Acceso usuarios
Paola Estefanía Buedo, Pedro Silberman
La entrevista médica es el momento en que se produce y reproduce en acto la Medicina. La evidencia muestra que existen limitaciones del modelo médico dominante. Es necesaria una reconfiguración de la práctica y de las herramientas que ayuden a un abordaje eficaz y accesible. Se presenta una herramienta práctica para la historia clínica que permita recolectar información mostrando la interacción con el sujeto, con las dimensiones contextuales y que acompañan al síntoma que presenta. Se desarrolló un instrumento a manera de esquema que permite incluir información relacionada tanto con cuestiones estáticas como dinámicas de las personas. Resulta una síntesis entre el genograma, el ecomapa y la Matriz de Procesos Críticos (Breilh, 2003). El esquema plantea una nueva herramienta que debe resultar en utilidad, practicidad y posibilidad de explorar nuevas dimensiones y debe convertirse en indispensable para el abordaje integral de la persona que consulta y su familia.
The interview is the most important for the overall assessment of a person suffering from a mental illness. The data relieved in the interview between subject and physician, will be key to start the diagnostic and therapeutic process. Even knowing its usefulness, psychiatric interview often reduced to explore the symptom, taking into account the use of qualifiers manuals as the only evaluative instance. The approach to the context of a subject and their social relations, in general, is relegated to other mental health professionals. This problem situation develops under the predominantly biological paradigm of modern Medicine.
Evidence shows that there are limitations of the dominant medical model specifically in the way that the therapeutics forms are carried out. One of the hypothesis has to do with the actual diagnosis approach that presents limits when the professionals try to understand a person and its context.
The main tools used in clinical practice are the genogram and ecomap, outline shaped structures that allow placing a lot of information that is easily recovered. The genogram shows family and relations between its members in a schematic way; and ecomap details the social activities of the subject and environmentsthat are important in their daily lives. The daily use of these tools allows to evaluate some important aspects of the person, but have limitations since both are static, covering a limited set of dimensions of the patient’slife and do not allow to reveal the cultural,social and family of the subject frames. In the literature there are not tools that improve instances of the two that have been presented, only the theoretical developments.
Areconfiguration of practice and concomitantly of the tools to support effective and accessible approach is neccesary. The aim of this article is to show a practical tool thatshowsinformation about the interaction of the subject with the contextual and relational dimensions. It is then necessary a pragmatic Context-Relational Analysis (CRA), which will allow to work in the clinical setting.
CRAit explain if we understand that the context of the subject is where they conducts relations with other subjects, institutions, social groups; these relationships are conditioned in some way by this context, and in turn, this will provide conditionsfor the subject relates. The context of a subject is all that aspect concerning its active reality, that is, the culture in which he lives, political and economic conditionsin effect; everything that defines a social structure. This context is providing ideas, images and actionsthat are building and rebuilding the life of that subject. Then we have the relational aspect, the dimension in which the subject constructs along with other subjects a common space. The ways of relating are specific to a place and a time, so when times changing also do it the modalities of formation ofsubjectivity. The relevance of this aspect of the psyche is so important that mental health is conceived as learning reality and the ability to maintain dialectical and transformative relationshipsthat allow manage and resolve contradictions and internal conflicts of the individual and those of this with the social context. A synthesis of the genogram, ecomap and Critical Process Matrix (Breilh, 2003) is proposed like a tool in a scheme form that includesinformation related to both static and dynamic issues of people. The scheme proposes a new tool that should be practical and with the ability to explore new dimensions. This approach must become essential to the integral care to consulting person and his family especially in the psychiatric field.
