Alienation of the medical work: tensions about the biomedical model and the managerialism in primary health care

• Autor(a) principal: Terra, Lílian Soares Vidal
• Data de Publicação: 2022
• Outros Autores: Campos , Gastão Wagner de Souza
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Trabalho, Educação e Saúde (Online)
• Texto Completo: https://www.tes.epsjv.fiocruz.br/index.php/tes/article/view/898
• topic: Processo de trabalho em saúde; Atenção primária à saúde; Médicos; Alienação (filosofia); work process in health; primary health care; physicians; alienation (philosophy); proceso de trabajo en salud; atención primaria de la salud; médicos; alienación (filosofía)

Based on the observation that the loss of autonomy in the capital market and managerialism have contributed to the emergence of alienation in the medical work of the Brazilian Unified Health System, we tried to analyze how this phenomenon occurs in primary health care. In 2015 and 2016, we interviewed and observed the work of 15 physicians in the municipality of Campinas (in the state of São Paulo, Brazil), reflecting upon the professional and clinical autonomy, and the management of the medical work. The analysis was made by constructig narratives by groups of topics, following a Marxist theoretical framework and the main studies regarding the medical profession in Brazil. Taking the similarities in the discourses, ways of working anddegree of alienation, we divided the physicians into four groups: activist, priest, missionary and technobureaucrat. We concluded that some dynamics intensify the alienation: the estrangement from planning; the fragmentation of care; and the prevalence of the biomedical model. In turn, some features of primary health care are related to a lower degree of alienation: the practice expanded on the territory and less focused on programmatical actions; the constitution on teams; the dialogue and the sharing of knowledge; a greater participation of the individuals in the care itself and in the health service.