Managing the difference: power relationships and professional boundaries in the mobile emergency care service

Abstract

Background: The Mobile Emergency Care Service (Serviço de Atendimento Móvel de Urgência-SAMU), which is provided by the Brazilian Health System, is influenced by economic, political and symbolic determinants, making it a system of interests and an area of conflicts. Objectives: To understand how power practices shape relationships and professional boundaries at the SAMU of Belo Horizonte, Brazil. Methodology: This is a qualitative case study based on the post-structuralist framework. Results: From the perspective of professional and territorial boundaries in the work performed at the SAMU, there are difficulties in recognising the group as a work team, while its discourses reinforce the historical dominance of the medical profession over the other professions. Conclusion: SAMU professionals struggle to identify and understand the thin line between their workspace and the workspace of others as their area of activity corresponds to the city as a whole. Setting its limit is a huge challenge due to the fragmentation of health services and the existing conflicts, which promote individualistic interventions that undermine the proposal to integrate the health care system.