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Are we at the “de profundis” of general medicine?

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by Ornella Mancin

24 GENDear Director,

do you remember the episode of the tumult of bread described by Manzoni in the Promessi sposi? Faced with yet another increase in the price of bread, the angry crowd attacks the bakers. Here with the necessary similarities and after centuries it seems to me that the mechanisms that are proposed are the same: if the bread, primary good, is not available to everyone, the fault lies with the bakers; if the essential health services fail, the fault lies with the doctors, mainly the “primary care” doctors, that is, the more basic ones, those that are more proximal to the citizen … They are an essential good like bread and cannot no longer be available, answering the phone more, no longer receiving us with the same frequency with which they did before, no longer having time for a chat, advice.

This must be how the protest mounts, no longer in the square with sticks but on social networks to rant against the “doctors” who are closed in their forts without deigning to answer the phone, even allowing themselves to send recipes late or to demand the appointment to be received.

The conditions change but the essence remains: whoever responds in the first person to the often “shortsighted” choices of the ruling class is the last link in the chain, the one who is forced to put his face to it.

After all, it has always been like this: all the no that we had to say, even rightly, to our patients (think when the AIFA notes or more recently the appropriateness decree were introduced) we family doctors had to say, making them digest them our patients in a thousand discussions to explain, for example, who could get the PPI for free and who could not.

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Now, however, the situation is much more serious because we are no longer talking only about having to pay for some drug or some service, it is about the lack of primary services always considered essential (family medicine and continuity of assistance) due to lack of doctors or for in fact, it was impossible for family doctors to do their own clinical work, now fully involved in the paperwork that the now defunct SISP should have done.

But the citizen who struggles to be visited by his doctor, no longer finds him as available as before, has to wait days to be received, often does not know our working context and the taxes that those who have put on his back and can not stand all this by rebelling.
What better strategy to destroy family medicine than by having the patients themselves turn against and invoke a new system?

A new system, a “format”, which coincidentally is already ready: it will be enough to force general practitioners to work 38 hours a week like all employees but listen, listen, keep the “advantages” of the agreement: free choice of the patient (and therefore still subject to the blackmail of revocation), no holidays, no illness, the need to find a replacement in case of need.
Wasn’t the addiction better at this point?

I also wonder but if we get 38 hours a week they will also think that we will continue to be available for evening meetings after dinner to receive company address lines, we will continue to answer the phone 12 hours a day including Saturdays and Sundays, we will go to do the visits domiciliary in non-working hours?

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Being self-employed is a status that characterizes a person as capable of organizing his working time independently to meet the needs of third parties at all times. If we now worked 38 hours per week we would hardly be able to cope with the enormous demands of this pandemic period (today on average each of us does 50-60 hours per week).

If you have to pigeonhole our work as freelancers in a predetermined amount of hours then let us become employees. What does it mean to be a freelancer with an agreement if I am not given the way to organize my work independently? Before you took away the freedom to treat the sick as needed by transforming Hippocratic medicine into administered and now you are also taking away the possibility of organizing our work.

This is the “de profundis” of family medicine, we just hope that we “old” of the profession will be spared this havoc and we will be allowed to retire (which I doubt) or at least not to participate for personal reasons.
A deep thanks to all those, first of all trade unions, who have spent so much effort to destroy any possibility of making us go back to being doctors.

Ornella Mancin
Doctor of general medicine

January 24, 2022
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