Roberto Assis Ferreira

O trabalho dos pediatras em um serviço público de urgências: fatores intervenientes no atendimento

This qualitative empirical study discusses the material and organizational conditions of work by pediatricians in a public emergency service, with the aim of identifying factors that affect care. The work was studied using group interviews and direct observation in the emergency unit. The results were compared with statistical and historical data from documental research. Forty-four pediatricians from seven teams were interviewed, and seven of the pediatricians were observed while on duty. The precarious referral and counter-referral system was a determinant factor leading to the heavy demand on the emergency unit. Agglomeration of patients and families at the entrance to the emergency service led to time pressure and interfered directly in the pediatric care. The study identified informal strategies devised and implemented by these physicians in attempts to guarantee the quality of care in keeping with pediatric principles.

Doctor-patient relationship in adolescence

Introduction: Medicine is not a science; it is a profession, a know-how. The doctor-patient relationship is sustained in a technical relationship; however, it goes beyond, representing the most specific dimension in the medical practice. The current biotechnological model favors the unfocused subject technique and fails to consider the patient prioritizing the disease in a protocol approach. Objective: to make considerations about the physician-patient relationship in the adolescence, related to puberty, which invades the child’s body, and questions about existence and sexuality. The doctor is faced with impasses that transcend techniques and protocols.Discussion: the doctor, in front of the patient, can take the place of knowing and power, however, he can transiently move to a place of not knowing about that teenager, who is an expert about himself. The doctor can also take the place of those who demand, which usually raises refusal in the patient. The teenager can, rarely, occupy the place of those who demand, and many times, finds himself in a position of refusal. He can take the place of the object or subject.Final considerations: the transfer, the core of the doctor-patient relationship, stands on the assumption of knowing and affection, and may have effects on the adolescent when clinical management is used. A veiled demand may emerge if the doctor opens the window of listening: one more question about what is bothering. It is forewarned here that hearing and listening are not equivalent and that the patient’s demands should be drawn up by the adolescent himself.

Silos of internal medicine and psychiatry: anorexia nervosa as a paradigm

This essay aims to rescue the concept of internal medicine and attempt to reflect, based on the history of Medicine and Psychiatry, on the technological changes of the contemporary world and their consequences in current medical practice. Anorexia nervosa is used as a paradigmatic example, and allows a contrastive discussion on the importance of the classical concept of internal medicine when approaching these manifestations. The method used was based on the reading of the history of Medicine and Psychiatry, allowing a critical observation of the directions taken by current medical practices.

Obesity, adolescence and subjectivity

Obesity has become an epidemic problem worldwide. In Brazil, the rise of incidence of obesity occurs particularly in adolescents. The results of measures for the control of obesity have, however, proved disappointing, suggesting the need for new ways of approaching the problem. This article presents subjective aspects involved in adolescent obesity as a contribution to this approach, in which the associated psychosocial aspects are highlighted in context.