On the possibility of conciliating the ideal of integral health care and the cacophony of health demands

Abstract

The aim of this article is to reflect on the feasibility of applying the principle of integral care to health services in Brazil. We propose that as we leave the level of abstraction and enter the chaos of day-to-day interactions, the notion of integral care is fractal: it reflects world views that are coherent in their micro-contexts, but are not always able to understand the diverse world views present in the interpersonal interactions of the network of care for health demands. In order to understand this complex interpersonal dynamics, an exercise in discursive analysis was carried out to contrast semantic diversity with the variety of person positions that are present in the daily life of health practices. We started by characterizing the ideal of integral care and its relation with health demands examining the diversity of meanings that are present in legislation concerning the Public Health System in Brazil. This analytic exercise was then followed by a dictionary investigation of the semantic diversity of the term demand so as to define a typology of person positions in dialogical interactions involving health demands. To illustrate this, we used a recent personal hospitalization experience of a patient that led us to reflect, also, on the ethical dilemmas that are present in the care of terminal patients.