A medicina entre a ciência e o cuidado : uma leitura de revistas de medicina (1990-2009)

Abstract

Dissatisfaction with medical practice is related to the discrepancy between the reality of the practice and the physicians expectations of working like a dedicated priest and like a well-trained scientist . I investigated how the ideals of caring compassionately for the patients and of using all knowledge about disease and cure are presented in modern medicine. In this intent, I read a sample of the Big Five medical journals, from 1990 to 2009. I privileged themes about medical knowledge and care in relation to clinic and not to public health. I began by reading a systematic sample, and then I extended it, studying some points I considered to be special or illustrative. My commentaries are intercalated with citations of articles from the journals, to offer the reader the bases of my impressions. I observed that the discourse on knowledge was given a bigger space, and it is more complex and elaborated than that on care. Beside the impressive advances in medical science, and the optimistic positivism in most papers, the journals show the uncertainties, the contradictions, and the limitations of methods and theories. There is a tension between the faith in science, the efforts to turn medicine into a science , and the logical and methodological difficulties to adequate single medical decisions to the scientific evidence . Medical knowledge appears as a mosaic, permanently reconstructed, and not capable of producing certainties. And the production and divulgation of knowledge are influenced by the beliefs and interests of researchers, supporters and editors. The discourse on care shows consistency; but gains prominence only where knowledge is lacking, as when discussing terminal care. The medical scientists , imprisoned in a labyrinth of guidelines and statistics, do not care about care. But, whenever they get sick, they complain about lack of care. There are also proposals of joining scientific evidence and narratives from patients and doctors in the construction of a knowledge-and-care practice that may be curative for both. But these proposals get no attention, not even from other authors of the same journals.