Clientes, cidadãos, pacientes: reflexões sobre as múltiplas lógicas de cuidado na atenção à saúde

Abstract

Clientes, cidadãos, pacientes: reflexões sobre as múltiplas lógicas de cuidado na atenção à saúde Clients, citizens, patients: considerations about the multiple logics of care in health services ResumoEste ensaio tem por objetivo contribuir para a discussão sobre o cuidado na atenção à saúde, trazendo aportes da psicologia social discursiva em diálogo com a teoria ator-rede. Com base nas considerações da filósofa Annemarie Mol, propomos que diversas lógicas sobre o cuidado estão presentes nas interações entre profissionais e pessoas que com eles e elas interagem. Mol contrasta duas maneiras de lidar com a doença: a lógica do cuidado e a da escolha. E, mais especificamente, duas modalidades de escolha: a vertente do mercado, na qual pacientes são situados como clientes; e a vertente da cidadania, na qual os pacientes são considerados cidadãos portadores de direitos. Sendo a prática em saúde uma rede heterogênea de atores, essas distintas lógicas são acionadas em diferentes momentos, posicionando profissionais e usuários ora como pacientes, ora como cidadãos, ora como consumidores de produtos e serviços. Concluímos com a provocação de que temos de aprender a conviver com a polissemia de repertórios que circulam nos espaços que habitamos cotidianamente e com a fluidez dos jogos de posicionamento: reconhecer a partir de que posições nossos interlocutores falam e em que posições somos colocados. Palavras-chave: Assistência à Saúde; Relações Interpessoais; Pessoalidade; Humanismo. Correspondência AbstractThe aim of this essay is to contribute to the discussion about care in health services, bringing to fore theoretical positions derived from discursive psychology in dialogue with actor-network theory. Based on the contributions of the philosopher Annemarie Mol, we propose that a diversity of logics of care is present in the interactions between professionals and people that seek health care. Mol makes a contrast between two ways of dealing with disease: the logic of care and the logic of choice, and, more specifically, two modalities of choice: the market version, where patients are considered as clients, and the civic version where patients are citizens that have rights. As heath practice is a heterogeneous network of actors, these different logics are mobilized at different moments positioning professionals and users sometimes as patients, as citizens and yet at other times as consumers of products and services. We conclude the essay with the provocation that we must learn to live with the polysemy of repertoires that circulate in the spaces we inhabit in our everyday lives and with the fluidity of positioning games: recognize from what person positions our interlocutors speak and in what positions we are placed.

The Language of Risk, Public Policies, and Childbirth in the Municipality of São Paulo: A Reading of Data From the Live Birth System 2010–2016

“…Among its municipalities, the city of São Paulo has the biggest population, with 11,696,088 million inhabitants, an area of 1,521.11 square kilometers, and a demographic density of 7,689.18 inhabitants per square kilometers. In 2016, the registered birth rate was of 14.43:1,000 inhabitants (SEADE, 2018).…”

The person-environment relationship in the process of finitude

“…In addition, caring for a family member undergoing a process of finitude in the home environment means dealing daily with the possibility of a traumatic episode, that is, death itself, an episode that terrifies most family caregivers (1)(2)(3)24) . Due to this scenario of suffering, the act of caring is full of contradictory feelings.…”

“…To do so, it needs different types of actions linked to different profiles of professionals. This starts from the premise that care is always a set of rules and principles that guide the subject-professional relationship and this historical construction reflects directly on the reconfiguration of the social representation of the meaning of falling ill and being cared for in contemporary times (1,3) .…”

Women with fetal death: nurses’ care limitations

“…Relational aspects, not restricted to face-to-face interactions, are also important and require more sensitivity from nurses, regardless of their lack of experience, lack of knowledge about what to tell these women, and the context of this care (7,9) . In addition to sensitivity, empathy is an essential skill to be developed in order to establish an effective communication (10) between the professional and the woman who has experienced fetal death.…”