Abstract

SCHEJTER, Virginia et al. El clínico pediatra en la alta complejidad: Un trabajo de campo. Arch. argent. pediatr. [online]. 2004, vol.102, n.6, pp.451-460. ISSN 0325-0075.

There are no field studies about the general pediatrician’s role in the third level of care. Garrahan Hospital is a high complexity pediatric hospital, organized under the criterion of progressive care. A matrix pattern-based organization model was implemented to solve the tension between the strong tendencies to specialization invading all areas of medicine, and the need of integrating medical actions. The model generated a crisis among general pediatricians working in the hospital. The objective of this study was to evaluate the different ideas of general pediatricians and specialists about their functions, opportunities and training to fulfil the requirements of their work in the new setting. Population, materials and methods. Qualitative research instruments were used in a case-study model. Individual interviews with a semi-structured questionnaire were administered to 25 pediatricians. Results. The interviewed physicians considered that the general paediatrician’s functions in a high complexity context are the care of patients with complex multisystemic illnesses, the organization of care of patients with chronic conditions, and the coordination of care and integration of actions during the period of hospitalization. However, they usually do not play the role of a bedside doctor. The general paediatrician acts also as a general consultant in ambulatory medicine. Conclusions. The professional crisis appears in a historical cross-road of two models of approach to medical problems and actions: the trend to specialization and the attempts to integrate knowledge. The convergence of a group of general pediatricians installed in a new hospital with a matrix patternbased organizational design, with new roles and responsibilities, produced a crisis of professional performance. They are still working in the process of generating a new profile: a general pediatrician specialized in polyvalent high complexity pediatrics. The young phisicians are working in a more interdisciplinary way.

Keywords : General pediatrician role; Matrix pattern organization; Progressive care; Polyvalent hospitalization; Bedside doctor; Internist.

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