O "Ato Médico" e as disputas jurisdicionais entre as profissões de saúde / The "Medical Act" and jurisdictional disputes between health professionals

Resumo O artigo analisou as implicações do Ato Médico na ordenação das relações entre as profissões de saúde e em aspectos relacionados ao controle do campo de conhecimento médico, à prática profissional e ao mercado de trabalho em saúde. Por meio de pesquisa qualitativa, investigou-se o Ato Médico mediante análise documental de material proveniente de 18 edições do Jornal Medicina do Conselho Federal de Medicina (CFM) (223 edições consultadas entre 1998 e 2018). Foram evidenciados interesses particulares no processo de negociação e de efetivação da Lei do Ato Médico, reconhecida como instrumento de controle profissional decorrente das transformações ocorridas no sistema de profissões da saúde e no mercado de trabalho em saúde. A regulamentação profissional dirigida ao exercício exclusivo de atos profissionais considerados atos médicos aparece como uma vantagem para a corporação médica. Ao pretender a exclusividade da prática médica em múltiplas abrangências, o Ato Médico termina por intensificar conflitos com profissões da saúde que compartilham seus atos profissionais. Foi concluído que o Ato Médico poderia ser também entendido enquanto resultado de um movimento pela valorização das bases liberais de atuação, objetivando a defesa da prática individual, da livre escolha, do custeio dos serviços pelo cliente e da prestação direta dos serviços.

Abstract The article analyzed the implications of the Medical Act in ordering the relations between health professions and in aspects related to the control of the field of medical knowledge, professional practice, and the health labor market. With qualitative research, the Medical Act was investigated by documentary analysis of material from 18 editions of the Jornal Medicina do CFM (223 editions consulted between 1998 and 2018). Particular interests were evidenced in the process of negotiation and enforcement of the Medical Act Law, recognized as an instrument of professional control resulting from the changes that occurred in the health professions system and in the health labor market. Professional regulation aimed at the exclusive exercise of professional acts considered to be medical acts appears as an advantage for the medical corporation. In seeking the exclusivity of medical practice in multiple areas, the Medical Act ends up intensifying conflicts with health professions that share their professional acts. The article concludes that the Medical Act could also be understood as the result of a movement for the valorization of the liberal bases of action, aiming at defending individual practice, free choice, the payment of services by the client, and the direct provision of services.

Las profesiones de la salud y la petición de un aborto / Health professions and the request for an abortion

Al aprobarse en Chile una ley que permite el aborto en algunas circunstancias y frente a la posibilidad de que en el futuro existan leyes aún más permisivas, surge la necesidad de reflexionar sobre la actitud que debe tener una institución como la nuestra que forma a profesionales de la salud. Tenemos que tener claridad en que nuestra oposición al aborto no es por razones religiosas ni otras particularísimas. Nos oponemos a realizar esas intervenciones porque ellas vulneran principios y valores propios de la profesión médica. Tenemos en una mujer embarazada a dos pacientes, y la medicina siempre debe respetarles la vida y otorgarles los cuidados de su salud. Debemos enseñar a nuestros alumnos a cuidar y acoger a todos nuestros pacientes como siempre lo hemos hecho.(AU)

Once approved in Chile a law that allows abortion in some circumstances and facing the possibility that in the future more permissive laws may exist, the need to think about the attitude that must take an institution as ours that forms health professionals arises. We must be clear that our opposition to abortion is not under religious or other very specific reasons. We oppose these interventions because they violate principles and values of the medical profession. We have two patients in front when we treat pregnant women, and medicine must always respect their lives and give them healthcare. We must teach our students to care for and welcome all our patients as we have always done.(AU)

¿Y antes de Fauchard qué?: la odontología en las cavernas, los templos, los hospitales y las universidades / And what was there before Fauchard?: dentistry in caverns, temples, hospitals and universities

Este trabajo muestra los orígenes de la odontología entre los primitivos habitantes del planeta, entre los médicos de la Antigüedad, el Renacimiento y la Edad Media hasta los tiempos modernos y la instauración del concepto de hospital clínico universitario. Sostiene que la práctica de la odontología es por definición un acto médico que tiene por objeto al ser humano en la sociedad y la salud a restablecer como bien único e indivisible, siendo ambos conceptos los que delimitan y enmarcan toda la práctica médica. La odontología nace junto con el ser humano, junto con el enfermar, el envejecer y el morir.

This paper shows the origin of dentistry among the primitive inhabitants of the planet, the physicians of the Antiquity, Renaissance and Middle Ages up to the modern times and the establishment of the concept of university clinical hospital. It endorses the practice of dentistry by definition as a medical act that has the human being in the society as the object of the act itself, and the health to restore as the one and indivisible good to enhance. Both concepts are the limits and natural frame of all the medical practice. Dentistry was born with the human being, together with getting sick, ageing and dying.

O ato médico e a subjetividade / El acto médico y la subjetividad / L'acte médical et la subjectivité / The medical act and subjectivity

O presente trabalho enfoca o ato médico sob o prisma de suas implicações subjetivas, discutindo, de maneira pormenorizada, os desdobramentos de uma prática que, cotidianamente, enfrenta impasses cuja importância e possibilidades de manejo são invisíveis ao olhar centrado exclusivamente nos processos biológicos de manutenção da vida. Ênfase é dada aos efeitos iatropatogênicos que tal perspectiva implica, procurando-se descortinar linhas de fuga que favoreçam a criação de alternativas mais produtivas tanto para o profissional quanto para os pacientes que demandam atenção no campo da saúde.

El presente trabajo enfoca el acto médico desde el prisma de sus implicaciones subjetivas discutiendo, de manera pormenorizada, los desdoblamientos de una práctica que cotidianamente enfrenta situaciones de difícil salida cuya importancia y posibilidades de manejo son invisibles a la mirada centrada exclusivamente en los procesos biológicos de mantenimiento de la vida. El énfasis es dado a los efectos iatropatogénicos que tal perspectiva implica, procurando hacer aparecer líneas de fuga que favorezcan la creación de alternativas más productivas, tanto para el profesional como para los pacientes que demandan atención en el campo de la salud.

Ce travail met en évidence l'acte médical sous le prisme de ses implications subjectives et propose pour ce faire une discussion détaillée des conséquences d'une pratique qui, quotidiennement, se trouve face à des impasses dont l'importance et les possibilités de maniement sont invisibles au regard ciblé exclusivement sur les processus biologiques de maintenance de la vie. Les effets iatropathogéniques que telle perspective implique sont mis en relief pour trouver des points de fuite qui puissent favoriser la création d'alternatives plus productives et pour le professionnel, et pour les patients, ce qui exige plus d'attention dans le domaine de la santé.

This article discusses the medical act from the perspective of its subjective implications, and questions the development of a practice that faces continual impasses. The difficulty is that the importance and possibilities related to the management of clinical realities are invisible to perception based exclusively on biological life processes. Emphasis is given here to iatropathogenic effects that this perspective implies. The author thus offers approaches that may favor the establishment of more productive alternatives for professionals and their patients who require attention in the field of health care.

Estratégias transdisciplinares: o ato médico na compreensão de graduandos da área de saúde / Transdisciplinaries strategies: the "medical act" in the health undergraduation students' comprehension

Trata-se de uma pesquisa descritiva e exploratória, com abordagem qualitativa, voltada para analisar as repercussões do Ato Médico (AM) a partir do ponto de vista de estudantes de graduação da área de saúde e estimular o desenvolvimento do senso crítico acerca da transdisciplinaridade para harmonia do trabalho em equipe. Os sujeitos do estudo são 105 estudantes de graduação, a saber: 34 de Enfermagem (6º Período), 45 de Nutrição (2º Período), 17 de Fisioterapia (1º Período) e 9 de Medicina (4º Período) e o instrumento utilizado para coleta de dados limitado a uma questão aberta, visando captar os significados do ato médico para os mesmos. A coleta dos dados ocorreu no primeiro e segundo semestres de 2004. Os resultados apontam o AM como retrocesso para a transdisciplinaridade, em decorrência da indevida apropriação do conhecimento em saúde pela medicina, contrapondo a legislação vigente. Conclui-se que o incentivo às discussões sobre o tema com estudantes da área de saúde possibilita maior esclarecimento de cada categoria acerca do domínio de conhecimento das demais, sobretudo, na compreensão de que o AM infringe um dos mais importantes princípios da transdisciplinaridade, o trabalho em equipe.

It is a descriptive and exploratory research, with qualitative approach, gone back to analyze the repercussions of the “Medical Act” (MA) starting from the health sciences undergraduation students' point of view and to stimulate the development of the critical sense concerning the transdisciplinarity for harmony of the work in team. The subject of the study are 105 undergraduation students, 34 of Nursing (6th Semester), 45 of Nutrition (2nd Semester), 17 of Physiotherapy (1st Semester) and 9 of Medicine (4th Semester), and the instrument used for collection of data limited to one open subject, seeking to capture the meanings of the medical act for the same ones. The data collection happened in the first and second semesters of 2004. The results aim MA as setback for the transdisciplinarity, due to the improper appropriation of the knowledge in health for the medicine, opposing the effective legislation. It is ended that the incentive to the discussions on the theme with students of the area of health facilitates larger elucidate of each category concerning the domain of knowledge of the others, specially, in the understanding that AM infringes one of the most important beginnings of the transdisciplinarty, the work in team

Several Issues on the Medical Act Revision

Medical Act is the substantial law regulating medical service providers' qualification, rights and obligations, and regulating establishment and management of medical institutions. The Korean Medical Act was enacted in 1951 in the commencement, and revised about 30 times until now. But, there were only 2 total revision, in 1962 and 1973. From that on, for the purpose of adopting to changing medical circumstances and easing unnecessary regulations, the necessity of total revision was proposed continuously. At last in August 2006, Ministry of Health and Welfare (Department of Medical Care Policy) established 'Medical Act Revision Task Force Team', and then 9 conferences were held. But, The Korean Medical Association objected to the revised bill very intensively. The first reason is that the bill was made in a mad rush, and the second reason is that the bill restricts medical doctors' self-regulation and discretion too much.

Desirable Educational Environment for the Better Clinical Clerkship / 医学教育

In order to implement, or enhance the quality of clinical clerkship, it is necessary to develop good educational environment which will be appropriate to allow medical students participate in medical team services. Important things to be considered will be, (1) Systematic management of the individual department's program by the faculty of medicine, (2) Developing educational competency within the medical care team function, and (3) Nurturing students' awareness forself-diected learning and cooperative team work, and teaching- and medical staffs' awareness of their educational responsibilities. In this paper, to develop better educational environment for clinical clerkship, we propose a desirable situation of the educational organization, dividedly describing on the roles of dean, faculties, board of education, department of medical education, clerkship director, teaching physicians, residents and medical students.