Pesquisa qualitativa em medicina de família e comunidade: a importância do olhar generalista

Armando Henrique Norman

doi:10.5712/rbmfc16(43)2659

Authors

Armando Henrique Norman Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC https://orcid.org/0000-0002-5267-7377

DOI:

https://doi.org/10.5712/rbmfc16(43)2659

Keywords:

Family Practice, Primary Health Care, Epistemology, Research, Education, Medical

Abstract

The historical and social contexts of each country shape the research, services, and the quality of professional training in healthcare activities. Thus, medical specialisation is the result of these processes and the research reflects each field of interest. This essay explores three points on Family and Community Medicine (FCM) research, namely: (a) research and specific training in FCM, which questions the need to investigate the value of FCM; (b) the generalist gaze that is necessary to guide research in this area of medical knowledge; and (c) qualitative research as the most appropriate methodology for analysing this field of medical knowledge. This line of research is the one that best contributes to the investigation of the specificities of FCM and its importance for health care. Therefore, in order to navigate the complex context of primary health care (PHC), the philosophical principles of the FCM should guide both academic activities and residency programmes, as well as research initiatives in FCM.

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Author Biography

Armando Henrique Norman, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC

Graduação em medicina pela Universidade Federal do Paraná-UFPR (1989-1995), Residência em Medicina Geral e Comunitária/Medicina de Família e Comunidade pela Pontifícia Universidade Católica do Paraná-PUC-PR (1999-2001), mestrado (2010-2011) e doutorado (2012-2015) pela Universidade de Durham, Reino Unido na área da Antropologia Médica. É membro externo do grupo de pesquisa "Conspiracy Theories in Health" do Wolfson Research Institute for Health and Wellbeing. Atuou como supervisor do Programa de Residência em Medicina de Família e Comunidade da Secretaria Municipal de Saúde do município do Rio de Janeiro-PRMFC-Rio (períodos 2012; 2016-2017). Atualmente trabalha como médico de família e comunidade na Secretaria Municipal de Saúde de Florianópolis, como preceptor do PRMFC da SMS Florianópolis e também como tutor dos estudantes de graduação em medicina da Universidade Federal de Santa Catarina (UFSC). Tem experiência nas áreas da Medicina de Família e Comunidade e da Antropologia Médica, atuando principalmente nos seguintes temas: Pagamento por Performance (P4P), Prevenção Quaternária (P4), Medicalização Social, Rastreamento, Medicina de Família e Comunidade (MFC), Atenção Primária à Saúde (APS), Medicina Preventiva e Medicinas Complementares (Homeopatia).

References

(1) Armstrong D.The emancipation of biographical medicine. Soc Sci Med. 1979;13:1-8. DOI: https://doi.org/10.1016/0271-7123(79)90002-6

(2) Balint M. The doctor, his patient, and the illness. Lancet. 1955;265(6866):683-688. DOI: https://doi.org/10.1016/S0140-6736(55)91061-8

(3) Engel G. The need for a new medical model: a challenge for biomedicine. Science (80- ). 1977;196(4286):129-136. DOI: https://doi.org/10.1126/science.847460

(4) Kleinman A. Concepts and a model for the comparison of medical systems as cultural systems. Soc Sci Med Part B Med Anthropol. 1978;12:85-93. DOI: https://doi.org/10.1016/0160-7987(78)90014-5

(5) McWhinney IR, Freeman T. Manual de Medicina de Família e Comunidade. Porto Alegre: Artmed; 2010. https://books.google.com.br/ books?id=rn7JQgAACAAJ.

(6) Ramirez Jaco B, Norman AH. A filosofia da Medicina de Família e Comunidade segundo Ian McWhinney e Roger Neighbour. Rev Bras Med Família e Comunidade. 2020;15(42):1991. doi:10.5712/rbmfc15(42)1991 DOI: https://doi.org/10.5712/rbmfc15(42)1991

(7) Harrison S.The Politics of Evidence-based Medicine in the United Kingdom. Policy Polit. 1998;26(1):15-31. DOI: https://doi.org/10.1332/030557398782018293

(8) Harrison S, Moran M, Wood B. Policy emergence and policy convergence: the case of “scientific-bureaucratic medicine” in the United States and United Kingdom. Br J Polit Int Relations. 2002;4(1):1-24. DOI: https://doi.org/10.1111/1467-856X.41068

(9) Norman AH, Russell AJ, Macnaughton J. The payment for performance model and its influence on British general practitioners’ principles and practice. Cad Saúde Pública. 2014;30(1):55-67. http://www.ncbi.nlm.nih.gov/pubmed/24627013. Accessed April 16, 2014. PMID: 24627013

(10) Jantsch AG. Pesquisa científica, atenção primária e medicina de família. Rev Bras Med Família e Comunidade. 2020;15(42):2466. doi:10.5712/rbmfc15(42)2466 DOI: https://doi.org/10.5712/rbmfc15(42)2466

(11) SBMFC. Currículo Baseado em Competências para para Medicina de Família e Comunidade. https://www.sbmfc.org.br/noticias/sbmfc- divulga-curriculo-baseado-em-competencias/. Published 2015. Accessed January 16, 2021.

(12) Neighbour R. The Inner Physician: Why and How to Practise “Big Picture Medicine.” London: Royal College of General Practitioners; 2016.

(13) Sheldrake R. Setting science free from materialism. Explor J Sci Heal. 2013;9(4):211-218. DOI: https:// doi.org/10.1016/j.explore.2013.04.004

(14) McWhinney IR. William Pickles Lecture 1996. The importance of being different. Br J Gen Pract. 1996;46(408):433-436. http://www.ncbi. nlm.nih.gov/pubmed/8776918. PMID: 8776918

(15) McWhinney IR. Family medicine as a science. J Fam Pract. 1978;7(1):53-58. http://www.ncbi.nlm.nih.gov/pubmed/670917. PMID: 670917

(16) Whitehead AN. Science and the Modern World. New York: Free Press; 1967.

(17) Norman AH, Tesser CD. Following McWhinney’s footsteps: from family medicine to traditional and complementary medicine. Interface Commun Heal Educ. 2019;23. DOI: https://doi.org/10.1590/interface.190036

(18) Middleton H, Moncrieff J. Critical psychiatry: a brief overview. BJPsych Adv. 2019;25(1):47-54. doi:10.1192/bja.2018.38 DOI: https://doi. org/10.1192/bja.2018.38

(19) Lermen Junior N, Norman AH. Medicina familiar y comunitaria y salud de la familia en Brasil: una estrategia para ofrecer atencion primaria de salud para todos. Medwave. 2013;13(1).

(20) Gérvas J, Pastor-Sánchez R, Pérez-Fernández M. Crying patients in General/Family Practice: incidence, reasons for encounter and health problems. Rev Bras Med Família e Comunidade. 2012;7(24):171-176. DOI: https://doi.org/10.5712/ rbmfc7(24)629

(21) Illich I. Medicalization and primary care. J R Coll Gen Pract. 1982;32(241):463-470. PMID: 6752403

(22) Murphy E, Dingwall R, Greatbatch D, Parker S, Watson P. Qualitative research methods in health technology assessment: a review of the literature. Health Technol Assess. 1998;2(16):iii-ix, 1-274. http://www.ncbi.nlm.nih.gov/pubmed/9919458. PMID: 9919458

(23) Norman AH, Russell AJ, Merli C. The Quality and Outcomes Framework: body commodification in UK general practice. Soc Sci Med. 2016;170. DOI: https://doi.org/10.1016/j.socscimed.2016.10.009

(24) Kontopantelis E, Springate DA, Ashworth M, Webb RT, Buchan IE, Doran T. Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study. BMJ. 2015;350(mar02_1):h904. DOI: https://doi.org/10.1136/bmj.h904

(25) Ryan AM, Krinsky S, Kontopantelis E, et al. Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study. Lancet. 2016;388(10041):268-274. DOI: https://doi. org/10.1016/S0140-6736(16)00276-2

(26) Lancet T. Is primary-care research a lost cause? Lancet. 2003;361(9362):977. DOI: https://doi. org/10.1016/S0140-6736(03)12837-1

(27) Greenhalgh T, Howick J, Maskrey N, Evidence Based Medicine Renaissance Group. Evidence based medicine: a movement in crisis? BMJ. 2014;348(17):g3725. PMID: 24927763 DOI: https://doi.org/10.1136/bmj.g3725

(28) Kelly MP, Heath I, Howick J, et al. The importance of values in evidence-based medicine. BMC Med Ethics. 2015;16(1):69. PMID: 26459219 DOI: https://doi.org/10.1186/s12910-015-0063-3

(29) Anjum RL, Copeland S, Rocca E. Rethinking Causality, Complexity and Evidence for the Unique Patient: a causehealth resource for healthcare professionals and the clinical encounter. Cham: Springer International Publishing AG; 2020.