, we do not have solutions in other areas, notably in the Health System. We lack examples of past successful public health initiatives almost as much as we have a wealth of past players and coaches. Unfortunately, we seem unable to look outside our borders and learn from others. Maybe we think that because foreigners have learned from our soccer, and how it has adapted and evolved, we can create our own Health System from scratch, ignoring or blind to the trends worldwide.

The voices on the streets argue that, instead of, or in addition to, our “FIFA pattern” stadiums, we should have… more hospitals! “FIFA pattern” hospitals! At the same time, primary care is limited with little access, poor continuity and almost no coordination of care, and with just 1,5% of physicians specialized for general primary care (community family physicians). People simply don’t know that, rather than more hospitals, we need more quality primary care, offering timely and comprehensive care as is delivered in the more organized services of Europe or Canada.

While Neymar goes to the “top notch” hospital, to receive “top notch” diagnostic imaging technology, my next patient tells me that his chronic lumbar pain is not, after all, related to his obesity and sedentarism as I had told him, but the result of an injury “just like Neymar’s” that he had years ago, and he asks for a CT and/or MRI. As I prepare myself to discuss the correct management, defending my patient from harmful health propaganda, I just wonder when we will have our McWhinney to inspire the physicians and patients to a better understanding of what we need - just as Pelé always reminds us how the game should be played!


gustavo_gussoGustavo Gusso, MD, PhD, is Assistant Professor of General Practice at University of São Paulo, and the Former President of the Brazilian Society of Family and Community Medicine


“Soccer is the most important thing of unimportant things” is a common expression in Brazil. It is attributed to Arrigo Sachi, an Italian coach and to Nelson Rodrigues, a Brazilian writer. Brazil will not be the same country after July 8th 2014 when the national soccer team was almost destroyed by the Germans. During the preparation for World Cup the most frequently discussed aspect was the “the legacy”. But this was not what we expected. Many patients I saw this week were very upset- just as if they had suffered a major personal trauma. Brazil has never really been at World War. The feeling is not of anger against the Germans. Not at all. Everybody is in shock, or what “specialists” might call “post-traumatic stress disorder -population based”. All my consultations this week began by asking patients about the game. The most common words used were “shame” and “pathetic”. Many of them told me they dreamed that it was not true.

The first responses on social networks were the jokes even before the game finished. It is one of the ways Brazilians deal with trauma. But now everybody in trying to understand what happened. Planning beat improvisation is the most common theory. But isn’t soccer an art? It is as important to train the basics as in ballet or in painting but surely talent is the most important part? It seems that this day is over.

Soccer is now more a business than an art - just as medicine. Medicine chose the evidence based path. Improvisation is linked more to communication, especially of risks and benefits, in supporting a shared decision. One might say that “medicine was art for centuries, then become a science for decades, and now it is business”.   Maybe that is unfair and there is still a vestige of art and science, at least in some doctors. In São Paulo it is not easy to find them. The main goal for good students at the University of São Paulo, with some exceptions, is to open a nice private office as soon as possible and charge R$ 1000,00 reais (US$ 400,00) for each consultation that may last from 30 to 90 minutes - like the famous professors.

People feel one reason for this tragedy is the organization of soccer and its shady relations with sponsors and television. There is too much corruption in the Brazilian Soccer Federation (the last president left the country and lives in Miami). It seems that in Brazil the soccer stakeholders use methods that are decades surpassed. The coach, Felipão is totally outdated. The German team planned well. Their current coach, Joachim Löw, was the assistant of the former coach and was not sacked even though he lost two World Cups (2006 as assistant and 2010 as coach). For this World Cup they built a quiet hotel close to an isolated and beautiful beach and now intend to sell it.

In conclusion, the lesson for now is that improvisation is not, or should not be, the most important player in modern world. It is true for medicine, for soccer, and for any “value chain” that attracts billions of dollars. For medicine as in soccer, the big question is to know the right place for art and improvisation. It still remains behind the medical consultation even in the current business model.

And, now we need all our professional skill and evidence based medicine to deal with the national post-traumatic stress disorder. Or not.