What is the purpose of an internal medicine infirmary?: thoughts from a university hospital

This work proposes a reflection on the relation between the hospital organizational structure based on its division in specialties infirmaries and the perpetuation of the fragmenting logic peculiar to biomedicine, the hegemonic western medical rationale. The field of study was Pedro Ernesto University Hospital. Through semi-structured interviews with general physicians, specialists and professionals in charge of hospital admissions the existence of two different discourses is examined: the clinical discourse and the specialist discourse. The analysis of these interviews pointed out and considered the deep relation between both discourses, the hospital structure and the medical care provided to patients. The investigation reveals that, although both discourses are definitely inserted in the biomedical paradigm, internal medicine identifies itself and is identified as responsible for the patient "as a whole", whereas the specialties are seen as responsible for only "a specific part". This difference influenced not only the manner of treating the patient but also the purpose of each service within the hospital. The clinical infirmaries were characterized as sectors consensually capable of satisfactorily dealing with the majority of patients. If on the one hand the broad scope of internal medicine is a source of pride to physicians, on the other hand the lack of autonomy that follows this characteristic determines a feeling of self-deprecation among some of these professionals. This work was made from a hermeneutic philosophical perspective such as one proposed by Hans-Georg Gadamer, with the aid of Thomas Kuhn's concept of paradigm and Ludwik Fleck's concept of thought style