A narrativa na e sobre a clínica na atenção primária: uma reflexão sobre o modo pensar e agir dirigido ao diálogo, à integralidade e ao cuidado em saúde

Abstract

The incorporation of the fellow who falls ill and his expectations of care is an appeal of the proposals to change primary care clinical practices. This perspective implies a new viewpoint of the sickening process which tries to break with the biomedical reductionism in which the clinic and its action are almost apart of the patient s discourse. This work employed the narrative as a conceptual and practical tool in primary care clinic to investigate the possibilities of enlarging the universe of discourse and interpretation, that is, the physician s narrative competence beyond a restrictive biomedical model. A non- systematic search was carried out, in medical and social sciences literature, trying to identify the conceptual aspects, meanings and perspectives that can be assumed to turn the narrative into a concept/idea, and its possible interfaces and applications to clinic. This appropriation of narrative instrumentalized the participant observation in the Family Health Program, in Niterói, as well as the analysis of results of semi-structured interviews with physicians. We noticed that the formation of the family doctor s professional identity and legitimacy is mostly guided by the organization promoted by the healthcare model, and not by the development of knowledge able to distinguish and qualify it. We found that the dialogic abilities developed in experiences in primary care clinic were apprehended and assumed by physicians as personal abilities and/or moral aspects. This thought created tension, translated in an ambiguous and fragmented discourse among proximity, liaison and dialogue with patients, and the formation of knowledge and clinical practice. The physicians limitations to incorporate new knowledge, based on their own experience, and the way biomedical rationality guides clinic, are epistemological and practical obstacles to enlarge medical narrative and interpretative competences. Such conditions hinder the development of a type of medical thought to reflect, develop and integrate practical knowledge and nonbiomedical knowledge as legitimate, able to be systematized, evaluated and reproduced within the clinic.