Representações e práticas sociais construídas por médicos em relação a usuários com sintomas vagos e difusos na atenção primária à saúde

• Autor(a) principal: Vescovi, Renata Goltara Liboni
• Data de Publicação: 2014
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
• Texto Completo: http://repositorio.ufes.br/handle/10/3098
• topic: Somatization; Primary health care; Social representation; Social practice; Clinic practice; Prática social; Pratica clínica; Somatização; Psicologia; Doenças - Aspectos psicossomáticos; Cuidados primários de saúde; Representações sociais; Clínica médica; 159.9

The phenomenon of vague and diffuse symptoms relates to nonspecific pains that are not directly associated with organic cause. As a phenomenon difficult to delimit it also carries other names: somatization, Somatoform Disorder, Conversion Disorder, Psychosomatic disorder, for example. We underscore the importance of considering these symptoms for the context of Primary Health Care (PHC), since the complaints with these characteristics appear in large numbers as patients demand to arrive to attend this context, in many countries. The vague and diffuse symptoms still configured as a challenge to the health teams because strong reference that guides professional practice model is the traditional clinic, focused on the disease and not the person who gets sick, it is not effective to deal with these demands. With a focus on PHC becomes relevant to investigate the medical clinic, consultations, locus of handling these cases of vague and diffuse symptoms by the doctor, in order to understand how to interpret and which developed therapies. The research conducted in this thesis aimed to understand social representations and social practices constructed by PHC doctors about patients with vague and diffuse symptoms. Two studies were carried out: participant observation conducted in a Family Health Center (FHC), divided into two stages (one in the general environment of the Center and other medical offices in the environment), the first of which comprised six observations, the second was held from three months; Semi-structured interviews with a case vignette, attended the five doctors working in the same FHC where the observation was made. The data, both as participant observation with interviews, were treated from the thematic content analysis. Participant observation verified the construction of images of the patients with vague and diffuse symptoms (VDS): "poor thing", "hard cases", “almost patients" and "tiresome". Regarding the affective aspect, impatience and boredom were present before VDS patients. Practices were observed and authoritarian character centered in a traditional clinical model, opposing the expanded Clinic. The interviews revealed aspects of the representational field related to VDS patients which included ideas and images associated with other objects of communication at FHC: general patients, the "good patient", sick person and population of a lower social class. Stood out as elements of objectification translated by figures built on VDS patients: "My health center, my life"; "Member of the Center "; "Chronic Center". The doctors also cited accustomed to expanded Clinic topics such as community action; practices aimed at preventing disease and promoting health. Both studies revealed dissonances on the practices targeted at VDS patients in this sense between the content observed during consultations and behaviors reported in the interviews. Highlights the hegemony of traditional clinical causeway where patient-centered doctor-centered relationships more. Revision of normative relations between health workers and VDS patients and openness to co-management of these patients in deciding the conduct of their treatment is suggested.