From health guidance to digital patients: twelve ways to use a school that never fit in just one classroom.
Today Escola de Pacientes has digital patients.
You can go to the site, choose a case, talk to a patient mediated by artificial intelligence, conduct a consultation, and then receive feedback on what you did. It is probably the most different part — and perhaps the most fun — to explain to someone who is just getting to know the School.
But it didn't start like this. And, above all, it isn't only for this.
Escola de Pacientes has existed since 2016 and has grown to serve three audiences that sometimes seem very different: patients, students, and health professionals. Over time researchers, teachers, and managers joined too, which complicates the introductory sentence a little but improves the project quite a lot.
Deep down, the idea remains simple: health knowledge only has full value when it can circulate.
From the article to the professional. From the professional to the patient. From the patient back to whoever teaches. From the classroom to the service. From the problem found in the service to a research project. From research, with some luck, to a better solution.
This path is rarely a straight line.
After ten years, when I look at what has been placed inside the School, I can find at least twelve uses.
There are probably others. But twelve is a number large enough to seem comprehensive and small enough to still fit in one text.
1. Explaining health to those who need to understand health
This is the oldest use and perhaps the most important.
People who work in health get used to strange words. Systemic arterial hypertension. Dyslipidemia. Posology. Exacerbation. Comorbidity. Therapeutic adherence.
After a while, they seem perfectly normal.
They are not.
An important part of the School has always been producing health guidance for patients, printed or digital, about diseases, prevention, medications, tests, nutrition, warning signs, and everyday care.
It is not about "simplifying because the patient doesn't understand." That idea has always bothered me a little.
It is about explaining well because we have an obligation to be understood.
There is an important difference.
The best technical information in the world loses much of its value if it ends up on a sheet nobody can use once they get home.
2. Making guidance survive the end of the consultation
Consultations end.
The doubts, curiously, do not.
Sometimes they start right in the elevator.
“Was I supposed to take it before or after lunch?”
“He said to come back if I got worse. Worse how much?”
“What was that exercise again?”
“Does this test require fasting?”
Hence a good part of the guidance folders, printed materials, digital files, links, and pages we have been accumulating over the years.
The idea is to extend the consultation a little without extending the doctor.
No professional can accompany someone twenty-four hours a day. And it would probably be rather unpleasant if they could.
But a clear instruction can keep working after the consulting room door closes.
3. Using video to explain what a paper explains poorly
Some things are better written down.
Others get better when someone shows them.
That is where videos began to occupy an important place at the School. Guidance on diseases, self-care, medications, and other health topics went through YouTube, social media, and the site itself.
Video is not automatically better than text. There are twenty-minute videos that could be three paragraphs, and ten-page texts that desperately called for a figure.
The format should serve the message.
When it works, audiovisual material lets you repeat an explanation as many times as needed, pause, go back, and share it with another family member.
It is a kind of consultation recorded in small pieces.
With the added advantage that a video doesn't get offended when someone asks it to go back thirty seconds.
4. Making a prescription truly simple
Simple Prescription was born from a very concrete problem: prescriptions can be technically correct and still be hard to use.
Name of the medication. Dose. Time. Duration. Instructions.
For someone who prescribes every day, the logic seems obvious. For an older person using several medications, for someone with reading difficulties, or simply for a family trying to sort pills on a kitchen table, perhaps it isn't.
The proposal was to reorganize the prescription to bring it closer to real life, including with visual aids and clearer language.
This project ended up growing, being studied, awarded, and institutionally adopted.
I like it because it represents a trait I try to preserve at the School: starting from the problem before starting from the technology.
We don't ask "what can we invent?"
We ask "what is going wrong?"
It is a less elegant question.
It tends to be more useful.
5. Better organizing care
Another set of tools was born from trying to organize care: Age-Based Medical Record, pre-structured templates, care plans, reminders, and technical materials.
In medicine, remembering is important.
Not having to depend solely on memory is even better.
A consultation involves dozens of pieces of information. Some are urgent; others come up once a year; others depend on that person's age, sex, previous diseases, medications, and risks.
Organizing this does not diminish clinical reasoning.
It frees part of him.
A good tool does not think for the professional. It keeps the professional from wasting thought mechanically remembering things that could be organized in front of them.
The mind is left for what really requires a mind.
6. Prescribing something you can't buy at a pharmacy
At some point Prescribe a Book appeared.
I have always liked the small provocation built into the name.
Not every prescription needs to end at a pharmacy.
Books, texts, and links can also help someone understand a disease, get through a hard time, change a habit, or simply look at a situation in a different way.
There was even a community book swap fair in this story.
Of course, nobody treats pneumonia by reading Machado de Assis.
There are limits to any intervention.
But health has never been merely the absence of disease, and care also involves knowledge, autonomy, bonds, culture, and what we do with our own stories.
Sometimes a pill is necessary.
Sometimes a book helps too.
It is worth knowing the difference.
7. Talking about health before anyone is sick
A good part of medicine begins after a problem appears.
Health promotion tries to arrive a little earlier.
Throughout the School's history, this appeared in materials about healthy habits, prevention, mental health, valuing life, and initiatives such as Healthy School.
There is an interesting difficulty here: avoiding turning health promotion into an endless list of things people should do.
Sleep eight hours.
Exercise.
Eat well.
Don't stress.
Have good relationships.
Thank you. Problem solved.
Life doesn't work that way.
Health education needs to recognize that individual choices exist within very different families, jobs, cities, incomes, schedules, and opportunities.
Autonomy matters.
The conditions to exercise it as well.
It is a slightly more complicated reflection than counting steps on a watch, but that is probably why it is worth making.
8. Practicing a consultation before the real consultation
Clinical simulations have been at the School since 2016.
At first, people played patients and students carried out simulated consultations. Remote formats, telesimulations, and, more recently, digital patients mediated by artificial intelligence followed.
A ferramenta mudou bastante.
The central goal remains recognizable: train before doing it for real.
Asking.
Listening.
Organizing hypotheses.
Recognizing warning signs.
Choosing what to investigate.
Proposing a management plan.
Explaining.
A consultation has many movements happening at once, and learning all of them directly in front of a sick person is not necessarily the kindest way to start.
Pilotos usam simuladores.
Surgeons use simulators.
It doesn't seem absurd that medical students can talk several times with a patient who agrees to be restarted.
9. Making mistakes, finding the mistake, and trying again
This is perhaps the most interesting use of digital patients.
Not simply simulating.
Repeating.
The student can conduct a consultation and receive structured feedback on the questions asked, the points missed, reasoning, communication, and management.
You can do it again afterwards.
There is something very powerful in turning error into learning material before it turns into harm.
This does not mean treating error lightly. Quite the contrary.
It means taking it seriously enough to create a safe place where it can appear.
A student who never makes a mistake in a simulation probably needs a harder simulation.
10. Teaching students and continuing to teach professionals
The School also grew within medical training and continuing education.
Clinical cases, questions, classes, study materials, references, workshops, and practical activities came to make up this environment for undergraduate and graduate students.
At the same time, technical materials and tools were being organized for health professionals.
This division between "student" and "professional" is administratively useful.
Intellectually, not so much.
O diploma muda a responsabilidade.
It should not end the status of being a student.
In health, perhaps the most dangerous professional is not the one who doesn't yet know.
It is the one who has already decided they know enough.
11. Keeping knowledge and turning experience into science
After a few years producing materials, another problem arises: where is everything?
Articles.
Guidelines.
Presentations.
References.
Results.
Key passages.
Old versions.
New versions.
Humanity has accumulated an extraordinary amount of knowledge and, in parallel, developed an impressive ability to forget where it saved it.
The Citation Bank emerged in this space of organizing references and supporting bibliographic searching.
At the same time, the School's activities were turning into research questions, undergraduate research, final projects, conference presentations, articles, and books.
Today there are dozens of publications related to the experience.
I like this cycle because it avoids two temptations.
The first is doing without studying.
The second is studying without doing.
Practice raises questions. Research tests answers. Some answers go back to practice.
When everything goes well, we start over with better questions.
12. Bringing together teaching, service, and community — and seeing what happens
Perhaps this is less a specific use and more the reason the other eleven exist together.
The School was born at the meeting point of care, university, and community.
A problem found in a health unit can become a tool.
The tool can be used by patients.
Students can help evaluate it.
Evaluation can become research.
Research may show that the tool needs to change.
A local solution can be adopted by an institution.
And then another problem appears.
The cycle starts again.
“Teaching–service–community integration” is the technical expression for this.
It is a correct expression.
It is also long enough to run the risk that nobody thinks much about it after putting it on a slide.
In practice, it means bringing together worlds that usually work separately.
Those who care for patients see things that those who research may not see.
Those who research know things that can change care.
Learners ask questions that someone who has worked for twenty years stopped asking.
And the person being cared for knows things about their own life that none of the three should imagine they can find out on their own.
Perhaps Escola de Pacientes is, in the end, precisely this meeting place.
Today there are digital patients, artificial intelligence, thousands of simulations, videos, articles, books, reference banks, and tools that were certainly not in the original 2016 plan.
Thankfully.
A project that, after ten years, does exactly what it imagined doing in the first one probably had excellent planning.
Or may simply not have learned much.
I prefer the first explanation for other people's projects.
For the School, I choose the second possibility in reverse: we kept learning and, because of that, we kept changing.
Tools appear, mature, and sometimes disappear. The technology that seems extraordinary today will probably seem quite ordinary in a few years.
The part I hope will remain is simpler.
Helping patients understand their health better. Helping students learn to care. And helping professionals keep learning while they care.
The rest is tools.
And tools, however good they are, exist to serve people.
Never the other way around.
