No hospital geral : lidando com o psiquico, encaminhando ao psiquiatra

AUTOR(ES)
DATA DE PUBLICAÇÃO

1989

RESUMO

The psychiatrist can be of use in unnumerable clinical situations found in the general hospital, but it atill is not clear as to the process by which the psychiatrist attracts referrals and the reasons and motivations that doctors have for referring or noto. A semi-structured interview was carried out on 50 doctors from the teaching hospital of the Universidade Estadual de Campinas with the objective of describing and understand (1) difficulties in the relationship with patients, (2) the possible meanings of the terms used to name them, (3) exactly what they decide to treat, what they decide to refer to the psychiatrist as well as (4) the "modus operandi" of referrals in the context of a university general hospital. The majority of related difficulties,was linked to institutional aspects such as the great number of patients, the waiting, the lack of material resources, the short time available for each consultation and to the kind of patient: his existential universe, the tife probléms he presents, often coded in a body language which is difficult to translate. The doctor finds himself in a conflicting position in the institution: on the one hand pressurized, on the other gratified by a set o rules and routines. When his ability to cure is affected, his self-steem is shaken and he may blame the "institution" or the "patient", thus defending himself from his frustration. The psychiatric terms used by doctors are ratified as natural tools of understanding and conduct. Their meanings havebeen adapted to new needs and values and they are not clear in the mind of the doctors interviewed. Thus the resulting comprehension is superficial, restricted to what is immediately perceptible or what causes disconfort. Labelling is used to conceal anxiety and to try to control deviant situations. Projective mecanisms are present not only in the idea that is formed of a person but also in the term chosen to name him. Sometimes it is the doctor himself who is "nervous". Rather then being based purely on clinical criteria, the referrals to the psychiatrist emerge as a result either of the doctor s conflicts or of the functioning of the institution. Some referrals need to be worked through in order for the doctor to overcome his resistance. Others are automatic: owing to institutional pressure or because something moved him deeply, the doctor directs his anguish and responsability outside himself, without realizing the motives that lead him to do so. In institutions, the referrals are part of an impersonal routine, reinforcing collusion in anonymity, obstructing the net of identifications and the search for empathy between professionals and patients. Referrals serve to keep up the defenses of thouse who give assistance or to expose them as well as to begin the seareh for a new adaptation of the staff in their assistential task. High hopes and idealizations are pinned on the psychiatrist, who is expected to repair for the damage that doctors feel they periodically inflict on their patients. He can also be an element that provokes hostility, jealousy and envy. Referral is used in a variety of ways and different things are expected of the psychiatrist, all influenced by transferential and contratransferential aspects of the patient-doctor-specialist triad.

ASSUNTO(S)

pessoal da area medica e pacientes

ACESSO AO ARTIGO

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