Poder no relacionamento entre profissionais e doentes

Abstract

The present article aims at presenting an analysis on the presence of power in the relation between the heath care professionals and the patients of a nephrology service.

For this purpose, the conceptions regarding the categories and sub categories, already defined in the ongoing doctoral thesis (of the article’s author) of dedicated to the study of this relation, were used as the focus of the present study.

This study adopted, as starting point, the growing importance of the bioétic principle of autonomy and (Beauchamp & Childress, 2002), and patients right to self-determination included in Patients’ Rights Charter. The study upon which this analysis is based, ongoing work of a doctoral thesis, has as central research question, to define which is the relational dynamic between heath care professionals and patients that best adequate to Health Care Quality Management and, at the same time, to the clinical and sociological reality.

In the context of this analysis, the fenomenográfico methodology, in line with qualitative methodologies, was adopted for being considered the most adequate to the study of phenomena in which the aim is to identify the diversity of existing conceptions on those phenomena. As the methodology defends that the phenomena should be better understood if the several intervenient perspectives are taken into consideration, the most important intervenient in the heath care providing process, doctors, nurses and patients were used as informants. According to this principle, 12 patients, 5 doctors and 10 nurses of a nephrology service, where substitution therapies of the renal function are performed, were interviewed. According to the results the diversity of existing conceptions in each group, as well as between the different groups were mapped.

Conceptually, this analysis was based on Focault ideas, namely on the study of the institutions where these relations of power are verified, including in these hospitals. The relations of power related to Knowledge and discipline are especially interesting, due to their presence in the contemporaneous culture (Machado, 1992) as giving the adequate support to structure the problematic under study. The power manifestations aspects are initiated, according to the heath care professionals’ terminology, with the “Catalogue” of the patients’. In this phase the differences of power between the three intervenient groups are evidenced, being also clear the existence of more power on the professional’s side. It is known and accepted that the patient is the knowledge/power receptacle of the professionals and that he must follow their recommendations, being also recognized the patient’s appropriation of the medical speech. The nurses are associated to a disciplinary power that is complemented with the surveillance and monitor of the patient’s body. In an initial moment, the doctors explore the power associated to their knowledge, considering themselves as the ideal people to solve all of the patient’s problems. The heath care professionals also explore and extend their powers in the family environment, being the informative process a veneration mean, using and sometimes abusing in persuasion strategies, instead of helping the patient self-determination. 

Nevertheless, this relation resembles more to a collusion situation between professionals and patients then to domination strategies, in which the power may be considered productive.

At this point we must highlight the health care professionals conscientiousness regarding their power’s utilization, to a point where they must question until where should they use that
power and under which circumstances, bearing in mind the patient’s right to self-determination. Conscientious that the heath care providing service is not lined by the same rules used in other services providing areas, it should be underlined that the health care professionals are also citizens with an ethic code to attend, what not always facilitates the need to distinguish the professional’s and the patient’s power decision boundaries.

What should not happen anymore is the almost exclusive use of the beneficence principle as orienting the heath care professionals’ action, under covering or ignoring the power existing in the relation during health care pratice.