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Alterity and empathy: essential virtues for the training of the dentist

Alterity and empathy: essential virtues for the


training of the dentist

Marcelo Mocelin Bark*; Marjory Posanski*; Kauhanna Vianna de Oliveira**; João Armando
Brancher***; Léo Kriger****; Marilisa Carneiro Leão Gabardo*****

* DDS. Graduate Student in Dentistry, Universidade Positivo


** MSc. Postgraduate Program in Dentistry, Universidade Positivo
*** PhD. Postgraduate Program in Dentistry, Universidade Positivo
**** MSc. School of Health and Biological Sciences, Pontifícia
Universidade Católica do Paraná
***** PhD. Postgraduate Program in Dentistry, Universidade Positivo

Received Dec. 14, 2017. Approved March 18, 2018.

ABSTRACT

Professional care in the health sector is attributed to certain assumptions that go beyond the mere
technical aspect. For transformation to occur, attention to curricular changes is indispensable during
the development of the dentist. Higher education requires strategies that remodel the way of thinking
about others. Alterity and empathy are virtues that, if triggered, can alter the relationship between the
professional and their patient. We sought to elucidate the meaning of these concepts as a reflexive
proposal in line with humanized health care, the National Curricular Guidelines (NCG), and contact
with the Unified Health System (UHS), who are propellers of change in academia. We adopted a
narrative review of literature, through documentary research and contemplating the national
legislation on higher education in dentistry, in addition to consulting the scientific bases Medline,
LILACS and SciELO. The keywords used were as follows: alteridade, alterity, empatia, empathy,
humanização da assistência, and humanization of care, from 2004 to 2017. Full texts that
contemplated the interrelation between these themes in the dental sector were selected. The
qualitative synthesis of the literature consulted allowed us to observe that there was a change that had
yet to be fully realized in spite of its relevance in relation to the technical and curative aspects
proposed in the NCG and which the UHS sought to implement as a new professional requirement in
the public sector. It was concluded that humanized care in dentistry is still a challenge. However,
academic changes that awaken the virtues of alterity and empathy must be established.
Descriptors: Virtues. Education, Higher. Unified Health System.

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Alterity and empathy: essential virtues for the training of the dentist

1 INTRODUCTION Thus, the aim of this study was to review,


Considering that procedural technique by way of narrative, the concepts of alterity and
alone does not constitute an excellent approach, empathy and present a reflexive proposal about
multiprofessional health care is a challenge for these virtues and humanized health care, in order
health professionals1. This challenge instigates to reveal the behavioral characteristics necessary
the readjustment of treatment, giving rise to the for the academic development in dentistry. This
need for a holistic view of the human being, that is in support of the debate of the proposals of the
is, an integral approach involving biological, NCG, and the contact with the Unified Health
psychological, and social aspects1. System (UHS), as drivers of changes in
In view of the training of a dentist with a academia.
broad vision, the National Curricular Guidelines
(NCG) for the undergraduate course in dentistry 2 METHODOLOGICAL COURSE
outline the ideal profile of a dentist’s The narrative review sought to base and
development2. The document outlines general contextualize the virtues of alterity and empathy
human, critical, and reflexive characteristics that along the precepts of the humanization of health
should guide the performance of the health care in the training proposed in the NCG that
professional at any level. It also points out that would affect the UHS.
the basis for procedural action is informed by the The bibliographical survey was carried out
technical and scientific rigors based on ethical, initially through research in specific textbooks
legal, social, cultural, and economic realities and documents of the national legislation that
principles2. deliberate higher education in dentistry. The
In order to cover all the aforementioned databases consulted were National Library of
aspects, the development of interpersonal Medicine (PubMed/NLM), Literatura Latino-
relations is important3. The primordial is to think Americana em Ciências da Saúde (LILACS), and
of the patient as a being and not solely showing Scientific Eletronic Library Online (SciELO),
professional concern for their signs and using the keywords: alteridade, alterity, empatia,
symptoms3. The humanization of care in empathy, humanização da assistência e
dentistry not only requires academic intellect, but humanization of assistance. These descriptors
also hospitality and sincerity in relationship as were derived from previously published articles,
well as the creation and development of as well as from Descritores em Ciências da
behavioral characteristics that are virtuous. Saúde (DeCS) and Medical Subject Headings
Health professionals should understand the (MeSH). The search period was from 2004 to
National Humanization Policy4, in order to be 2017.
able to give quality care and to promote the We adopted a selection of full texts in
awareness, receptivity and recognition of Portuguese, English and Spanish. Editorials,
oneself5. theses, or dissertations were not included. We
This way, behavioral virtues applied to analyzed the content of our sources by reading
others can bring about their well-being as a abstracts to determine and select those whose
reward6. Therefore, reflection on subjective well- content were related to the central scope of the
being, that is satisfaction and gratitude, is study. The texts were then read in full and
required. grouped thematically.

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Alterity and empathy: essential virtues for the training of the dentist

3 RESULTS expressed but also the conditions of their conjugal


lifes, family, work, as well as anxieties and anguish
Ethics, Education and Receptivity of routines are expressed frequently. Care based on
When reflecting on education, one cannot the integral approach to the human being, also
solely envisage this as a good school education provided in the NCG2, requires bonding,
and possibly a university education. The theme is acceptance, and above all, understanding of
linked to reflection on the best way to live. The changes. Then, one realizes that in order to deal
study to identify the best way of living and the with change, they need above all, to pay attention
best life is essentially related to ethics. This word to people. Paulo Freire, the Brazilian who most
cannot be interpreted pragmatically to only mean earned the title honoris causa in the history of our
behaviors suitable or not appropriate to society7. country, was also a master at this. When someone
The authors further cite that, "Ethics has to do came to talk to him, a world-famous man, Paul not
with coexistence. Here is its object. But their only stopped to listen, he gave them all his
understanding and understanding also involve attention. Not infrequently, he placed his hand on
intellectual effort because it is thought about the interlocutor's shoulder to create the semblance
shared life, about relationships. It is a knowledge of equality, a bond or a physical connection to
that mobilizes, that comes from the other and that manifest what Aristotle called friendship: two
curiously is absent from our formal education. At bodies in a single soul"10.
school, reflection on coexistence occupies a However, a critical analysis identifies the
marginal or zero position"7. challenges faced in regard to receptivity in health
Upon understanding that the search for the practices11, including oral practice12,13. As for the
best way to live and coexist is undeniably professional aspect, there is a lack of understanding
gathered from shared lives and interpersonal of the real meaning of receptivity12,13.
relationships, we note that human receptivity
when determining the quality of dental care is Alterity and Empathy
relevant. Debating the concept of humanization in
Receptivity entails listening to those who dental care evokes important perceptions
seek care and thus providing appropriate responses regarding the technical and scientific evolution in
which favor the health care process. It is the dentistry, since this area of health was marked by
provision of a focused, responsible, and resolute disharmony between technicality and the quality
service8. According to Hennington9, receptivity of human contact14,15. The importance of
means humanizing care. receiving the patient who suffers, and thus
Within the National Humanization Policy of requires the transcendence of knowledge related
the UHS, the host, as a guideline in its ethical to oral health, is evident. There is need to
aspect, refers to receptivity as the commitment to understand that the healing process goes beyond
recognize another demonstrated in the attitude of the area of scientific knowledge14. For this, the
welcoming them along with their differences, pain, dental profession must contemplate technical
joy, and way of living8. skill, scientific formation and the human
Academics and professionals in the dental perception of the promotion of health16.
sector have daily experiences reported by patients; One of the behavioral characteristics that is
therefore, not only are the pathologies and the essence of good relationships is empathy. The
discomforts related to their oral conditions state of empathy denotes the correct perception

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Alterity and empathy: essential virtues for the training of the dentist

and reference of others, by putting oneself in is acquired19.


someone else's shoes in order to understand their Specifically, in the context of NCG, some
thoughts and emotions in a given situation17. examples can be given of how these virtues can
Empathy is a useful virtue which links and help in the development of competencies such as
triggers an affective bridge between the health health care, since the responsibility does not end
professional and the patient18. Because of the with the technical act but in the resolution of the
facilitating nature of bonding, empathy health problem as a result of decision-making
legitimizes humanity, that is, a sense of because the most appropriate actions are desired.
belonging is cultivated and a feeling of In addition, they are directly related to
acceptance arises, causing the individual in need competencies that directly or unintentionally
of treatment to feel more comfortable with involve communication and leadership.
expressing their needs17. The importance of
empathy during anamnesis can be reflected upon. Humanized Care in Dentistry
It is well known that good surgical/therapeutic When the meanings of empathy and
planning depends on the quality and specificity otherness are internalized, the need to propose
of the information obtained during diagnosis. humanization in dental care is evident. The
Empathy can be understood here as an auxiliary concept of humanization is understood as an
tool in collecting personal information necessary affable and manageable action, that is,
for the treatment plan. Is it preferable to reveal benevolent and kind treatment towards one
intimacies and information to those who another20. However, it is clear that there is an
understand and embrace us or to the girdles of abyss between the theory and the practice of
labels that emanate the disinterest of particular humanization in care because this teaching-
conditions? learning methodology requires changes in
Acting synergistically with empathy, both relation to attitudes, behavior, values, culture,
striving for interpersonal bonding and otherness, and concepts among other factors16,20.
is the ability to see the other as a different being. In this way, building humanized
In other words, it is accepting the condition of the pedagogical projects is a challenge for higher
existence of other opinions, cultures, education institutions (HEI)21. Humanizing care
knowledges, appearances and beliefs, knowing is not limited to just calling the patient by name
that such virtues do not justify generalizing and and constantly smiling, but entails contemplating
inflexible explanations19. Thus, we recognize the and understanding the fears, anxieties, and
fundamental use of alterity in the process of uncertainties demonstrated by the patients and
academic development as well as in the with that knowledge, providing support and
professional-patient relationship. constant attention22.
From the perspective of alterity, education Based on the precepts set forth in
is seen as a construction evidenced by the Resolution CNE/CES 32 referring to vocational
particular relationship between subjects of training that goes beyond the technicalities, the
different thoughts. Thus, amidst the process of Ministry of Health and Education in partnership
interaction, not only are concepts learned and with the National Program of Reorientation of
information obtained, but above all, the Vocational Training in Health implemented
discernment of contexts that promote the some HEI, the Programa Nacional de
assimilation of elements of implacable meaning Reorientação da Formação Profissional em

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Alterity and empathy: essential virtues for the training of the dentist

Saúde (Pró-Saúde)20. In order to cover the new Education26 proposes modernization of the
trends in academic education, Pró-Saúde undergraduate curricula according to these needs
launches an academic and educational which makes the importance of professional
opportunity to develop skills related to training to cater to the reality of the country
humanized care, integrating the student into the evident. This refers to a general profile capable
UHS network from the beginning of their of applying preventive and social philosophy to
academic training20. Studies show that these health, and appreciating and understanding social
programs improve the development of participation, intersectoral approach, and
interprofessional education23,24. practice outside the city under supervision in
public institutions26.
Insertion in SUS x Difficulties
One way of providing the expected Multiprofessionalism x Technicality
professional performance that is interdisciplinary This literature review examines the theory
and integrated, is having contact with the UHS, of what would constitute a complete
thus being able to develop personal abilities that training/actuation/qualification of a professional
aid health as described in the NCG2,25. Dentistry dentist2, as well as some methods and academic
courses require a re-adaptation of training changes necessary for giving rise to fundamental
systems, so that they contributes to the virtues including empathy and otherness that
qualification of professionals who meet the enable quality care namely the humanization of
demands of the system16,21,25. Based on these, it health care.
is notable that change procedures offer hope for The proposal advocates for the
new possibilities of initiative that may aid in development of skills that do not promote
greater contact of the students with professional isolation from everyday realities, but provide
practices linked to collective health26. coping mechanisms for all kinds of difficulties.
However, difficulties are present and Integrating this into the reality of the public
cannot be denied. One is the conditions related to health system requires coexistence with
the integration of the dentist into SUS: difficulty behavioral plurality.
in the social perception of health practices and Mechanistic understanding uncovers
the extent of interventions; limited concept of awareness and makes it a mere reflection of
health-disease given the non-incorporation of the material things27. Therefore, the need to
social dimension; low effectiveness of health understand subjectivities arises so that this
promotion actions triggered by social exclusion; consciousness is hypertrophied27. The productive
low incorporation of the guidelines proposed by potential that the combination of graduation in
UHS; oral health being strongly guided by the dentistry with UHS can trigger is remarkable. It
clinical model; isolation of the lack of is in this contact with the reality of the country
interdisciplinarity; and the privilege of curative that educating, teaching, and treating is being
actions25. However, in order to overcome these built with the awareness of true values in life.
difficulties, the curricular matrix should be This is because education requires research,
reorganized and proposals that meet the demands respect for the learners' knowledge,
requirements of the reality of the public health critically reflects on practice; common sense;
system should be developed because they are reality; joy and hope; conviction that change is
indispensable. The Federal Council of possible; and knowing how to listen, and above

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Alterity and empathy: essential virtues for the training of the dentist

all demands conscious decision-making27. the continuity of learning29. This highlights the
In view of the above, intellectual work importance of integrating the student in UHS
must go beyond theoretical innovations and be from the beginning of their academic
applied to the academic practices of future health development20 and proves the interconnected
professionals. Additionally, this practice that is relationship between education and health: there
aimed at offering general education should have is an evolutionary dependence between UHS,
its content internalized by professors, in order to NCG and academic development29.
break the limits of the training itself, which is Morita and Kriger29 explain that acting in a
often linked to the technical concepts28. multiprofessional way requires taking a break
It is necessary to combat the critical nodes from work that is centered on individuality and
present in vocational training. The term "critical seeking to develop teamwork from which
node" refers to the mistaken teaching model that emerges sharing, planning, tasks and establishing
collides with the search for graduates who have a cooperation and collaboration. Interdisciplinary
curriculum and the experience that contemplates and transdisciplinary teams are associated with
the social needs related to health, that is, the increase in the quality of academic care30.
reality of UHS. The technical, individualized and Going beyond the limiting mechanistic
medicalized emphasis demonstrates the understanding27 and raising generalist
2,22
fragmentation of the teaching model and presents professional behavior presented alterity and
itself as a real node that prevents curricular empathy as foundations for the establishment of
reform that seeks humanized care28. humanization in dental care. The inclusion of the
Ethics, being understood as an intellectual student from the first academic years was
pursuit to improve coexistence and the sharing of highlighted in the reality of UHS20, because the
experiences, translates to being a lifelong necessary modifications in favor of a
practice7. It can be seen that the NCG for professional profile of excellence require a non-
graduation in dentistry are fundamental keys to dissociation between theory and practice29. Thus,
training in this field that is in harmony with the through the understanding and adaptation of such
essential requirements that a dentist must values and tools, individuality in care is giving way
possess2. to the multiprofessional approach, as the academic
Although there have been reflective interacts with the reality of UHS and, consequently,
innovations about the new curricular approaches makes the concepts of interdisciplinarity and
for health professionals, dentistry has proven to transdisciplinary practical29, gradually solving the
be historically backward in terms of critical nodes that present themselves as challenges
requirements29. Another node to solve aims at to be overcome28.
practical conformation to the multiprofessional Nonetheless, it is fundamental that the SUS
and interdisciplinary model proposed by the has an interlocutor between schools during the
NCG2. The implementation of the NCG sought formulation and application of pedagogical
to reformulate the curricular matrices and projects, as opposed to solely being an internship or
consequently, to update the student's abilities, practical field29. It is emphasized that "it is in the
among them: critical thinking, decision-making understanding of the concept of health, in the
capacity, acting in multiprofessional teams, possibility of forming a professional capable of
strategic planning for sustainable change, making a permanent contribution to the health
administering and managing health services and production of the society in which lives the

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guidelines are amplified”29. Therefore, to advance Given the importance of the topic, as well as
such a process, there must be constant interaction the incessant discussion about the best way to live,
between health and education policies, given that it is important to readjust professional goals when
the critical analysis of the NCG refers to the we refer to health. In order for the virtues of
reflection that profound changes must occur in empathy and otherness to cause a revolution and in
order for future professionals to be able to meet order to humanize dental care, opportunities are
UHS demand, that is, the reality29. needed in which coexistence with reality
Morita and Kriger29 affirm that the transforms consciousness. More than excellence in
traditional pedagogical model is ineffective, since procedures, which is also indispensable, goodwill
the concepts of its content are not linked to reality and receptivity in human contact is required. Every
and social needs. Therefore, the didactic- change is possible and this is the purpose of NCG,
pedagogical ideal that is sought requires that the supported by the UHS.
method of teacher-centered learning should be
transformed into a practice of multiple scenarios RESUMO
that suit social reality. With regard to the Alteridade e empatia: virtudes essenciais
articulation of knowledge, we must seek the para a formação do cirurgião-dentista
exchange of theoretical-practical experiences in O atendimento profissional vinculado à saúde se
isolated disciplines for content and experiences of deve a certas premissas que ultrapassam o
aspecto meramente técnico. Para que
integrated specialties. Regarding multiprofessional transformações ocorram, a atenção às mudanças
work, this should occur among professionals from curriculares é indispensável durante a formação
the same discipline, forming teams from each do cirurgião-dentista. O ensino superior carece
health area. The fourth fundamental point refers to de estratégias que remodelem a forma de se
the transformation of pedagogical practices and pensar o outro. Alteridade e empatia são virtudes
learning scenarios. Reformulation of specialty que, se desencadeadas, podem alterar a relação
profissional-paciente. Buscou-se elucidar o
clinics should occur so that, from the beginning of
significado desses conceitos, como proposta
the course, students are inserted into integrated reflexiva em consonância com o atendimento
clinical settings. Therefore, interaction with the humanizado em saúde, as Diretrizes Curriculares
SUS from the beginning of academic development Nacionais (DCN), e o contato com o Sistema
favors the desired changes and the construction of Único de Saúde (SUS), como propulsores de
a multiprofessional consciousness. The literature transformações no meio acadêmico. Adotou-se a
reports successful experiments with positive revisão narrativa da literatura, pela pesquisa
documental, contemplando a legislação nacional
repercussions in the reiteration of the formative
acerca da educação superior em Odontologia,
process.31-33. somada a consulta às bases científicas Medline,
LILACS e SciELO. As palavras-chave
4 FINAL CONSIDERATIONS empregadas foram: alteridade, alterity, empatia,
Merely aiming at the humanization of care, empathy, humanização da assistência e
these virtues are not expected to be used in a humanization of assistance, no período de 2004
pragmatic way, and consequently, they fail to be a 2017. Foram selecionados textos completos na
área odontológica que contemplassem a
provided realistically to the professional. In interrelação entre os temas. A síntese qualitativa
addition, humanization requires commitment to da literatura consultada permitiu a observação de
sincerity when aiming at the best possible approach que houve uma mudança, ainda não totalmente
to a human being who needs help. concretizada, mas relevante, com relação à

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Alterity and empathy: essential virtues for the training of the dentist

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