Domiciliary medical visit: space for interaction, communication and practice: case study in health family program, municipal district of Florianopolis Santa Catarina / Visita médica domiciliar: espaço para interação, comunicação e prática: estudo de caso no Programa Saúde da Família, município de Florianópolis - Santa Catarina

Renata Borges

This study discusses the domiciliary medical visit, with base in research accomplished in the municipal district of Florianópolis, Santa Catarina, in the context of the Family Health Program. The main objective was to understand medical visit as a space for interaction and as a powerful instrument of communication between the professional, the patient and his or her family. Qualitative methodology and case study were adopted along with triangulation techniques, combining interviews, participant observation and the reading of documents. Interviews with semi-structured scripts were performed, one for doctors and another for users and relatives. The interviews were recorded and transcribed with the patients and the professionals permission, and a free consent and informed form were signed by all participants. Seven doctors and ten users and their relatives, who had received visits of these doctors, were interviewed. In step concurrently with the interviews, medical professionals were observed while home visiting ten families who were not interviewed later by the researcher. By analyzing the information it was found that the visit allows the doctor to ponder on his or her professional practice, putting him or her through challenges that involve his or her ability to communicate and interact outside of a protected context, represented by the health center and clinic, and where the demands arising from the way of life of patients and their families shows up. The perception of professionals over the visit is that it is an activity that is effective in the clinical outcome of patients treated, as was reported a decrease in the number of hospital admissions after the start of home care. For professionals, the medical monitoring and proposed treatment adhesion are influenced by the bond established between professional, patient and family, which improves communication and allows an interaction that impacts the treatment. The health problems that motivated the visits were, in general, chronicle diseases, but also acute problems can demand attendance. The absence of a caregiver did not prevent the medical professional to maintain the home care. The eligibility criteria for medical visits vary according to the situation that is experienced by health staff. Care is taken so that the assistance takes place in a participatory manner. The users and their relatives related that the medical visit allows closer relation with the doctor and the comprehension of the case. It was concluded that domiciliary medical visit favors the interaction between those involved by establishing communication geared towards mutual understanding, raising questions about the inflexible hierarchy between doctor and patient when aspects of the context and the relations of users with their families and community emerge. The interaction that occurs gears the professional towards a conduct which seeks to go beyond the technical efficiency (technical success), heading into the practical success and promoting the participation of the patient and family regarding the care provided

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