Relación clínica y problemas éticos en atención primaria, São Paulo, Brasil

Abstract

Objectives Main Objective: to identify ethical problems in primary care according to nurses’ and doctors’ perceptions. Secondary Objective: to know ethical issues of patient-professional relationships in primary care. Design Synthesis to integrate and reinterpret primary results of qualitative studies. Setting Primary healthcare centers, Sao Paulo, SP, Brazil. Participants and/or context Incidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience. Methods Individual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results. Results Patient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation, and includes feelings and values, with communication skills. Conclusions Ethical problems in primary care are common situations. For quality and humane primary care the relationship should consist of dialogue, trust and cooperation.