IJCS | Volume 31, Nº4, July / August 2018

452 Mallet et al. Cardiology and films Int J Cardiovasc Sci. 2018;31(4)451-453 Viewpoint proximity of death and indication for exclusive palliative care. 2-4 But we might have to face even tougher situations when managing patients with heart failure, such as answering the following questions: “Howmany years do I still have?”, “Will I live to attendmy child’s graduation?”, “Will I live to see my grandchildren grow up?”, and other questions that might cross their mind. Perhaps one of the defenses we put up is to restrict all room for that sort of questioning. In addition to not being the proper solution, this attitude somehow postpones coping with those issues, which ends up avoiding that discussion, because, not rarely, the outcome soon becomes clear to both patients and families. However, that attitude hinders the communication with patients and families, delaying their understanding of the situation. In addition, the discussion about that scene can go beyond medicine as we realize that the diagnosis is established by a female doctor of Asian origin. This can lead us to debate our reality in the Brazilian medicine, in whose graduation programs female students predominate. Howwill this affect medical practice? Will this change the doctor-patient relationship? Moreover, the Asian origin of the doctor can open the discussion about “the other”, “the foreigner” in a country that seems to move away from its cosmopolitan tradition. Perhaps we could draw a parallel to the issue that “the other”, through the quota system, affirmative actions, ProUni and FIES, has become an increasing presence at medical schools in Brazil, one of the most elitist courses in the country. The other film from 2016, Ken Loach’s “I, Daniel Blake”, was awarded with the Palm d’Or in the Cannes Film Festival and also approaches the heart failure issue, but from a social perspective. In that film, set in England, Daniel Blake, interpreted by Dave Johns, after having a heart attack, is advised by his doctor not to return to his work at a carpentry, and, thus, must fight the bureaucratic forces of the system to receive Employment and Support Allowance. He faces the bureaucratic system, the coldness of the institutions, which supposedly exist to make the patients’ lives easier, the difficulties enlarged by his digital illiteracy, and a whole process that reminds us of the Franz Kafka’s novel “The Trial”, which tells about the distressing, meaningless and cruel bureaucratic trial to which citizens are submitted. Watching this filmcanbring to the classroomdiscussions about situations rarelyapproached in lecturesonmyocardial infarctionandheart failure, butwhichareextremelyfrequent whenmanagingpatientswith such conditions.Whohas not beenasked: “Doctor,whencan I goback towork?”, “Doctor, amI entitled to retirement benefits?”, “Howdo I receivemy support allowance?”, “Doctor, they have cut my benefits. What should I do?”. These situations are so frequent for those following patients up aftermyocardial infarction and with heart failure that we have to know something about the legislation to instruct our patients in a responsible way regarding their rights, providing themwith reports to allow themtohave their rights ensured.Usually such reports need to be systematically renewed, which not rarely makes the patient feel shy, fearing to be bothering the doctor. An additional theme for discussion in that film is the question of “the other”. In one of his several visits to the government offices, Daniel Blake befriends a white woman who had just moved to the city and also seeks for social support. She has two children, one of them is a black girl, who also suffers with the social security insensitivity. Although our patients might face much bigger difficulties than English citizens do, this film shows that bureaucracy and insensitivity are not exclusive characteristics of our society. Conclusion The use of films or film scenes is an important tool to discuss heart conditions, not only regarding the disease’s technical aspects, but also the social, ethical and existential aspects involved in the diagnosis of a severe heart disease. To quote Arthur Kleinman, the laureate films “Manchester by the Sea” and “I, Daniel Blake” are examples that can help us practice medicine in a more sensitive and reflexive, alert and morally responsible way in face of the emotional and experiential challenges presented by the profession . 5 Author contributions Conception and design of the research: Mallet ALR, Geovanini F, Andrade L, Kestenberg D. Analysis and interpretation of the data: Mallet ALR. Writing of the manuscript: Mallet ALR, Geovanini F, Andrade L, Kestenberg D. Critical revision of the manuscript for intellectual content: Mallet ALR, Geovanini F, Andrade L, Kestenberg D. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.