Entre saberes e resistências: relações de poder na comunicação em saúde da prática clínica na atenção primária

Abstract

Primary Health Care (PHC) is the structuring axis of the Brazilian Unified Health System, and communication is one of its greatest contemporary challenges, aggravated by the proliferation of fake news and the infodemic. This research aimed to understand how professionals working in PHC in Santa Catarina perceive, experience, and manage the power relations established in clinical health practices during consultations with patients, especially in addressing health misinformation, through the lens of Foucault's assumptions about power relations. The study aligns with Sustainable Development Goal (SDG) 16 of the 2030 Agenda, specifically target 16.10, by discussing the importance of public access to qualified information and the strengthening of health institutions in tackling disinformation. This is a qualitative, exploratory, and descriptive-analytical study, conducted in the field and anchored in the Foucauldian theoretical-epistemological perspective. Data collection took place between September 2025 and January 2026, with 18 professionals (9 physicians and 9 nurses) from the nine macro-regions of health in Santa Catarina, selected by convenience sampling from municipalities in stratum 4 of the Index of Health Development and with larger populations. Inclusion criteria were: having at least three years of professional experience in primary health care and having performed, in the last six months, direct care activities for family health service patients, including medical or nursing consultations. Professionals who worked exclusively in service management, without direct patient care, as well as those linked to secondary or specialized care services, were excluded. Data collection involved semi-structured individual interviews, a visual activity of technical/practical skills, and notes in field diaries. Data were processed using IRaMuTeQ software and analyzed through the lens of Minayo’s thematic analysis to identify thematic units (nuclei of meaning), although the central analytical framework was Foucauldian, aiming to understand the power dynamics present in the participants' discourses. The results reveal that communication in primary health care is not neutral, but operates as a device of governance. The emphasis on dialogue and active listening often masks a regulatory function, in which the professional acts as a mediator of scientific truths to neutralize divergent knowledge and reinscribe the patient within the institutional norm. Misinformation was identified as functioning as a "regime of competing truth" challenging state control and the authority of biomedical knowledge. The study indicates that when patients seek information online or resort to popular knowledge (such as the use of herbal teas), they exercise freedom and counter-conduct, ceasing to be passive objects and becoming subjects who question the norm. It is inferred that confronting misinformation in the microphysics of the clinical encounter depends less on hierarchical authority and more on the professional's negotiation skills, requiring access to the patient's symbolic universe to reorient care practices and strengthen the bond within the Brazilian Unified Health System.