El médico de cabecera al inicio del siglo XXIentre la curación y la sanación

Abstract

The study investigates the attitudes and social representations of the process health/illness/disease and the clinical relation in Primary Health Care (PHC). A population perspective has been looked for, and it has been carried out by means of a qualitative technique, with 12 discussion groups, which include Spanish population, both urban and outlying, taking into account the different bio-social-stratums. Healthcare and illness care appear as the meaning of the PHC. The concept HEALTH appears as a value, not as a fact associated to values. Health in not a clear objetive, nor has it a meaning shared by all social actors. Illness is the subjetive experience of discomfort in the social environment, with a meaning for the person and without definitive biomedical treatment. This illness in included in the fundamental field of the family physician (FP). The disease as a rational interpretation of the illness which threaten the individual or collective identify is better to be controlled and dominated by the "specialist" as the most qualified representative of the "Mother Science". The clinical relation with the FP aims to understand and relieve to diagnose a disease, and relieve illness is not to treat the disease. The FP finds himself between the treatment of banal pathologies and the healing of complex problems. The healing of the complex is demanded from the most demythologized professional. From a sociological side, the FP is looked for to participate in a secular ritual which legitimize the sick's role, and provide control and protection. There is an imprecise limit between SCIENCE and RITUAL in PHC. More symbolic efficiency of the ritual and also more unrest appear in the middle-low-sociostratum. From a personal perspective, a sense to the illness is looked for through the clinical relation. Art and science in PHC are closely related. The artistic facet, necessary in the handling of the illness has beneficial effects, side effects and counter-indications that must be known and evaluated to improve the quality of the clinical relation. Qualitative investigation play here a very important role.