Saúde é colocar-se em risco: normatividade vital em Georges Canguilhem / Health is putting oneself at risk: vital normativity in Georges Canguilhem

Resumo Este artigo objetiva apresentar uma crítica ao modelo biomédico de saúde predominante nas ciências médicas, a partir do conceito de normatividade vital, proposto por Georges Canguilhem. Na introdução apresentamos, a partir de um breve histórico do conceito de saúde, a normalização como o primado fundamental do modelo biomédico. Na primeira parte, discutimos o problema da determinação do normal e do patológico, da saúde e da doença, no pensamento de Canguilhem, buscando situar esses conceitos em função de valores individuais, questionando a existência de um processo normativo em biologia. Na segunda parte, pretende-se demonstrar que a normatividade vital defendida por Canguilhem é uma ferramenta conceitual fundamental para o entendimento da lógica de produção biológica. Esta lógica de produção não toma a norma como critério de valoração das formas de vida possíveis. Não são as individualidades biológicas que se adéquam ou se afastam das normas, mas, ao contrário, é a individualidade biológica enquanto potência de criação de novas formas que produz o processo de sua normatividade. Por fim, destacamos o impacto crítico do conceito de saúde entendido como uma abertura ao risco, enfatizando essa dimensão da saúde como a capacidade de enfrentar novas situações de vida.

Abstract This article aims to criticize the biomedical health model prevalent in medical sciences, based on the concept of vital normativity proposed by Georges Canguilhem. In the introduction we present, from a brief history of the health concept, normalization as the fundamental primacy of the biomedical model. In the first part, we discuss the problem of determining normal and pathological, health and illness in Canguilhem's thought, seeking to situate these concepts in function of individual values, questioning the existence of a normative process in Biology. In the second part, it aims to demonstrate that the vital normativity advocated by Canguilhem is a fundamental conceptual tool for the understanding of organic production logic. This production logic in Biology does not take the norm as criterion for valuing possible forms of life. Biological individuals do not fit or deviate from the rules, but biological individuality, as a power of generating new ways, produces the normativity process. Finally, we highlight the critical impact of the concept of health understood as an openness to risk, emphasizing this dimension of health as capacity to face new situations of life.

Un clínico en el siglo XXI / A clinician in the 21st century

La tradición clínica enfrenta desafíos que derivan del vertiginoso avance científico y tecnológico y a la vez del cambio social que caracterizan los inicios del siglo XXI. Las condiciones de hoy en día exigen una modernización de la práctica que recupere el protagonismo del paciente, emplee inteligentemente la asombrosa tecnología disponible y se inserte armónicamente en las nuevas realidades sociales. Esta es la clínica del siglo XXI.

At the beginning of the 21st century, clinical practice faces new challenges associated with very fast scientific and technological advances. Societies have also changed and current conditions demand modernization of clinical practice. Now we acknowledge the need for a patient-centered medical practice. Novel technologies will also participate in this new social fabric. This is the new clinical practice of the 21st century.

Errors by surgical pathologists in India: results of a questionnaire survey.

BACKGROUND: Data from the United Kingdom show that most surgical pathologists are aware of about one serious mistake in their reports every year. There are no corresponding data from India or the developing world. I made an attempt to determine the rate of error made by Indian pathologists. METHODS: A postal questionnaire was sent to 96 pathologists and 71 clinicians in different cities. The questions included some related to their experience with error in histopathology, as well as a few on the respondents' views on the legal and ethical aspects in the case of medical error. RESULTS: Fifty pathologists and 47 clinicians responded. Of the evaluable responses, 32 pathologists were aware of 86 errors in the past 5 years, while 30 clinicians recalled 162 errors. Most mistakes that pathologists remembered were cases related to lymphoid disease (n = 15) while for clinicians, gastrointestinal tract (n = 12) and lymphoid tissue (n = 9) were common sites of error. Benign-malignant errors were the most common type of error. CONCLUSION: The discrepancy between the rates of error between the two groups suggests that better pathologist-clinician communication is required. Medical councils and related governing bodies should consider introducing a quality control programme for anatomic pathology.