A Construção do “ser médico” - Centro de Referência e Treinamento ...

Abstract
Silva GSN. The building of the “doctor being” and the death: meanings and
consequences to care humanization. [thesis]. São Paulo: Faculdade de
Medicina, Universidade de São Paulo; 2006. 276p.
we have sought the understanding of the process for building a “doctor
being” and its relation to the phenomenon of death, based on the narratives
of students in the process of becoming doctors. A qualitative research took
place with the medical school students from the Federal University of Rio
Grande do Norte, chosen from all levels of the under-graduation (from the
first year to medical residency), with the objective of investigating how this
relation with death helps to promote the detachment among the medical
scientific technologies and the dialogical processes of caring in the daily
medical practice. The existential phenomenology, Gadamer´s Hermeneutics
and the theory of communicative action, of Habermas, constitute the
philosophical basis of the narratives production and interpretation work. To
produce the narratives two techno-methodological strategies were combined:
In depth interviews with scripts and workshops using projective role-play
activities, seeking for a deeper and sufer in the interpretative analysis. The
results were grouped in seven theme categories: 1) Concepts of a “doctor
being”; 2) Concepts of death; 3) Concepts of the students/residents about
facing the process of a patient´s death; 4) Death approaching; 5) The
medical initiation; 6) Meeting death through a scene; 7) Desires of change in
the medical education. The analysis and reflections developed point towards
the idea that a “doctor being” is connected to the ideal of being a good
doctor, which means being technical and human in the illness and death
processes. Although part of a social and institutional culture of death denial,
the interviewed students revealed sensibility to the re-humanization of the
death process. These conceptions are also present in the new curriculum
proposal, but they find tension facing the biomedical model which they are
included. The anatomy initiation defines one type of path to be followed,
based in the expropriation of subjectivity, where the detachment of emotions
is the guarantee of objective knowledge. The prescription of a noninvolvement
is adopted, coexists with signals of relativization (to not get too
involved), when the aim is humanization in the medical practice, which
prescribes a good communication with the patient about to die. The students
move between these two scenarios, with rare role-models, few experiences
to name and deal with death, and many paradoxes. In their meeting with the
patient to die, the caretaker faces the difficulties of not promoting the
distance between intention and gesture in their interactions. They reclaim a
medical education able to re-gather sense and emotion; doctor and patient;
technique and caring; life and death. The work suggests, at last, the
advances towards existential ontology, from the philosophical-hermeneutics
and the communicative reason as ways to a conceptual consolidation able to