Perícias em Saúde no SIASS: conflitos entre o cuidado e o controle

Abstract

When a worker falls sick and when the workplace is the very locus where the illness occurs, the medical evaluation is the official process through which evaluation of the benefit claims based on such illness is made, and this can be a moment of great importance in the worker’s life, especially when it refers to long medical leaves, when a removal from the workplace is needed or in the cases which disability retirement is required. In the federal sphere, in the Executive Branch, these evaluations are coordinated by the Subsistema Integrado de Atenção à Saúde do Servidor (SIASS). The SIASS policy is guided by the Worker Health and, as concerns the medical evaluation procedures, recommends the existence of multi-professional teams, where physicians and dentists are the medical evaluators, while psychologists and social workers constitute the support team. The latter works with the “health evaluation” notion to the detriment of “medical evaluation”. Bearing in mind what is evaluated and measured in the medical evaluation procedure, and based on the SIASS rules, the aim of this study is to examine how such evaluation are understood by its practitioners, trying to analyze the kind of values which guide these activities, with emphasis on the professionals’ comprehension of the health-illness-work process. Firstly, there is a theoretical analysis of subjects such as changes in the world of work, issues concerning suspicion in the medical evaluation context and aspects of managerialism. Secondly, through a qualitative methodology, documents which rule the SIASS have been examined and an ethnography of Medical Evaluations Congress has been carried out. Thirdly, interviews have been made with 32 professionals that work with medical evaluation at 5 federal educational institutions in Rio de Janeiro. The data collected has been entered into the Atlas.ti software and the analysis turned to the constitution of thematic axes discussed in the end. The data analysis was marked out by the spectrum amongst the several practices that the labor studies have already defined, namely the practices closer to the management and the practices closer to the Health Worker. A constant conflict has been noticed among the care functions linked to the health professions, once the worker undergoing a medical evaluation reports suffering, and the idea of control, linked to the justice, to the legal framework of the worker’s claim, the period of the sick leave. Notwithstanding some references to the medical evaluation practices closer to the “health evaluation” notion, the reports are permeated by the aprioristic suspicion regarding the worker’s claim, due to the idea that the main mission of the medical evaluation is to safeguard the Public Administration. Therefore, a conflict of interests has been identified in the very heart of the medical evaluation function, when it is performed by health professionals: those focused on the care function and those whose main interests are justice and managerialism. In addition, the interviewers’ reports, as well as some of the regulatory documents, show a scarcity of mentions to the work organization as the cause of sickness.