| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 4.51 MB | Adobe PDF |
Authors
Mieiro, Sandra de Castro Guimarães
Advisor(s)
Abstract(s)
O processo de comunicação é um aspeto central na construção de uma relação
médico-doente, a qual está no cerne do percurso terapêutico.
Esta investigação explora, assim, o processo comunicacional entre médico e doente
numa consulta de medicina geral e familiar, e em que medida as competências de
comunicação são exercidas e percecionadas. As competências de comunicação são
valorizadas e exercidas pelos médicos? As competências de comunicação dos médicos são
valorizadas e reconhecidas pelos doentes?
O projeto de investigação que deu corpo ao documento final desta Tese de
Doutoramento apresentou-se como um estudo empírico, construído sobre pesquisa
documental e bibliográfica, perscrutadora de raízes, conceitos e utensílios materiais e
mentais, norteadores da atividade de pesquisa e da respetiva observação e análise que
permitiu acionar o diálogo entre os fenómenos que nos propusemos estudar: a
comunicação médico-doente no contexto de uma consulta de Medicina Geral e Familiar,
no setor privado da saúde em Portugal.
Este tema despertou em nós um interesse particular, resultado da crescente
visibilidade desta questão e do debate gerado em torno do mesmo, quer na comunicação
social, quer no contexto da Academia. A relação clínica médico–doente comporta
características próprias inerentes aos objetivos dos dois intervenientes, sendo uma
construção de uma relação de ajuda. As relações assentam, desde o início, numa vivência
afetiva que lhes confere sentido. Por isso, uma comunicação eficaz entre o médico e o
doente é uma competência clínica essencial.
Assente numa abordagem interpretativista, esta investigação desenvolve-se num
contexto de referências teóricas que permitem a construção de argumentos e hipóteses, que
testamos empiricamente, com o objetivo de responder à pergunta de partida: Em que
medida as competências de comunicação interpessoal são exercidas pelos médicos numa
(...) O conhecimento não é uma coisa pura, independente dos seus instrumentos
e tão pouco dos seus utensílios materiais, mas também dos seus instrumentos mentais
que são os conceitos; a teoria científica é uma atividade organizadora do espírito, que
põe em ação as observações e que, bem entendido, põe também em ação este diálogo
com o mundo dos fenómenos (Morin, 1990, p. 42).
consulta de Medicina Geral e Familiar? O enquadramento teórico proposto assenta na
tradição sociocultural em Ciências da Comunicação, com contributos de outras tradições
do mesmo campo científico.
As abordagens sistémica, micro-analítica, a proxémia e a cinésia foram referências
dimensionais para a interpretação do processo comunicacional entre médico e doente. A
constituição das ferramentas de pesquisa do trabalho empírico privilegiaram as questões
que se prendem com dimensões e variáveis elegíveis no processo comunicacional de
relacionamento.
O trabalho empírico desenvolve-se na aplicação de dois questionários online, com
métodos mistos de amostragem – um, orientado para médicos, tendo sido obtidos 33
questionários com resposta; e outro, orientado para doentes, tendo sido realizados 481
questionários. Em ambos os questionários foram aplicadas as mesmas questões,
englobadas nas dimensões da comunicação efetiva, comunicação verbal, comunicação não
verbal e comunicação afetiva. A análise dos resultados obtidos confirma que os médicos
apresentam um desempenho positivo na componente comunicacional, em diferentes
dimensões analisadas. São identificadas, contudo, nas questões colocadas, algumas lacunas
mais específicas que dizem respeito aos fatores relacionados com a preparação da consulta,
do resumo da mensagem, do foco no enquadramento cultural e socioeconómico do doente,
na expressão vocal e corporal.
Com os resultados alcançados, procurámos estabelecer, quando possível, uma
ponte que fomente a sensibilização para a importância da humanização no processo
relacional, pressuposto essencial na interação entre Pessoas, em que o Médico e o Doente
são os principais protagonistas.
The process of communication is a central aspect in building the doctor-patient relationship, which is at the crux of the therapeutic path. As such, this investigation examines the communication process between doctor and patient within a general practice and family medicine consultation, as well as to what extent communication skills are used and perceived. Are communication skills valued and practiced by doctors? Are doctor’s communication skills valued and appreciated by patients? The investigation project that embodied the final document of this Doctoral Thesis materialised as an empirical study built upon documental and bibliographical research that sought roots, concepts, as well as material and mental tools that led the research activity and the observation and analysis that allows for setting in action the dialogue between the phenomena that we proposed to study: doctor-patient communication within a general practice and family medicine consultation in the private healthcare sector in Portugal. This topic became of particular interest to us given the growing awareness and debate that has been garnering both in the media and within Academia. The doctor-patient relationship in clinical practice involves particular features that derive from each subject’s own goals, becoming the construct of a helping relationship. Relationships are based from inception upon an affective experience that forms their very sense. Therefore, effective communication between doctor and patient is an essential clinical skill. Grounded upon an interpretivist approach, this investigation is carried out within a context of theoretical references that allow for the setting of arguments and hypothesis to be empirically tested so as to provide answers to the initial question: To what extent are (...) Knowledge is not something pure, separate from its instruments, its material tools or even its mental tools, such as concepts; scientific theory is an organizing activity of the mind, which puts observations into action and which, of course, also puts into action this dialogue with the world of phenomena. (Morin, 1990, p. 42). interpersonal communication skills applied by doctors within a general practice and family medicine consultation? The proposed theoretical framework relies on a sociocultural approach within Communication Sciences, with contributions from other traditions in the same scientific field. The systemic, micro-analytical, proxemic and kinesics approaches were dimensional references in the interpretation of the communication process between doctor and patient. The selection of tools to be incorporated in the empirical research favored the spheres which are linked to variables and elective dimensions within a relational communication process. The empirical research was developed by applying two online surveys, using mixed sampling methods – the first, directed at doctors, which gathered 33 completed questionnaires; another was directed at patients, with a total number of 481 responses. Both surveys featured the same questions, grouped around the effective communication, verbal communication, non-verbal communication and affective communication dimensions. Analysis of the results confirms a positive outcome in what concerns doctors’ performance in the different dimensions within the communication component. However, some more specific deficits have been identified in the proposed questions, namely preparation for the consultation, message summarization, focus on the patient’s socioeconomic and cultural background, and vocal and body expression. With the data we obtained, we have sought wherever possible to establish a bridge that will raise awareness to the importance of humanizing the relational process, an essential cornerstone in Human interaction, where Doctor and Patient are both protagonists.
The process of communication is a central aspect in building the doctor-patient relationship, which is at the crux of the therapeutic path. As such, this investigation examines the communication process between doctor and patient within a general practice and family medicine consultation, as well as to what extent communication skills are used and perceived. Are communication skills valued and practiced by doctors? Are doctor’s communication skills valued and appreciated by patients? The investigation project that embodied the final document of this Doctoral Thesis materialised as an empirical study built upon documental and bibliographical research that sought roots, concepts, as well as material and mental tools that led the research activity and the observation and analysis that allows for setting in action the dialogue between the phenomena that we proposed to study: doctor-patient communication within a general practice and family medicine consultation in the private healthcare sector in Portugal. This topic became of particular interest to us given the growing awareness and debate that has been garnering both in the media and within Academia. The doctor-patient relationship in clinical practice involves particular features that derive from each subject’s own goals, becoming the construct of a helping relationship. Relationships are based from inception upon an affective experience that forms their very sense. Therefore, effective communication between doctor and patient is an essential clinical skill. Grounded upon an interpretivist approach, this investigation is carried out within a context of theoretical references that allow for the setting of arguments and hypothesis to be empirically tested so as to provide answers to the initial question: To what extent are (...) Knowledge is not something pure, separate from its instruments, its material tools or even its mental tools, such as concepts; scientific theory is an organizing activity of the mind, which puts observations into action and which, of course, also puts into action this dialogue with the world of phenomena. (Morin, 1990, p. 42). interpersonal communication skills applied by doctors within a general practice and family medicine consultation? The proposed theoretical framework relies on a sociocultural approach within Communication Sciences, with contributions from other traditions in the same scientific field. The systemic, micro-analytical, proxemic and kinesics approaches were dimensional references in the interpretation of the communication process between doctor and patient. The selection of tools to be incorporated in the empirical research favored the spheres which are linked to variables and elective dimensions within a relational communication process. The empirical research was developed by applying two online surveys, using mixed sampling methods – the first, directed at doctors, which gathered 33 completed questionnaires; another was directed at patients, with a total number of 481 responses. Both surveys featured the same questions, grouped around the effective communication, verbal communication, non-verbal communication and affective communication dimensions. Analysis of the results confirms a positive outcome in what concerns doctors’ performance in the different dimensions within the communication component. However, some more specific deficits have been identified in the proposed questions, namely preparation for the consultation, message summarization, focus on the patient’s socioeconomic and cultural background, and vocal and body expression. With the data we obtained, we have sought wherever possible to establish a bridge that will raise awareness to the importance of humanizing the relational process, an essential cornerstone in Human interaction, where Doctor and Patient are both protagonists.
Description
Keywords
Comunicação médico-doente Comunicação interpessoal Competências de comunicação Comunicação em contexto profissional Medicina Medicina geral e familiar Communication doctor-patient Interpersonal communication Communication skills Communication in the work environment Medicine Family medicine