versão impressa ISSN 0102-311X
Cad. Saúde Pública vol.14 no.4 Rio de Janeiro Out. 1998
| Daniela Riva Knauth || |
Debate sobre o artigo de Christopher Peterson
Debate on the paper by Christopher Peterson
Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
The author's proposal to study the 'medical slang' used by physicians and heath care staff in daily clinical practice is quite innovative. Few studies have focused on this issue, although it calls the attention of the 'lay person' who has contact with the medical milieu. According to the common-sense view, such slang plays the role of maintaining a distance between the physician and patient and relieving tensions inherent to the profession, in constant contact with suffering and death. It also appears as a way of promoting rapport within the health care staff, through a complicity created by speaking the 'same language'.
The author does not accept these explanations and suggests that 'medical slang' can be seen as creating new meanings in physicians' relationship to: patients, clinical knowledge and specialization fields, and the health care system as a whole. He stresses the specificity of the Brazilian case he has studied, where such slang points to a kind of critique of the functioning of the health system, through such puns as trambiclínicas, pilantrópicos, mulambulatórios, and Embromed. As the author himself highlights, this critique is linked to physicians' discontentment towards the dependence of professional practice on different health plans and public policies.
Thus, although he points to these contextual variables, the author searches for the meaning of physician slang more in the etymological origin of the words forming the puns than in the position these physicians occupy in the medical field. Another contextual aspect overlooked by the author, and which might have led his analysis in a different direction, placing the critical nature of slang in a relative light, is the recurrence of the type of behavior it expresses in Brazilian society; here I am reminded of the work of Roberto Da Matta (1983, 1997) concerning the relationship of Brazilians to institutions, norms, and laws. The author's proposal of understanding 'medical slang' as an expression (albeit incipient) of the search for either a new ethic or an adjustment of medical ethical principles to the reality confronted by physicians would thus gain argumentative weight.
Another contextualization which I consider fundamental, and which is lacking in the article, refers to medical culture per se, i.e., the place and role of so-called medical 'slang' and metaphors in the construction and identification of the 'medical world'. Byran Good (1994), in analyzing how doctors construct their objects, states that learning medicine is similar to "learning a foreign language", not only because it involves learning specific scientific terms, but above all in learning a way of observing and describing which is proper to these professionals. In this sense, we might ask how these medical 'slang' terms and metaphors enter into this learning process? Do they express this particular way of viewing and describing the world of medicine? If so, they should not be viewed only through the etymological sense of the words that constitute them. The slang and metaphors used to designate relations between specialization fields, the different 'types' of patients, and the health plans and policies can be seen as ways physicians have learned to deal with these situations, reaffirming values and principles pertaining to the profession itself, and thus constructing a particular reality. In this context, the hospital and the outpatient service (along with their respective patients and staff) are a prime object of construction and expression of such representations.
DA MATTA, R., 1983. Carnavais, Malandros e Heróis: para uma Sociologia do Dilema Brasileiro. 4th ed., Rio de Janeiro: Zahar.
DA MATTA, R., 1997. O que Faz o Brasil Brasil. 8th ed., Rio de Janeiro: Rocco.
GOOD, B., 1994. How medicine constructs its objects. In: Medicine, Rationality and Experience. (B. Good, ed.), pp. 65-87, Cambridge: Cambridge University Press.