Uterine Fibroids, medically termed uterine leiomyoma, are benign tumors of smooth muscle cells that grow in the uterus. While they are the most common pelvic neoplasm in women and fewer than 1 percent of fibroids develop into cancer, uterine fibroids can cause infertility, adverse pregnancy outcomes, and greatly affect one’s quality of life. Black women have been disproportionately affected by fibroids; when compared to white women, Black women are: 2-3 times more likely to have fibroids, diagnosed at a younger age, more likely to have 7 or more fibroids, more likely to have more severe and more troublesome symptoms (anemia, severe pelvic pain, constipation, and stomach aches), and have twice as many hysterectomies due to fibroids. Black women’s disproportionate affliction with uterine fibroids is particularly concerning given the historical medical injustices associated with Black women’s bodies and reproductive rights from slavery to present day. By placing Black women at the center of analysis and using a Black feminist epistemological framework, this study aims to make a unique contribution to medical sociology as well as literature on the theoretical and practical management of sickness and wellness among Black women in the United States. Using qualitative interviews and grounded theory methodology, the study examined how Black women frame the condition of having uterine fibroids. Specifically, the study investigated a) how Black women conceptualize having fibroids, b) how Black women’s conceptualizations of fibroids affect their feelings about selves or their lifestyles, c) the mechanisms, if any, by which Black women deal with uterine fibroids, d) how their multiple race, class, and gender identities affect their illness experiences and types of treatment that they seek, and e) how conventional and complementary/alternative medicine shapes Black women’s experiences with fibroids. Conceptualizations about fibroids are rooted in the race-gendered histories of Black women and the unique stressors that they face. Through interactions with doctors and among peers, Black women resist the unbearable burden of uterine fibroids through various coping strategies, but generally “keep it moving”. They avoid invasive surgeries through patient agency by being advocates for their medical treatment, self-researching, dialoguing with others, and directing doctor-patient interactions.

The recent expansion of general practitioner (GP) out of hours cooperatives indicates that many British GPs see this as the solution to managing out of hours work, particularly the 'problem' of 'inappropriate' demand. This thesis investigates the highly contentious subject of 'inappropriateness' of demand for out of hours GP services for children under five, and develops a methodology that allows for a reconceptualisation of the issues involved based on the beliefs, assumptions and practices of all those concerned, rather than locating the 'problem' within the province of parents alone, or within the doctor-patient relationship as a bounded system. Using a predominantly sociological and anthropological conceptual framework, the thesis draws on a synthesis of views and practice, bringing those of professionals and parents together with fieldwork observations based in the primary care centre setting. It suggests that contrary to talk about management of the 'problem' in technical, bureaucratic and medical terms, this becomes a moral issue in practice. Scientific or organisational imperatives disguise largely moral proscriptions and examples illustrate ways in which moral and emotional dimensions embedded within these social relations can conflict with particular forms of rationality. The analysis shows how organisational initiatives that fail to take account of such moral frameworks can produce unexpected and unintended consequences. The thesis illustrates the value of what is described as a dialogic process, taking account of the fluidity between voices, layers of time and space, and interchange between researcher, participants, and future audiences. The play of these issues in the rapid and extensive growth of cooperatives is discussed in the wider context of the rhetoric of consumerism and shifts in interprofessional practices and relationships. Negotiation of 'appropriate' supply of and demand for out of hours services has had a major impact on government initiatives for primary care as a whole. Thus key elements in the formation of cooperatives, originally targeted at a more narrow conceptualisation of problems, can be seen as expressing a deeper impetus for change, and serving as vehicles for more fundamental and rapid development.

This study examines the way people use online resources within their personal healthcare practices to better understand how individuals manage their health issues in the age of the Internet. It specifically addresses the extent to which the Internet is used as an information database and associated patterns of use, whether the Internet represents a source of support or enables a supportive encounter and the implications of using the Internet as part of the health management across relationships with medical professionals and oneself. Using a sequential mixed methods design, the data was gathered within a larger multidisciplinary research project conducted in East York, Ontario. An initial quantitative analysis of 350 surveys describes Internet usage. The qualitative analysis of the 86 follow-up interviews of people recounting their personal health management processes demonstrated the importance of social networks, subjective health status and Internet user-style. The facile ability to engage with health information is transforming definitions and experiences of health and relationships with medical professionals. Examining medical encounters mindful of the aspects of trust, power, knowledge and privilege reveals an evolution to the doctor-patient relationship brought about by both information and personal empowerment. Using the Internet reinforces primary relationships and points to the development of new relationships that are sought at moments of meaningful life events or circumstances. New types of connections are being built across the Internet based on shared experiences, health concerns and health identities. Applying Actor Network Theory furthers an understanding of how search engines and online resources can emerge as actors in health information seeking and health management processes. Internet use is now a part of everyday life and is no longer limited to affluent early adopters as the gaps between those with access diminish in urban Canada. While its use is becoming intrinsically linked to health management it is not a panacea for improving health outcomes. As the populations’ collective health knowledge increases, so does the presumption that health management is a personal imperative. This notion that the achievement of good health is an individual responsibility or the theory of Healthism, frames the interpretation of the large percentage of the sample indicating they are striving to become healthier. Social workers need to acknowledge the place of the Internet within its practice and to balance the emphasis on individualized health management with the perspective that health outcomes reflect community mores. It is important for social workers to treat the Internet as a medium of relationships and for social workers to become knowledgeable about what these connections can provide in terms of support and information and what the limitations and risks of these relationships can be.

This study examines the way people use online resources within their personal healthcare practices to better understand how individuals manage their health issues in the age of the Internet. It specifically addresses the extent to which the Internet is used as an information database and associated patterns of use, whether the Internet represents a source of support or enables a supportive encounter and the implications of using the Internet as part of the health management across relationships with medical professionals and oneself. Using a sequential mixed methods design, the data was gathered within a larger multidisciplinary research project conducted in East York, Ontario. An initial quantitative analysis of 350 surveys describes Internet usage. The qualitative analysis of the 86 follow-up interviews of people recounting their personal health management processes demonstrated the importance of social networks, subjective health status and Internet user-style. The facile ability to engage with health information is transforming definitions and experiences of health and relationships with medical professionals. Examining medical encounters mindful of the aspects of trust, power, knowledge and privilege reveals an evolution to the doctor-patient relationship brought about by both information and personal empowerment. Using the Internet reinforces primary relationships and points to the development of new relationships that are sought at moments of meaningful life events or circumstances. New types of connections are being built across the Internet based on shared experiences, health concerns and health identities. Applying Actor Network Theory furthers an understanding of how search engines and online resources can emerge as actors in health information seeking and health management processes. Internet use is now a part of everyday life and is no longer limited to affluent early adopters as the gaps between those with access diminish in urban Canada. While its use is becoming intrinsically linked to health management it is not a panacea for improving health outcomes. As the populations’ collective health knowledge increases, so does the presumption that health management is a personal imperative. This notion that the achievement of good health is an individual responsibility or the theory of Healthism, frames the interpretation of the large percentage of the sample indicating they are striving to become healthier. Social workers need to acknowledge the place of the Internet within its practice and to balance the emphasis on individualized health management with the perspective that health outcomes reflect community mores. It is important for social workers to treat the Internet as a medium of relationships and for social workers to become knowledgeable about what these connections can provide in terms of support and information and what the limitations and risks of these relationships can be.

This study explores the experiences of General Practitioners (GPs) and patients in the management of type 2 diabetes in contemporary Australia. I focus on the way the socioeconomic position of patients is a factor in that experience as my underlying interest is in exploring how health inequalities are understood, approached and handled in general practice. The study is thus a practical and grounded exploration of a widely debated theoretical issue in the study of social life, namely the relationship between the micro day-to-day interactions and events in the lives of individuals and the broad macro structure of society and the position of the individual within that. There is now wide acceptance and evidence that people’s social and economic circumstances impact on their health status and their experiences in the health system. However, there is considerable debate about the role played by primary medical care. Nevertheless, better theoretical understanding of the importance of psychosocial processes in generating social inequalities in health suggests medical care may well be important, as such processes are crucial in the care of chronic illnesses such as diabetes which are now such a large part of general practice work. I approach this study through an exploration of patient centred clinical practice. Patient centredness is a pragmatic, idealised prescriptive framework for clinical practice, particularly general practice. Patient centredness developed in part in response to critiques of biomedicine, and is premised on a notion of a more equal relationship between GP and patient, and one that places importance on the context of patients’ lives. It contains an implicit promise that it will help GP and patient engage with and confront social disadvantage.

Working at the intersection of medical sociology and the psychology of health, language and communication, in this PhD I use thematic analysis (TA) and conversation analysis (CA) to provide an insight into various aspects of doctor-patient communication that may be considered, or are constructed as, challenging and/or delicate for either the patient, doctor or both at a Gender Identity Clinic (GIC) in the UK. This project involves the secondary analysis of two existing data-sets: (i) 21 recorded telephone interviews between my PhD supervisor and transsexual patients who attended the GIC; (ii) 156 transcribed audio-recordings and 38 video-recordings (total = 194) of psychiatrist-patient consultations in the GIC. The first original research paper uses TA to investigate the views and experiences of transsexual patients regarding their communication with psychiatrists at the GIC. An important finding was that patients actually appreciated being challenged in this setting, subsequently the implications of this are considered with regards to the achievability and desirability of patient centred communication. The second research paper uses CA to consider how patients overtly challenge psychiatrists in the GIC in ways that have not been shown in conversation analytic research on medical interactions to date. Analysis of the data corpus revealed that there were three common ways in which patients challenged psychiatrists at the GIC, which are (1) by problematising their questions; (2) by disagreeing with statements that are made regarding their treatment; (3) and by initiating complaints. The findings of this study are considered in relation to the implications that they have for clinicians and for the persistence and desirability of asymmetry in clinical interaction in light of the current debates surrounding the concept of patient-centeredness. The final research paper also uses CA, in this instance to study how the topic of weight, which is often constructed and orientated towards as delicate in talk-in-interaction, is occasioned and discussed by psychiatrists and patients at the GIC. Whereas previous CA research on this topic has focused on how this is constructed by speakers as a moral issue, this paper is concerned with focusing on how psychiatrists (1) establish with patients that their weight is an issue, (2) encourage patients to lose weight by informing them that this is their responsibility and (3) offer advice on the behavior changes associated with weight loss. The results of this paper are discussed with regards to the implications that they have for clinicians who discuss the potentially delicate topic of weight with patients in a number of different settings. This project contributes towards the growing debates regarding the achievability and desirability of patient centred communication and the persistence of asymmetry in clinical interaction. It also contributes to medical conversation analytic literature to date on asymmetry and talk about weight in clinical interactions.

O desenvolvimento de habilidades de comunicação em médicos tem sido apontado como uma necessidade e uma competência fundamental para o exercício da medicina. A empatia é uma habilidade interpessoal que pode ser descrita como a capacidade de compreender o ponto de vista e os sentimentos de uma outra pessoa sem julgá-los e de comunicar esse entendimento de modo que a pessoa que fala se sinta verdadeiramente compreendida pela pessoa que ouve. Essa habilidade promove um senso de validação na pessoa que fala, especialmente em situações de conflito, reduzindo a probabilidade de rompimento e fortalecendo os vínculos interpessoais. A empatia dos médicos é atribuída à sua educação pessoal, sendo raro o desenvolvimento dessa competência social durante o curso de formação médica. O desconhecimento sobre essa habilidade e sua função no exercício profissional motivou a realização deste estudo sobre a empatia em médicos que atuam em diferentes contextos de atenção à saúde no município do Rio de Janeiro. Participaram desta pesquisa 75 profissionais, dos quais 25 atuavam no nível da Atenção Primária, composto por equipes de saúde da família e por centros municipais de saúde; 12 pertenciam a unidades mais especializadas que correspondem ao nível de Atenção Secundária e 38 trabalhavam nos ambulatórios de hospitais universitários da Atenção Terciária. Foi aplicado o Inventário de Empatia (I.E.), que avalia os quatro fatores que compõem a habilidade empática: 1) Tomada de Perspectiva: capacidade de compreender o ponto de vista e os sentimentos da outra pessoa; 2) Flexibilidade Interpessoal: capacidade de aceitar perspectivas muito diferentes das próprias; 3) Altruísmo: capacidade de suspender temporariamente as próprias necessidades em função do outro; 4) Sensibilidade Afetiva: sentimento de compaixão e de preocupação com o outro. Os resultados mostraram que o grupo avaliado obteve médias semelhantes às apresentadas nos dados normativos do I.E. nos fatores Tomada de Perspectiva e Flexibilidade Interpessoal, enquanto superou a média no fator Altruísmo e ficou abaixo da média no fator Sensibilidade Afetiva. Esses dados indicam que a amostra de médicos avaliada possui uma capacidade mais acentuada de sacrificar suas próprias necessidades para atender ao outro, ainda que não associada necessariamente a um sentimento de compaixão equivalente. Isto pode estar relacionado com a reduzida importância dada ao aspecto emocional na formação médica. Em relação à avaliação da empatia por contexto de atenção em saúde, não foi encontrada diferença significativa entre os grupos com exceção do fator Tomada de Perspectiva. Neste componente, os médicos do Programa Saúde da Família destacaram-se significativamente do grupo de Atenção Secundária, o que parece estar relacionado com a proximidade do profissional com o contexto de vida do paciente e com a educação continuada que recebem através de treinamentos e capacitações onde são valorizadas as habilidades de comunicação desses profissionais. A partir desses resultados propõe-se que o desenvolvimento da empatia seja incluído nos cursos de formação médica e no planejamento das condições de trabalho nos diversos níveis de atenção à saúde. / The development of communication skills of physicians have been argued as a necessity and a fundamental competence for medical professional exercise. Empathy is an interpersonal ability that may be described as the capacity to comprehend another persons point of view and feelings without judging them and to communicate this comprehension in a way that the speaker feels truly understood by the listener. This ability promotes a validation sense on the speaker, especially in conflict situations, reducing the probability of breaking off and strengthening interpersonal ties. Physicians empathy is attributed to personal education, being rare the development of this social competence along the medicine graduation course. Unknowing about this ability and its function on professional exercise has motivated the realization of this study on empathy of physicians that work in different contexts of health care system in the city of Rio de Janeiro. The participants of this research were 75 physicians, who 25 worked at Primary Health Care level, composed by teams of Family Health Program and by physicians of ambulatory units; 12 belonged to more specialized units, which correspond to the Second Health Care level and 38 worked at universities hospitals of the Third Tier of Health Care. The Inventory of Empathy (I.E.) was applied, assessing the four factors that compose the empathic ability: 1) Perspective Taking: capacity of comprehending other persons point of view and feelings; 2) Interpersonal Flexibility: capacity of accepting perspectives very different from ones perspective; 3) Altruism: capacity of suspending temporary ones necessities for the other; 4) Emotional Sensibility: feeling of compassion and comprehension of the other. The results show that the assessed group has means similar to the ones presented in the normative data of the I.E. on the factors Perspective Taking and Interpersonal Flexibility while it has overtaken the mean of the factor Altruism and has undertaken the mean of the factor Emotional Sensibility. These data suggest that the physicians assessed have higher capacity of sacrificing their own necessities for attending the other, though it was not necessarily associated to an equivalent compassion feeling. This may be related to the reduced importance of emotional aspect in medical graduation. On the assessment of empathy by contexts of health attention, it was not found a significant difference between the groups, but the factor Perspective Taking. On this component, the physicians of Family Health Program have been significantly detached from the group of Second Health Care, what seems to be related to the physicians proximity of the patients life context and to the continuous education that they receive through trainings in which the communication skills of these professionals are highly valued. With these results, it is proposed that the development of empathy should be included in medical training and on the working conditions plans of all health attention levels.

Made available in DSpace on 2014-06-11T19:29:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-08-30Bitstream added on 2014-06-13T19:59:21Z : No. of bitstreams: 1 nakamoto_ps_me_botfm.pdf: 542514 bytes, checksum: b9c66c060bb33cb166412fcd8ae7a9f1 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Os hospitais de ensino têm sido estimulados a transformarem-se em um serviço que recupere a dimensão essencial do cuidado: a relação entre humanos exaltada na Política Nacional de Humanização (PNH). O estudo da humanização no processo de desenvolvimento do Sistema Único de Saúde (SUS) é relevante e sua observação em um pronto socorro de hospital universitário pertinente, pois este funciona como um centro do sistema de saúde, atraindo para si uma enorme demanda, que muitas vezes sobrecarrega os seus serviços. O Hospital das Clínicas da Faculdade de Medicina de Botucatu (HC-FMB) recebe pacientes de todos os níveis de complexidade, sendo o seu pronto socorro, uma das referências à DRS-VI para procedimentos de alta complexidade em urgência/emergência e um local de tensão e sobrecarga de atendimento. Este trabalho tem como objetivo analisar a humanização no Pronto Socorro do HC-FMB sob a perspectiva dos profissionais de saúde. Trata-se de uma pesquisa qualitativa em que foram entrevistados oito médicos, uma enfermeira e uma psicóloga, que refletem posições frente à realidade, momentos do desenvolvimento e da dinâmica social, preocupações e interesses próprios, característicos de uma pesquisa social da qual emergem contradições e conflitos do cotidiano de trabalho. A análise dos discursos permitiu a elaboração de núcleos temáticos sobre os quais são apresentados os resultados: a) Pronto Socorro e ambiência: espaço físico inadequado que compromete o atendimento e contrapõe-se ao conceito de ambiência proposto pelo Ministério de Saúde; b) Pronto Socorro e seus usuários: embora tenha havido uma reorganização da unidade que deixou de ser uma porta de entrada de livre acesso, o PS ainda atende a casos de baixa complexidade e pacientes de todos os níveis sociais, devido à carência de outros serviços de urgência na região... / The teaching hospitals have been stimulated to become a service that recovers the essential part of care: the relationship among human beings mentioned in the National Humanization Policy. The humanization study in the development process of Sistema Único de Saúde (SUS) (Brazilian public health system) is relevant and the observation of the system in a university teaching hospital pertinent, because it functions as a health care center, attracting to itself great demand, which often overloads its services. The Clinical Hospital from Botucatu Medical School (CH from BMS) receives patients of all levels of complexity, and its emergency department is a reference to the DRS-VI for high complex procedures in emergency/urgency and a place of tension and overload of care. The purpose of this paper is to analyze the humanization of the emergency department of the CH from BMS through the eyes of the health professionals. This is a quantitative research into which eight doctors, a nurse and a psychologist were interviewed; who reflect their position towards the reality, moments of development and the social dynamics, concerns and personal interests, typical of a social research from which emanate contradictions and conflicts of the daily work. The analyses of the interviews allowed the elaboration of theme centers through which the results are presented: a) Emergency Department and environment: inappropriate physical space which compromises the care and opposes the environment concept proposed by the Ministry of Health; b) Emergency Department and its users: even though there has been a reorganization of the department, which is no longer a free access entrance, the emergency department still cares for cases of low complexity and patients of all social levels, due to the lack of other emergency services in the area; c) Emergency Department, care space: the unit overload is justified... (Complete abstract click electronic access below)

Resumo: Os hospitais de ensino têm sido estimulados a transformarem-se em um serviço que recupere a dimensão essencial do cuidado: a relação entre humanos exaltada na Política Nacional de Humanização (PNH). O estudo da humanização no processo de desenvolvimento do Sistema Único de Saúde (SUS) é relevante e sua observação em um pronto socorro de hospital universitário pertinente, pois este funciona como um centro do sistema de saúde, atraindo para si uma enorme demanda, que muitas vezes sobrecarrega os seus serviços. O Hospital das Clínicas da Faculdade de Medicina de Botucatu (HC-FMB) recebe pacientes de todos os níveis de complexidade, sendo o seu pronto socorro, uma das referências à DRS-VI para procedimentos de alta complexidade em urgência/emergência e um local de tensão e sobrecarga de atendimento. Este trabalho tem como objetivo analisar a humanização no Pronto Socorro do HC-FMB sob a perspectiva dos profissionais de saúde. Trata-se de uma pesquisa qualitativa em que foram entrevistados oito médicos, uma enfermeira e uma psicóloga, que refletem posições frente à realidade, momentos do desenvolvimento e da dinâmica social, preocupações e interesses próprios, característicos de uma pesquisa social da qual emergem contradições e conflitos do cotidiano de trabalho. A análise dos discursos permitiu a elaboração de núcleos temáticos sobre os quais são apresentados os resultados: a) Pronto Socorro e ambiência: espaço físico inadequado que compromete o atendimento e contrapõe-se ao conceito de ambiência proposto pelo Ministério de Saúde; b) Pronto Socorro e seus usuários: embora tenha havido uma reorganização da unidade que deixou de ser uma porta de entrada de livre acesso, o PS ainda atende a casos de baixa complexidade e pacientes de todos os níveis sociais, devido à carência de outros serviços de urgência na região... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The teaching hospitals have been stimulated to become a service that recovers the essential part of care: the relationship among human beings mentioned in the National Humanization Policy. The humanization study in the development process of Sistema Único de Saúde (SUS) (Brazilian public health system) is relevant and the observation of the system in a university teaching hospital pertinent, because it functions as a health care center, attracting to itself great demand, which often overloads its services. The Clinical Hospital from Botucatu Medical School (CH from BMS) receives patients of all levels of complexity, and its emergency department is a reference to the DRS-VI for high complex procedures in emergency/urgency and a place of tension and overload of care. The purpose of this paper is to analyze the humanization of the emergency department of the CH from BMS through the eyes of the health professionals. This is a quantitative research into which eight doctors, a nurse and a psychologist were interviewed; who reflect their position towards the reality, moments of development and the social dynamics, concerns and personal interests, typical of a social research from which emanate contradictions and conflicts of the daily work. The analyses of the interviews allowed the elaboration of theme centers through which the results are presented: a) Emergency Department and environment: inappropriate physical space which compromises the care and opposes the environment concept proposed by the Ministry of Health; b) Emergency Department and its users: even though there has been a reorganization of the department, which is no longer a free access entrance, the emergency department still cares for cases of low complexity and patients of all social levels, due to the lack of other emergency services in the area; c) Emergency Department, care space: the unit overload is justified... (Complete abstract click electronic access below) / Orientador: Eliana Goldfarb Cyrino / Coorientador: Antonio de Pádua Pithon Cyrino / Banca: Ana Cecília Silveira Lins Sucupira / Banca: Ana Teresa de Abreu Ramos Cerqueira / Mestre

O desenvolvimento de habilidades de comunicação em médicos tem sido apontado como uma necessidade e uma competência fundamental para o exercício da medicina. A empatia é uma habilidade interpessoal que pode ser descrita como a capacidade de compreender o ponto de vista e os sentimentos de uma outra pessoa sem julgá-los e de comunicar esse entendimento de modo que a pessoa que fala se sinta verdadeiramente compreendida pela pessoa que ouve. Essa habilidade promove um senso de validação na pessoa que fala, especialmente em situações de conflito, reduzindo a probabilidade de rompimento e fortalecendo os vínculos interpessoais. A empatia dos médicos é atribuída à sua educação pessoal, sendo raro o desenvolvimento dessa competência social durante o curso de formação médica. O desconhecimento sobre essa habilidade e sua função no exercício profissional motivou a realização deste estudo sobre a empatia em médicos que atuam em diferentes contextos de atenção à saúde no município do Rio de Janeiro. Participaram desta pesquisa 75 profissionais, dos quais 25 atuavam no nível da Atenção Primária, composto por equipes de saúde da família e por centros municipais de saúde; 12 pertenciam a unidades mais especializadas que correspondem ao nível de Atenção Secundária e 38 trabalhavam nos ambulatórios de hospitais universitários da Atenção Terciária. Foi aplicado o Inventário de Empatia (I.E.), que avalia os quatro fatores que compõem a habilidade empática: 1) Tomada de Perspectiva: capacidade de compreender o ponto de vista e os sentimentos da outra pessoa; 2) Flexibilidade Interpessoal: capacidade de aceitar perspectivas muito diferentes das próprias; 3) Altruísmo: capacidade de suspender temporariamente as próprias necessidades em função do outro; 4) Sensibilidade Afetiva: sentimento de compaixão e de preocupação com o outro. Os resultados mostraram que o grupo avaliado obteve médias semelhantes às apresentadas nos dados normativos do I.E. nos fatores Tomada de Perspectiva e Flexibilidade Interpessoal, enquanto superou a média no fator Altruísmo e ficou abaixo da média no fator Sensibilidade Afetiva. Esses dados indicam que a amostra de médicos avaliada possui uma capacidade mais acentuada de sacrificar suas próprias necessidades para atender ao outro, ainda que não associada necessariamente a um sentimento de compaixão equivalente. Isto pode estar relacionado com a reduzida importância dada ao aspecto emocional na formação médica. Em relação à avaliação da empatia por contexto de atenção em saúde, não foi encontrada diferença significativa entre os grupos com exceção do fator Tomada de Perspectiva. Neste componente, os médicos do Programa Saúde da Família destacaram-se significativamente do grupo de Atenção Secundária, o que parece estar relacionado com a proximidade do profissional com o contexto de vida do paciente e com a educação continuada que recebem através de treinamentos e capacitações onde são valorizadas as habilidades de comunicação desses profissionais. A partir desses resultados propõe-se que o desenvolvimento da empatia seja incluído nos cursos de formação médica e no planejamento das condições de trabalho nos diversos níveis de atenção à saúde. / The development of communication skills of physicians have been argued as a necessity and a fundamental competence for medical professional exercise. Empathy is an interpersonal ability that may be described as the capacity to comprehend another persons point of view and feelings without judging them and to communicate this comprehension in a way that the speaker feels truly understood by the listener. This ability promotes a validation sense on the speaker, especially in conflict situations, reducing the probability of breaking off and strengthening interpersonal ties. Physicians empathy is attributed to personal education, being rare the development of this social competence along the medicine graduation course. Unknowing about this ability and its function on professional exercise has motivated the realization of this study on empathy of physicians that work in different contexts of health care system in the city of Rio de Janeiro. The participants of this research were 75 physicians, who 25 worked at Primary Health Care level, composed by teams of Family Health Program and by physicians of ambulatory units; 12 belonged to more specialized units, which correspond to the Second Health Care level and 38 worked at universities hospitals of the Third Tier of Health Care. The Inventory of Empathy (I.E.) was applied, assessing the four factors that compose the empathic ability: 1) Perspective Taking: capacity of comprehending other persons point of view and feelings; 2) Interpersonal Flexibility: capacity of accepting perspectives very different from ones perspective; 3) Altruism: capacity of suspending temporary ones necessities for the other; 4) Emotional Sensibility: feeling of compassion and comprehension of the other. The results show that the assessed group has means similar to the ones presented in the normative data of the I.E. on the factors Perspective Taking and Interpersonal Flexibility while it has overtaken the mean of the factor Altruism and has undertaken the mean of the factor Emotional Sensibility. These data suggest that the physicians assessed have higher capacity of sacrificing their own necessities for attending the other, though it was not necessarily associated to an equivalent compassion feeling. This may be related to the reduced importance of emotional aspect in medical graduation. On the assessment of empathy by contexts of health attention, it was not found a significant difference between the groups, but the factor Perspective Taking. On this component, the physicians of Family Health Program have been significantly detached from the group of Second Health Care, what seems to be related to the physicians proximity of the patients life context and to the continuous education that they receive through trainings in which the communication skills of these professionals are highly valued. With these results, it is proposed that the development of empathy should be included in medical training and on the working conditions plans of all health attention levels.