De l'urgence ou le mouvement de la rencontre

Abstract : Although a relatively new medical specialty, Emergency Medicine has become an established and indispensable discipline within the French health care system given that its role and play are no longer questionable. However, many contingencies interfere with the practice, modifying or even disturbing healthcare results and impact. Therefore, the role of the emergency medicine physician is evolving based upon expectations of the health care system and individual patients.As it also depends on chance, the individual patient encounter in this context is mostly unpredictable and may be chaotic, and sometimes seems almost impossible to achieve. How can the physician render order out of chaos such that a high quality of care can be delivered despite chaotic work conditions? Is patient encounter a delusion, an unpredictable opportunity, or should it be anticipated as in a working plan, and even, should it be considered the full responsibility for this short-reaction-time medicine? The ethical questioning thus identified, using my experience as an emergency physician to better define the physician’s role in the emergency department has constituted the mainstay of this research project. During our reflection, diverse philosophical, sociological, and fictional sources have allowed us to support and convey our point. Realistic and factual analysis of the main features of in-hospital emergency medicine has proved to be a critical step in order to unveil the impact of this specific environment where the patient encounter takes place. Throughout the dissertation, we attempt to envision the patient’s encounter from another perspective: standing aside the course of care for questioning the caregiver's attitude, which is usually fatalistic in the practice of emergency medicine. Indeed, in emergencies and the emergency room, patient and caregiver intersubjectivity mandate the caregiver to explore his/her mission.This ethical shift facilitates a qualitative analysis of physician-patient interactions to define better the scope of the emergency physician’s role and the variables that define physician resiliency. Within this framework, the dimension of utility becomes a potential carrier of the encounter, like full ethical support. Indeed, would caregiver's utility be supported by his/her mission, his/her actions or by him/herself? Lastly, the irrepressible move toward the patient requires a transcendental approach to fulfill the commitment. Then it appears that beyond the initial contract, which is the promise of the best care, a new commitment arises: first and foremost, seeking out the encounter with the patient. Even and especially in emergencies, this commitment is critical as it permits the healthcare professional to emerge at the very heart of his/her mission.
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Aline Santin. De l'urgence ou le mouvement de la rencontre. Philosophie. Université Paris-Saclay, 2019. Français. ⟨NNT : 2019SACLS055⟩. ⟨tel-02137418⟩

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