Publications IPH Magazine Special: 60th Anniversary The Relationship Between Professionals And Patients In The Health Sector - Tendencies And Perspectives

The currently great theme in the Health scenario is the search for quality in its broadest sense.

Institutions and professionals have been focusing on the issue, trying to get all they can from technologies, working in teams in order to solve problems, pointing to solutions and assessing results.

Significant structural, functional and behavioral problems have arisen, which has led the Health Sector towards focusing on Management Quality, overcoming problems, aiming to achieve the efficiency and the effectiveness in their most diversified aspects.

In that perspective, we have tried to analyze: The professional relationship between the Health sector and the Patient.

When focusing on that relationship, and referring to Balint (1978), we can see it is in the first meeting between doctor and patient that the therapeutic link is shaped. It is at the end of the first interview that the doctor announces the diagnosis and designs a therapeutic plan, pushing the following interactions.

Balint points to interference during the flow of the treatment, as when the patient grants exaggerated authority to the doctor or passively waits for the doctor to solve all his problems, behaving either submissively or demanding too much. The psychoanalytical terminology mentions transference or transference elements, meaning emergencies between the lines related to strong emotions or past experiences, all of which sometimes unchain inadequate doctor´s reactions, or counter-transference.

Patients are different from each other; human behavior is determined not only by biological factors, but also by complex factors related to the human sciences, in which the individual, only and unique, is hardly apprehended as a whole. It would be important that doctors make a global diagnosis, including patients´ psychological and social peculiarities.

Balint points to the need for the patient to get involved in finding out the best way to deal with the conflictive situations in his life.

Haynal (1981, p17) expresses his views regarding the doctor-patient dialogue:

"The multiple aspects in the patient´s claims make up all the complexity in his meeting with his doctor; he does not bring the doctor a sick organ only, but the anxiety and psychological or social problems arising from that illness".

When looking for a doctor, the patient expects to be listened to and understood; his discourse sends messages beyond his body´s malfunctioning. Such messages reflect a request for help and may have some relevance to the etiopathogenic chain.

Balint and collaborators (1988) showed that a few extra minutes devoted to collecting this kind of information can bring important contributions, as it used to happen when there were family doctors. There is a need for a whole clinical assessment, where anguish, depression, worries, patient´s relationship with family and social group are integrated in the general examination. During the appointment, the patient has expectations concerning the doctor´s interest in him as a human being, not as one more case.

Haynal (1981) so details the doctor-patient relationship:

The doctor who has received information allowing him to understand the patient´s psychology - to decode his intentional discourse, to foster his emotional and affective response, to interpret his behavior, his mimes and gestures - may, however, find his work difficult since he needs to identify with this patient. In fact, other people´s inward life can only be understood when we can "put ourselves in their shoes", when we try to live vicariously what other people try to describe, and we can at a later time detect it, thanks to a new distanced stand.  Those two moments may present a certain difficulty, even when the doctor is convinced of the importance to understand the patient psychologically and also his psycho-social environment.  Three things may happen: (a) that the patient´s problems sound like an unpleasant echo to the doctor, and that may cause the latter to go into a defensive, involuntary, almost automatic movement; (b) that the doctor will not be able to identify with certain patients, whom he finds dislikable for reasons that he may not be conscious of or that he cannot overcome; and (c) that the doctor feels too distant from a patient that appears strange and inscrutable to him.

The patient´s anguish or depression may pose an obstacle to the satisfactory development of his dialogue with the doctor, since this anguish is related to the body´s destruction, suffering, invalidity, some fear of the intervention, all sometimes deriving from the patient´s lifestyle or from conflicts causing functional or psychosomatic illnesses.

Menzies (1990) points to situations causing nurses to feel stressed when handling tiresome, repugnant or frightening tasks, eliciting strong contradictory feelings, either libidinous or aggressive, and generating deep anxiety.  He still mentions that the direct impact of physical illness on nurses becomes intensified as they deal with the task of detecting psychological stress on other people and dealing with them, sometimes even with their mates´ stress.

Considering the several topics mentioned above, we can understand that the relationship between diversified professionals in the Health sector and the patient extend to intrapersonal and interpersonal aspects stemming from the communication process, the interaction and the ambivalence of the sentiments involved, which should all be monitored, detected and addressed.

How must the Health sector´s professional perform and what aspects must call his attention?

At first one can say that it is advisable that the Health sector´s professional search for self-knowledge to make it easy for him to understand the patient´s illness and to choose the most adequate management for the illness and the patient.

When relating to a patient, the professional must perceive him as a being in the world; and he must also understand the clinical investigation of the illness as a consequence of the interaction between his patient and the world, observing the spontaneous expression in his discourse, as well as allowing himself to be guided by it with a listening attitude, trying to detect the psychological, social or somatic forces determining his present discomfort.

At times the patient needs the professional to keep a rather directive posture, acting as a moral source of help, support or as someone he can exchange ideas with in order to find immediate cathartic relief or sort out conflicts.  On other occasions catharsis is not enough; a conversation allows the patient to become conscious of his problems/needs, and he will later search for psychotherapeutic help.

It is necessary that the professional in the Health sector set certain conditions to enable the patient to reflect on the meaning of his illness´s process.

The professional, working as a catalyst, should elicit each individual´s possibilities and resources to be used in healing an illness, as the individual tries to clarify the meaning of his initiatives in life and of his illness as well. Therefore, it is necessary that psychologists, as well as other professionals in the Health sector, become aware of their own responsibilities, jointly making adequate use of the resources available, even adopting personal participation.  Allied to personal/professional competence, technology contributes to the effectiveness and the increased confidence between patients and professionals in the Health sector.

At the opening of the First Brazilian Hospital and Health Humanization Congress in São Paulo, Mezomo (1980) declared that all Health policies, and, within them, all hospital structure, find their ultimate goal in Man, as subject and beneficiary, and not as a mere object and vessel of the care he receives. According to the author, it is caring for the Human Being as a whole that makes the Health initiatives ethically and morally correct. He says, "Everyone in need of Health is primarily a Person, even when his physical and psychic conditions seem to deny it!"

Mezomo stresses the need for Health professionals to present a conduct characterized by human, not only technical and therapeutic, values. In that sense, a deep union develops between the Health sector professional and the person under his care; there is a need for them to get integrated around the common goal to preserve or recover Health, adopting a Holistic Approach.

Following the Idea of humanization, we could say that Health care tries to respond to an anguished cry for help. Only the patient can measure his pain and anguish. Therefore, the Health professional´s responses cannot be standardized and uniform, since those may not always integrate him and his patient as necessary.

Thus, the professional must listen to the appeal and feel the anguish so he can respond adequately. Listening and feeling, as well as understanding the patient deeply, are a Health sector professional´s primary task, since all Health care service is a meeting among people, which makes it necessary for the patient to express himself and effectively contribute to the process of his full physical, psychological, social and spiritual reintegration. The patient must desire his Health and accept the therapy as recommended. He is, therefore, an agent of his own Health, extending it to his family, social and professional context. Acting becomes clear through the adjustment of the patient to the conditions of hospital life. That is necessary because illness breaks his interaction with the social and family environment, thus provoking an exchange of roles, a change in his life´s balance and routine. At a critical moment, the patient starts to depend on other people.

The understanding of the occasional difficulties faced by the patient after a long period of illness in the hospital can make him develop some fear regarding his own release; or can make him feel insecure at returning to his social or work context. As a consequence, the Health team must face the patient as an integrated unit, in his physical, psychic, social, economical and spiritual aspects, and must deliver medical, social care and therapeutic services to the patient, characterized by quality, efficiency and effectiveness standards.

The emphasis on the hospital humanization process has brought perspectives regarding doctors´ and other Health professionals´ performance, and has, therefore, guaranteed that trust and effectiveness be restored more broadly during the treatment; it has also provided initiatives aimed at preventing illnesses and improving the patient´s life quality, allowing for more respect regarding individual differences and the appreciation of relationships.

Among the most important actions, we can list:

As a final consideration, it is essential that Health professionals learn how to deal with patients, regarding both diagnosis and effective orientation concerning changes in patients´ lifestyle, suggesting preventive actions related to habits, attitudes and behaviors patients may eventually present. Therefore, the relationship Health professionals/Patient becomes a determining factor in the latter´s recovery, an ally in restoring self-esteem and self-image, granting him autonomy and responsibility for the recovery process, generating compromise and commitment among those involved.

BALINT (1978) in BERWICK, Donald M. et alii.  Melhorando a Qualidade dos Serviços Médicos, Hospitalares e da Saúde.  São Paulo, Makron Books, 1995.

CAMPOS, Terezinha C. Padis.  Psicologia Hospitalar.  São Paulo, EPU,2005.

KANAANE, R. Comportamento Humano nas Organizações: O Homem rumo ao século XX. 2ª ed. São Paulo: Atlas 2012.

MENZIES (1990) in MIRSHAWKA, Vitor.  Hospital: Fui bem atendido: a vez do Brasil. São Paulo.

HAYNAL (1981) in REVISTA MEDICINA SOCIAL - Ano XIII, no. 144-Maio/98 (Informative Publication of the Associação Brasileira de Medicina de Grupo - Abrange, the Group Medicine Brazilian Association). I´ve researched in the magazine.