Contribuições da medicina antroposófica à integralidade na educação médica: uma aproximação hermenêutica (original) (raw)
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A compelling paradox confronts present-day medicine. Major advances in medical technology are proclaimed almost daily. Built on this flourishing technology are equally significant gains in the physician's ability to understand the mechanisms of illness, devise new treatments, prolong life, and cure disease more often. Inexplicably, dissatisfaction with medicine grows despite this real progress. Many patients dread medical technology and feel a deepening sense of alienation from their physicians. Patients tend to view doctors more as remote technicians than as healers. The technology is experienced as invasive and dehumanizing. As a result, patients frequently fail to accept their doctor's recommendations or to comply with treatment regimes. Even in the face of the solidly documented efficacy of orthodox treatments, patients turn to unorthodox medical practices, perhaps in increasing numbers. Dissatisfaction is also apparent on the physicians' side. 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Liaison psychiatrists increasingly round with other physicians in order to stress the psychological, social, and humanistic dimensions of health care at the bedside. Admitting committees at medical schools are more sympathetic to candidates with a background in the humanities. At the conclusion of training, more attention is now devoted to the physician's humanistic attributes. For example, the American Board of Internal Medicine has recently required "high standards of humanistic behavior in the professional lives of every certifiable candidate." Despite these recent initiatives, an ongoing 3-Year review of the education of student doctors by the Association of American Medical Colleges continues to uncover an inadequate emphasis on humanism in medical schools. Integrated efforts such as the ones mentioned above, laudable though they may be, prove inadequate because they merely graft a kind of remedial humanism onto a fundamentally technological and biomedical practice. If the root disciplines of medicine remain natural sciences, such as biochemistry, physics, and physiology, we might wonder how the addition of humanistic approaches would substantially change medical practice. This task of integrating humanism into medical science is rendered even more puzzling when we realize that "humanism" remains an ambiguous term. It can refer to some "art of medicine," to ethical values, or to human sciences, such as psychology and sociology. Do calls for "humanism" require that we supplement the science of medicine with the healing arts? Or do they indicate that the physician, in addition to his scientific expertise, must also develop a mastery of ethical distinctions and judgments? Or is the appeal to "humanism" an injunction that the doctor move from a model of illness based on the natural sciences to a more encompassing framework that also includes the human sciences? If so, how can the doctor become an expert in so many disciplines? The difficulty encountered in trying to fit diverse humanistic and technological concepts and approaches into an encompassing scientific framework constitutes a crisis for scientific medicine. We shall address this crisis by first discussing the strengths and weaknesses of what we view as the most persuasive attempts to resolve it. Since George L. Engel's important article, these two orientations go by the names of "the biomedical model" and "the biopsychosocial model." We shall contend that the shortcomings of both of these models can be fully discerned only when we recognize a fundamental aspect of the physician-patient relationship that they overlook. As long as this more basic aspect of medical practice remains concealed, any approach, whether scientific or humanistic, will misconstrue the patient. Medical practice, in other words, becomes intelligible only when its moorings in a fundamental domain of human experience are clarified and delineated. This more basic domain we shall find in the phenomenological conception of everyday human experience as the source of meaning for all science and humanism. The grounding of scientific medicine in everyday human experience-which phenomenologists call "the lifeworld"-will lead us to redefine the notion of scientific method. This reconception of science will generate a view of the hierarchy of the sciences with respect to which medicine can find its rightful place. Through this phenomenological approach we shall propose a new model for medicine. We, however, shall not simply super- impose the human disciplines on a biomedical foundation. Rather we shall reconceive the nature of "science" such that medical practice remains fully rigorous and rational precisely by being humanistic.
MEDIC, 2020
This article begins by introducing the different interpretations and movements associated with professionalism, as well as their relationship with medical ethics and bioethics. It then formulates and presents a proposal linked to virtue-based professionalism in which, on the one hand, these three fields are reconciled and, on the other hand, medicine is able to preserve its identi-tarian goals, adapt to social and technological changes, and contribute to social progress. More concretely, it argues for the need to recover the heart of medicine, that is, to reincorporate its subjective dimension and learn to properly apply it to professional knowledge and practice. To achieve this objective, a three-stage training plan that inverts David T. Stern's pyramid is presented. In the first stage, doctors (current or future) learn to exercise the virtue of sensory contemplation-the first habit of the heart-at the patient's bedside. Professionalism guides this eminently practical training step. The second stage explores the reasons behind professional ethics from the internal logic of medicine, a task for which the study of the history of medical thought is crucial. Here medical ethics plays a special role. Professional training culminates in the acquisition of the intellectual virtues that enable intellectual contemplation-the second habit of the heart. With it, doctors are able to decide what is truly best for each patient, assume responsibilities as a citizen and last, but not least, take on the practice of medicine with passion. Bioethics introduces professionals to this third training stage, which typically occurs in the university setting.