The stifling of comprehensive care in 20- minute consultations

Sistema Único de Saúde and Primary Health Care principles constrained in competency learning during Family and Community Medicine Residency

Abstract

Introduction: Family Practice (FP) is consolidated in Primary Health Care (PHC) as the go for specialty in developing its attributes and principles of the “Sistema Único de Saúde (SUS)”, the Brazilian public health system, seeking to implement the Social Production of Health (SHP) paradigm. The Residency in FP (RFP) is considered the gold standard for training these professionals capable of transcending the provision of services, articulating interdisciplinary care networks and overcoming the biomedical model in the complex PHC scenario, which has been improved with the development of skills for the specialty. However, the precariousness of working conditions that marks the history of PHC stands out as a challenge to be overcome. Objectives: Develop reflections on the main challenges that characterize Primary Health Care (PHC) and pathways to overcome them. Methods: A critical essay was carried out, based on narrative review. The databases of Scientific Electronic Library Online, Google Scholar, and Biblioteca Virtual em Saúde were searched using the descriptors “Family and Community Medicine”,” “Residency”, “Competency Based Education”, “Working Conditions,” and “Precarious Work”.” The literature found was articulated with the experience and reflection of the authors. Discussion: The results describe how precariousness has characterized work in PHC and negatively impacted the overcoming of biomedicine by SHP. This precariousness is marked by the competitiveness of neoliberal management models, reinforcing a reduced and fragmented concept of health, which weakens the SUS and compromises its constituent attributes. In relation to RMFC, the findings reveal not only losses in training, but also theoretical and practical difficulties faced by professionals in identifying problems, as well as in reflecting and acting on these limitations in the development of skills, strongly subverted by medicalizing biomedicine. To explain these difficulties and propose solutions, the fragility of bioethical training, especially ethical-political training, is discussed. The concept of dialogical competence associated with political engagement is highlighted as potential ways to overcome these difficulties. Conclusions: Criticism of the current scenario proves to be both challenging and fundamental in the fight for health as a right.