Alameda Cuesta Almudena, Pazos Garciandía Alvaro
Unidad Enfermería, Departamento de Ciencias de la Salud II, Universidad Rey Juan Carlos, Madrid, España.
Rev Esp Salud Publica. 2009 Nov-Dec;83(6):863-75. doi: 10.1590/s1135-57272009000600009.
The frequent attendance is a worrying phenomenon for the health systems of Western countries, due the high work load it generates and its high costs in material and human resources. This work aims to study the meanings, categories and practices that general practitioners build around the frequent attendance.
Qualitative study, based on a socio-subjective approximation, through in-depth interviews. Eight interviews were conducted with Primary Health Care physicians in Madrid. The discourses were examined from a pragmatist perspective.
The figure of the Primary Health Care physician is at the intersection of professional and institutional contradictory logic, which generates high levels of professional malaise. The social and psychological aspects appear in a confused way, due the consideration of the non-physical aspects as outside the realm of medicine. Frequent attendance is problematic because: it is situated in the center of the sign-symptom dichotomy. its management requires so much time. it requires a comprehensive approach. it avoids the medical performance as a professional who diagnosed and establishes an etiological treatment. These problems eventually can lead to conflict in the professional-patient relationship.
The meanings for the frequent attendance will vary significantly depending on the socio-subjective positions, so the approach proposed here could help to understand the complexity of a problem that is built within the relationships between particular subjects crossed by different institutional dynamics, labour disputes, career paths and ideologies.
由于频繁就诊产生的高工作量以及其在物质和人力资源方面的高成本，频繁就诊对西方国家的卫生系统来说是一个令人担忧的现象。这项研究旨在探讨全科医生围绕频繁就诊所构建的意义、类别和实践。
基于社会主观视角，通过深度访谈进行定性研究。对马德里的初级卫生保健医生进行了八次访谈。从实用主义角度审视这些话语。
初级卫生保健医生的角色处于专业和机构矛盾逻辑的交叉点，这导致了高水平的职业不适。社会和心理方面以一种混乱的方式出现，因为非身体方面被视为超出医学领域。频繁就诊存在问题的原因如下：它处于体征 - 症状二分法的核心位置；其管理需要大量时间；它需要综合方法；它避免了作为诊断并确立病因治疗的专业人员的医疗表现。这些问题最终可能导致医患关系冲突。
频繁就诊的意义会因社会主观立场而有显著差异，因此本文提出的方法有助于理解一个在由不同机构动态、劳动纠纷、职业道路和意识形态交织的特定主体之间的关系中构建起来的问题的复杂性。
