Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Background: Evidence-based medicine (EBM) involves the care of patients using the best available evidence from the results of good quality clinical research to guide clinical decision making 1 – 3. By incorporating the principles of Evidence-based Medicine (EBM), the family practitioner would be able to treat a patient according to the best clinical research available. This principle is implemented widely in the USA, Canada, the United Kingdom and Europe. In South Africa, however, EBM is not yet as widely incorporated into family practice. This is so despite the plethora of websites available to practitioners and the relative ease with which applicable research evidence can be found. Very few published studies are available regarding EBM or Evidence–based Practice (EBP) in the South African context. The findings of this study would thus highlight reasons and/ or barriers preventing family practitioners from implementing EBM in their respective practices. This could also lead to further research into possible methods of implementation of EBM into South African family practices. Aim: The aim of the study was to describe the perceptions, knowledge and attitudes of private practitioners regarding evidence based practice and to identify the barriers encountered in evidence based practice. Methods A questionnaire survey of general practitioners in Gauteng, South Africa, was conducted. Questionnaires were distributed to a random sample of practitioners in the Gauteng region. Two hundred and twenty one (221) practitioners participated in the survey and responded to questionnaires mailed to them. The questionnaire was mailed, faxed or e-mailed to the practitioners, which they then completed and returned for statistical analysis. Study design The study design is that of quantitative, statistical analysis (descriptive cross-sectional survey). Setting General practitioners were randomly selected from a list of practitioners in the Gauteng Province. Doing a nationwide survey would have been a mammoth undertaking. It was therefore decided to limit the research to one province and therefore it was only concentrated on practitioners practicing in the Gauteng area. Results It is interesting to note that of the two hundred and twenty one participants in this study; only 10% of the practitioners were against using EBM in their practices. This, however, stands in stark contrast to the 56% of practitioners who do not implement EBM in their practices or make use of the EBM principle at all. The major barriers preventing practitioners from implementing EBM is depicted in the following graph: Lack of time and the training in aspects of Evidence-based medicine were the main barriers preventing the full scale implementation of EBM in family practices in Gauteng. Conclusion Participating Gauteng doctors were in principle, very positive towards the implementation of EBM in their respective practices. Most of the participants agreed that EBM would benefit their patients’ care and treatment. Very few of the participants, however, make use of EBM in practice. A lack of training and time constraints were the main barriers with regards to the implementation of EBM. Proper training of medical students at undergraduate level at faculties of health sciences, would go a long way assisting prospective doctors in mastering the concept of EBM and increasing their overall awareness of EBM. Further definitive research would assist in establishing whether such awareness would be associated with improved implementation of evidence in the form of evidence based guidelines in practice.

Adequate access to and appropriate use of medical evidence by clinicians have been posited as influencing the quality of clinical decisions and outcomes of patient care. The broad aim of this case study of a tertiary hospital was to provide understanding of how the information experiences and practices of paediatric physicians in Nigeria influenced their information practices and the potential implications for patient care. To achieve the research aim and objectives, a qualitative exploratory study was conducted using multiple sources of data: interviews, diaries, observation and social network chats. Overall, twenty semi-structured interviews were conducted, and seven clinicians provided a week-long information activity self-reports through diaries. Supplementary data were gained via the researcher's personal observation and social media chats with some participants. Paediatricians in the cadre of: Consultants, Senior Registrars, Registrars and Residents provided the data which was analysed using the interpretative method. The results indicate that the paediatricians' information needs were on: managing challenging cases, supporting diagnostic decisions, managing evolving diseases, managing illnesses in the tropical context, drugs and dosage, refreshing the memory, keeping updated, and passing professional examinations. In general: i)there was haphazard approach to information literacy tuition for the clinicians during professional education resulting in varied information capabilities, and inadequacy of knowledge and skills for good information practice; ii) obtaining medical information from colleagues was the predominant feature of paediatricians' information practices; iii) printed textbooks were the paediatricians preferred source for obtaining medical evidence, however, there was a growing popularity in the use of electronic medical information sources, including at the point of care; iv) a perception of inadequacy of the hospital library services resulted in the paediatricians developing rejection behaviour towards the services, labelled in this study as information service rejection behaviour (ISRB); v) there was general perception by the paediatricians that access to, and use of medical information supports patient care and achievement of better treatment outcomes. This perception instilled a sense of value for information use, demonstrated through the clinicians' dedication to the self-provision of information resources; vi) a dearth of medical resources germane to the contextual management of illnesses led to inadequate clinician knowledge in a good number of cases. A new model of information behaviour entitled 'the knowledge production model of the paediatricians' information behaviour has been developed from the findings of this study, thereby extending existing scholarly perspectives on people's information behaviour. The Kpro model enunciates the concept of 'knowledge-based information behaviour' (KIB) which was exhibited by the paediatricians. The study recommends that i) the information literacy skills training (ILST) model developed from the findings, be used as a practical tool for inculcating information literacy to the paediatricians at the level of residency training; ii) the hospital management/librarians prioritise the improvement of information resources, services and infrastructure e.g. reliable internet service, e-library at wards and consulting rooms, and clinical librarian services, to enhance good information practices among the clinicians; iii) retraining of the hospital librarians for increased service delivery effectiveness; iv) increased local research through the establishment of Journal Clubs by the paediatricians to enhance local publishing of medical literature.

Introdução: As doenças crônicas não transmissíveis (DCNT) são o problema de saúde pública mais frequente entre adultos e idosos e seu impacto na morbimortalidade em países em desenvolvimento é elevado. Médicos de atenção primária desempenham um papel importante na promoção de comportamentos saudáveis à população, no entanto, estudos apontam que esses profissionais encontram dificuldades para aconselhar os pacientes no manejo de mudança no estilo de vida baseado em evidências. Objetivo: Essa dissertação tem como objetivo validar um instrumento de avaliação de conhecimentos de fatores de riscos modificáveis no controle de DCNT para médicos brasileiros de atenção primária. Métodos: Foi realizado um estudo transversal de validação com profissionais médicos de atenção primária dos serviços públicos de municípios de todas as regiões do Brasil. Os dados foram coletados no período de setembro de 2014 a novembro de 2014. O instrumento foi previamente traduzido e culturalmente adaptado. O instrumento foi respondido por 848 médicos. Também foi identificado o perfil demográfico e de formação dos participantes. Para descrever as propriedades pscicométricas do instrumento foi utilizado a teoria clássica dos testes. Análise fatorial exploratória e teste Mann-Whitney foram utilizados para estudo de validação e de reprodutibilidade, respectivamente. Resultados: Em geral, os profissionais mostraram ser confiantes para aconselhar os pacientes e avaliaram de forma bastante positiva seu conhecimento sobre os fatores de risco para DCNT. Observou-se um escore médio de conhecimento de 53,5 acertos (±5,5), de um total de 74. Médicos com especialização em saúde da família tiveram um escore maior quando comparado aos que não possuíam essa titulação. Na análise fatorial exploratória foram retidos 16 fatores, que convergiram para definição de cinco dimensões: sódio no manejo da hipertensão, carboidratos no manejo do diabetes e obesidade, efeitos preventivos no desenvolvimento de DCNT, alimentos Saudáveis e fonte de gorduras e desenvolvimento de DCNT. As dimensões identificadas convergiram com o quadro conceitual da autora do instrumento. A consistência interna do instrumento obteve valor adequado, mas a estabilidade no tempo observou-se apenas para algumas dimensões: carboidratos no manejo do diabetes e obesidade e fonte de gorduras e desenvolvimento de DCNT. Conclusão: Foi possível concluir que este instrumento é uma ferramenta útil para identificar profissionais que necessitam apoio para orientar pacientes com DCNT sobre modificação de estilo de vida e também pode ser aplicado para avaliar intervenções de educação direcionadas a estes profissionais. / Introduction: The chronic noncommunicable diseases (NCDs) are a frequent public health problem among adults and elderly and high-impact on morbidity and mortality. It is essential that primary care services are organized and able to undertake appropriate interventions for the management of modifiable risk factors for these diseases. In this sense, primary care physicians play an important role in promoting healthy behaviors. However, these professionals find it difficult to counsel patients. Objective: This thesis aims to validate an instrument of evaluation of knowledge of modifiable risk factors in the control of NCDs for Brazilian primary care physicians. Methods: A cross-sectional study with physicians of primary care public services of municipalities in all regions of Brazil. Data were collected from September 2014 to November 2014. The instrument was previously translated and culturally adapted. To assess the validity and reliability, the instrument was answered by 848 physicians. It was also identified the demographic profile and training of the participants. To describe the psychometric properties of the instrument was used the classical test theory. Results: In general, professionals proved to be confident to advise patients and evaluated very positively their knowledge of the risk factors for NCDs. There was an average knowledge score of 53.5 correct answers (± 5.5), a total of 74. Doctors with specialization in family health had higher scores compared to those who did not have this degree. Exploratory factor analysis were retained 16 factors that converged to define five dimensions: sodium in the management of hypertension, carbohydrates in managing diabetes and obesity, preventive effects on the development of NCDs, Healthy foods and fat source and development of NCDs. The dimensions identified converged with the conceptual framework of the instrument author. The internal consistency of the instrument obtained proper value, but the stability over time was observed only for some dimensions: carbohydrates in managing diabetes and obesity and fat source and development of NCDs. Conclusion: It was concluded that this instrument is a useful tool to identify which professionals need support to guide patients with NCDs on lifestyle modification and can also be applied to evaluate educational interventions directed to these professionals. / Teleducação

Law / LL.M.

Submitted by Gilvan Almeida (gilvan.almeida@icict.fiocruz.br) on 2016-09-26T14:06:08Z No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 203.pdf: 1965470 bytes, checksum: 6bfe6cfcb88f82b1c3d90e545a26aaee (MD5) / Approved for entry into archive by Barata Manoel (msbarata@coc.fiocruz.br) on 2016-10-04T19:29:12Z (GMT) No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 203.pdf: 1965470 bytes, checksum: 6bfe6cfcb88f82b1c3d90e545a26aaee (MD5) / Made available in DSpace on 2016-10-04T19:29:12Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 203.pdf: 1965470 bytes, checksum: 6bfe6cfcb88f82b1c3d90e545a26aaee (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Casa de Oswaldo Cruz. Rio de Janeiro, RJ, Brasil. / Eduardo Estrella Aguirre (Tabacundo, 1941 Quito, 1996) foi um médico psiquiatra que incursionou no estudo do passado científico equatoriano através da história social da ciência, tendo formado parte da Sociedade Latino-Americana de História das Ciências e da Tecnologia desde 1984. O presente trabalho estuda sua trajetória intelectual e profissional no período compreendido entre 1959 e 1987, com o objetivo de compreender as condições socioculturais locais e internacionais do surgimento da segunda geração latino-americana de historiadores das ciências na década de 1980. O período de 1959 a 1987 da vida de Estrella contempla sua educação universitária em Quito, sua especialização médica na Espanha, sua profissionalização em órgãos públicos equatorianos de educação e serviços médicos, e sua transformação em historiador das ciências através de pós-graduações em história em Quito e em Madrid. As fontes primárias utilizadas foram sua obra intelectual no período apontado e a documentação de seu arquivo pessoal e dos órgãos em que estudou e trabalhou. A análise de sua trajetória permite-nos concluir que as tarefas acadêmicas de Estrella sempre estiveram estreitamente vinculadas aos fatores culturais, sociais e históricos da medicina no Equador. Por isso, seu interesse pela história das ciências foi consequência da importância que deu aos aspectos socioculturais relacionados com a medicina. / Eduardo Estrella Aguirre (Tabacundo, 1941 – Quito, 1996) was a psychiatrist who studied Ecuador’s scientific past under the social history of science context and founded part of the Latin American Society of History of Science and Technology in 1984. This paper studies his intellectual and professional career in the period between 1959 and 1987 in order to understand local and international cultural conditions of the emergence of the second generation of historians of Latin American science in the 1980s. The period from 1959 to 1987 of Estrella’s life provides an insight into his university education in Quito, medical specialization in Spain, professional career in Ecuadorian public institutions for education and medical services, and the development to historian of science through postgraduate studies in history from Quito and Madrid. The primary sources used were his intellectual work in the indicated period and documents from his personal archive and from entities in which he studied and worked. The analysis of his career allows us to conclude that Estrella’s academic work was always closely linked to the cultural, social and historical factors of medicine in Ecuador. Therefore, his interest in the history of science was a consequence of the importance he gave to the sociocultural aspects of medicine.

Entre 1972 et 1984, des non médecins du Mouvement pour la liberté de l’avortement et de la contraception ont pratiqué des avortements hors de la sphère médicale, dans le même temps que la professionnalisation de l’acte s’accélérait. Au moyen d’une ethnographie historique combinant un large corpus d’entretiens rétrospectifs et d’archives, la thèse s’intéresse à la politisation de l’avortement et éclaire sa constitution en problème de santé publique. Cette étude localisée de groupes MLAC ayant revendiqué une pratique propose une analyse incarnée à la fois de l’instauration du monopole médical sur l’avortement et des résistances à ce processus. Dans le temps de la lutte, médecins comme profanes participent à l’acclimatation et à l’adaptation en France de la méthode par aspiration. Il est remarquable que, des collaborations et conflits découlant de ces interactions, l’autorisation d’accès aux savoirs élaborés en commun ait échu aux seul⋅es détenteurs/rices de titres médicaux.La thèse constitue ensuite en objet d’étude le cas exceptionnel des MLAC qui ont maintenu une pratique profane après le vote de la loi sur l’IVG et renouvelé leur radicalité malgré la phase d’institutionnalisation dans laquelle sont entrés les acquis féministes. En remettant en cause tant la spécialisation des actes corporels que la domination patriarcale des corps féminins, ces « dissidentes » affirment progressivement l’orientation féministe de leur action. Au même moment, l’infusion du self-help en France soutient la réorientation de leur registre de revendication en enrichissant leur armature idéologique. La façon dont elles se l’approprient, alliée à la politisation de l’existence quotidienne des femmes et au développement de nouvelles pratiques de soins – les accouchements notamment –, invitent à considérer les MLAC dissidents comme une mobilisation de santé. / From 1972 to 1984, unskilled members (i.e. without a medical degree) of the Movement for the Liberation of Abortion and Birth Control aborted women outside medical spheres, whereas the practice was getting more and more professional. Thanks to a historical ethnography combining a wide corpus of retrospective interviews and archives, the thesis focuses on the politicization of abortion and highlights its constitution as a matter of public health. This survey of some local committees of the MLAC which claimed this practice puts forward a deep analysis of both the establishment of the medical monopoly of abortion and protests against this process. During the fight, physicians and unskilled practitioners take part in the introduction and adaptation in France of the aspiration method. We can notice that from collaborations and conflicts resulting from these interactions, the authorized access to the technical know-how learnt in common benefited only fully qualified physicians.The thesis then looks into the outstanding subject of the MLACs which maintained the practice outside medical structures after a bill was passed in favour of IVG – i.e voluntary termination of pregnancy – and resumed their radical militancy in spite of the institutionalization step including feminist achievements. By questioning both the specialization of practices on bodies and the patriarchal domination of female bodies, these « dissidents » gradually assert the feminist orientation of their action. At the same time, the spreading of self help in France supports the reorientation of their demands and enriches their ideological basis. The way they appropriate new orientations, plus the politization of women’s daily life and the development of new caring methods – notably deliveries (childbirths) – urge us to consider dissident MLACs as a mobilization for health.

Introdução: As doenças crônicas não transmissíveis (DCNT) são o problema de saúde pública mais frequente entre adultos e idosos e seu impacto na morbimortalidade em países em desenvolvimento é elevado. Médicos de atenção primária desempenham um papel importante na promoção de comportamentos saudáveis à população, no entanto, estudos apontam que esses profissionais encontram dificuldades para aconselhar os pacientes no manejo de mudança no estilo de vida baseado em evidências. Objetivo: Essa dissertação tem como objetivo validar um instrumento de avaliação de conhecimentos de fatores de riscos modificáveis no controle de DCNT para médicos brasileiros de atenção primária. Métodos: Foi realizado um estudo transversal de validação com profissionais médicos de atenção primária dos serviços públicos de municípios de todas as regiões do Brasil. Os dados foram coletados no período de setembro de 2014 a novembro de 2014. O instrumento foi previamente traduzido e culturalmente adaptado. O instrumento foi respondido por 848 médicos. Também foi identificado o perfil demográfico e de formação dos participantes. Para descrever as propriedades pscicométricas do instrumento foi utilizado a teoria clássica dos testes. Análise fatorial exploratória e teste Mann-Whitney foram utilizados para estudo de validação e de reprodutibilidade, respectivamente. Resultados: Em geral, os profissionais mostraram ser confiantes para aconselhar os pacientes e avaliaram de forma bastante positiva seu conhecimento sobre os fatores de risco para DCNT. Observou-se um escore médio de conhecimento de 53,5 acertos (±5,5), de um total de 74. Médicos com especialização em saúde da família tiveram um escore maior quando comparado aos que não possuíam essa titulação. Na análise fatorial exploratória foram retidos 16 fatores, que convergiram para definição de cinco dimensões: sódio no manejo da hipertensão, carboidratos no manejo do diabetes e obesidade, efeitos preventivos no desenvolvimento de DCNT, alimentos Saudáveis e fonte de gorduras e desenvolvimento de DCNT. As dimensões identificadas convergiram com o quadro conceitual da autora do instrumento. A consistência interna do instrumento obteve valor adequado, mas a estabilidade no tempo observou-se apenas para algumas dimensões: carboidratos no manejo do diabetes e obesidade e fonte de gorduras e desenvolvimento de DCNT. Conclusão: Foi possível concluir que este instrumento é uma ferramenta útil para identificar profissionais que necessitam apoio para orientar pacientes com DCNT sobre modificação de estilo de vida e também pode ser aplicado para avaliar intervenções de educação direcionadas a estes profissionais. / Introduction: The chronic noncommunicable diseases (NCDs) are a frequent public health problem among adults and elderly and high-impact on morbidity and mortality. It is essential that primary care services are organized and able to undertake appropriate interventions for the management of modifiable risk factors for these diseases. In this sense, primary care physicians play an important role in promoting healthy behaviors. However, these professionals find it difficult to counsel patients. Objective: This thesis aims to validate an instrument of evaluation of knowledge of modifiable risk factors in the control of NCDs for Brazilian primary care physicians. Methods: A cross-sectional study with physicians of primary care public services of municipalities in all regions of Brazil. Data were collected from September 2014 to November 2014. The instrument was previously translated and culturally adapted. To assess the validity and reliability, the instrument was answered by 848 physicians. It was also identified the demographic profile and training of the participants. To describe the psychometric properties of the instrument was used the classical test theory. Results: In general, professionals proved to be confident to advise patients and evaluated very positively their knowledge of the risk factors for NCDs. There was an average knowledge score of 53.5 correct answers (± 5.5), a total of 74. Doctors with specialization in family health had higher scores compared to those who did not have this degree. Exploratory factor analysis were retained 16 factors that converged to define five dimensions: sodium in the management of hypertension, carbohydrates in managing diabetes and obesity, preventive effects on the development of NCDs, Healthy foods and fat source and development of NCDs. The dimensions identified converged with the conceptual framework of the instrument author. The internal consistency of the instrument obtained proper value, but the stability over time was observed only for some dimensions: carbohydrates in managing diabetes and obesity and fat source and development of NCDs. Conclusion: It was concluded that this instrument is a useful tool to identify which professionals need support to guide patients with NCDs on lifestyle modification and can also be applied to evaluate educational interventions directed to these professionals. / Teleducação

Introdução: As doenças crônicas não transmissíveis (DCNT) são o problema de saúde pública mais frequente entre adultos e idosos e seu impacto na morbimortalidade em países em desenvolvimento é elevado. Médicos de atenção primária desempenham um papel importante na promoção de comportamentos saudáveis à população, no entanto, estudos apontam que esses profissionais encontram dificuldades para aconselhar os pacientes no manejo de mudança no estilo de vida baseado em evidências. Objetivo: Essa dissertação tem como objetivo validar um instrumento de avaliação de conhecimentos de fatores de riscos modificáveis no controle de DCNT para médicos brasileiros de atenção primária. Métodos: Foi realizado um estudo transversal de validação com profissionais médicos de atenção primária dos serviços públicos de municípios de todas as regiões do Brasil. Os dados foram coletados no período de setembro de 2014 a novembro de 2014. O instrumento foi previamente traduzido e culturalmente adaptado. O instrumento foi respondido por 848 médicos. Também foi identificado o perfil demográfico e de formação dos participantes. Para descrever as propriedades pscicométricas do instrumento foi utilizado a teoria clássica dos testes. Análise fatorial exploratória e teste Mann-Whitney foram utilizados para estudo de validação e de reprodutibilidade, respectivamente. Resultados: Em geral, os profissionais mostraram ser confiantes para aconselhar os pacientes e avaliaram de forma bastante positiva seu conhecimento sobre os fatores de risco para DCNT. Observou-se um escore médio de conhecimento de 53,5 acertos (±5,5), de um total de 74. Médicos com especialização em saúde da família tiveram um escore maior quando comparado aos que não possuíam essa titulação. Na análise fatorial exploratória foram retidos 16 fatores, que convergiram para definição de cinco dimensões: sódio no manejo da hipertensão, carboidratos no manejo do diabetes e obesidade, efeitos preventivos no desenvolvimento de DCNT, alimentos Saudáveis e fonte de gorduras e desenvolvimento de DCNT. As dimensões identificadas convergiram com o quadro conceitual da autora do instrumento. A consistência interna do instrumento obteve valor adequado, mas a estabilidade no tempo observou-se apenas para algumas dimensões: carboidratos no manejo do diabetes e obesidade e fonte de gorduras e desenvolvimento de DCNT. Conclusão: Foi possível concluir que este instrumento é uma ferramenta útil para identificar profissionais que necessitam apoio para orientar pacientes com DCNT sobre modificação de estilo de vida e também pode ser aplicado para avaliar intervenções de educação direcionadas a estes profissionais. / Introduction: The chronic noncommunicable diseases (NCDs) are a frequent public health problem among adults and elderly and high-impact on morbidity and mortality. It is essential that primary care services are organized and able to undertake appropriate interventions for the management of modifiable risk factors for these diseases. In this sense, primary care physicians play an important role in promoting healthy behaviors. However, these professionals find it difficult to counsel patients. Objective: This thesis aims to validate an instrument of evaluation of knowledge of modifiable risk factors in the control of NCDs for Brazilian primary care physicians. Methods: A cross-sectional study with physicians of primary care public services of municipalities in all regions of Brazil. Data were collected from September 2014 to November 2014. The instrument was previously translated and culturally adapted. To assess the validity and reliability, the instrument was answered by 848 physicians. It was also identified the demographic profile and training of the participants. To describe the psychometric properties of the instrument was used the classical test theory. Results: In general, professionals proved to be confident to advise patients and evaluated very positively their knowledge of the risk factors for NCDs. There was an average knowledge score of 53.5 correct answers (± 5.5), a total of 74. Doctors with specialization in family health had higher scores compared to those who did not have this degree. Exploratory factor analysis were retained 16 factors that converged to define five dimensions: sodium in the management of hypertension, carbohydrates in managing diabetes and obesity, preventive effects on the development of NCDs, Healthy foods and fat source and development of NCDs. The dimensions identified converged with the conceptual framework of the instrument author. The internal consistency of the instrument obtained proper value, but the stability over time was observed only for some dimensions: carbohydrates in managing diabetes and obesity and fat source and development of NCDs. Conclusion: It was concluded that this instrument is a useful tool to identify which professionals need support to guide patients with NCDs on lifestyle modification and can also be applied to evaluate educational interventions directed to these professionals. / Teleducação

As mudanças registradas nas últimas décadas no universo do trabalho afetaram distintas categorias de trabalhadores. Com a categoria médica não foi diferente. O grande desenvolvimento tecnológico, voltado para a medicina e para a indústria farmacêutica, acrescido do crescimento das empresas compradoras de serviços médicos, compõe um novo cenário que altera o processo, a organização e as relações trabalhistas desta categoria profissional, o que repercute nas condições de trabalho e na saúde dos trabalhadores. Tomando como referência este quadro de mudanças, esta pesquisa objetivou investigar as relações entre o trabalho e a saúde de médicos do Sistema Único de Saúde do município de Jaguariúna (SP). A pesquisa de caráter qualitativo teve como principal técnica de coleta de dados a entrevista (individuais abertas e baseadas no método de instrução ao sósia). Ao todo foram entrevistados quinze (15) médicos e dois (2) gestores da Secretaria de Saúde do município. Os dados obtidos revelaram que aqueles profissionais estão submetidos a um processo de trabalho, baseado no modelo de medicina tecnológica, que lhes tira a autonomia para gerir o próprio trabalho, os sobrecarregam e os expõem a situações de muita pressão. Tal condição faz com que os médicos não se sintam realizados e nem, algumas vezes, se reconheçam no próprio trabalho, além dos relatos de ausência de apoio dos colegas para execução das tarefas e reconhecimento por parte das chefias e pacientes, o que representa um empobrecimento da identidade profissional e a vivência de uma atividade de trabalho contrariada. De acordo com os depoimentos, as condições e a organização do trabalho, de maneira geral, interferem nas condições de vida e saúde daqueles médicos. Hipertensão e transtornos mentais comuns, sob a forma de stress, ansiedade e depressão foram os principais problemas de saúde que os entrevistados relataram sofrer, porém nem todos os identificaram como relacionados ao trabalho. / The last decades had remarkable changes recorded in the world of work that affected different categories of workers. It wasnt different with the medical profession. The great technological development, focusing on medicine and the pharmaceutical industry, added to the growth of the purchasing companies of medical services, makes up a new scenario that changes the process, the organization and labor relations of the professionals in this category, which brings repercussions for the work conditions and workers health. Taking this frame changes as a reference, this study aimed to investigate the physicians from the Sistema Único de Saúde (National Health System) in Jaguariúna city regarding to the relations between doctors work and health. The qualitative research was performed with interviews in which the data collection was the main technique (individually and self-confrontation). Altogether were interviewed fifteen (15) physicians and two (2) administrators of the Sistema Único de Saúde (National Health System) of the mentioned city. The obtained data revealed that those professionals are submitted to a process of work based on the model of medical technology, which takes away their autonomy to manage their own work, burdens and exposes them to high pressure situations. This condition makes the doctors feel the lack of accomplishment and in this case they can even reach the point of do not recognize themselves in their own work, a part of the reports showing the lack of support from the workmates to execute daily tasks and insufficient recognition from managers and patients, which represents an impoverishment of their professional identity and the experience of a contradictory work activity. According to testimony, the work conditions and organization in general, affect the doctors life and health conditions. Hypertension and common mental disorders, expressed mainly in as stress, anxiety and depression were the main health problems that interviewed reported suffering, but not all identified them related to work.

O presente trabalho objetivou a apreensão dos significados e concepções acerca do adoecimento pelas LER/DORT, para médicos peritos do INSS/SP e portadores de LER/DORT do CEREST/SP. Para tanto, foi empregada metodologia qualitativa, utilizando-se como instrumento de coleta de dados a entrevista em profundidade, com roteiros distintos para médicos peritos e portadores de LER/DORT. Foram entrevistados três médicos peritos, todos do sexo masculino, com idades entre 50 e 65 anos e mais de 10 anos de experiência em perícias médicas e, no outro pólo da investigação, participaram do estudo seis portadores de LER/DORT, pacientes do serviço de atendimento ambulatorial do CEREST/SP, sendo cinco do sexo feminino e um do sexo masculino, com idades entre 35 e 55 anos, todos empregados no setor de serviços e em afastamento pelo INSS. Ao material coletado foi aplicada análise de conteúdo temática da qual foram extraídos três eixos temáticos mais abrangentes: os sujeitos de pesquisa, o trabalho e a relação médico-paciente em contexto de perícia médica. Foi possível apreender que a relação médico-paciente que se estabelece entre peritos e portadores de LER/DORT é peculiar já que, a perícia consiste em ambiente de consulta médica permeado pelo julgamento da lei previdenciária. Nesse contexto, ocorre o embate entre portadores de LER/DORT, que levam ao momento da perícia a expectativa do atendimento direcionado à assistência e do reconhecimento de sua condição, e médicos peritos, cuja atuação está direcionada à determinação da capacidade para o trabalho e limitada por normas institucionais, fator de tolhimento ao exercício de sua autonomia profissional. / The present work has aimed at the comprehension of meanings and conceptions concerning RSI illnesses to INSS/SP medical examiners and RSI patients from CEREST/SP. In order to achieve that, the qualitative methodology was chosen making use of thorough questioning as an instrument of data collection, having distinct scripts to medical examiners and RSI patients. Three medical examiners were interviewed, all male, ranging from 50 to 65 years old, having at least 10 years of experience as professionals in the area. On the other side of the investigation, six patients with RSI from the ambulatory care CEREST/SP were interviewed, 5 female and 1 male, ranging from 35 to 55 years old, all employees to the service sector on leave of absence by the INSS. Thematic content analysis was applied to the collected material, from which three main thematic axes were extracted: the subjects to this study, the work and the doctor-patient relation regarding medical examination. It has been possible to comprehend that the relation doctor-patient established among examiners and patients with RSI is peculiar, since the examination takes place in a doctor\'s office environment permeated by the judgment of the social security law. Within this context, there is a hassle among RSI patients, who take to the moment of their examination their apprehension directed to the assistance and recognition of their condition, and medical examiners, whose expertise is directed to the establishment of the work capability limited by institutional rules, what is a restricting factor in the exercise of their professional autonomy.