December 16th –
Dear Director,
in the last period it has been customary for the main national television networks to broadcast at least one program every day which talks about the “crisis of our NHS”. From time to time the news is declined in a different way, considering the multiple facets of the matter.
Personnel numbers, costs, the number of patients waiting in the various emergency rooms of the peninsula and so on are skilfully pitted and examined.
Sometimes, the most virtuous programs also propose hypothetical solutions or, even more rarely, they call politics into question.
However, I would like to underline how the common denominator of these examinations, in the end, always turns out to be the “lack (real or relative) of Healthcare Professionals”.
The analysis of this aspect, especially in the last few days, has been enriched with further considerations, because, finally, the media have begun to admit that, perhaps, it is not a question of a real shortage in absolute value but of a shortage of doctors willing to work in the public structures of our health service.
The most daring have gone even further and have begun to speak of the “escape” of doctors and nurses from the NHS.
And in fact, considering the data that in 2022 speak of about 100 resignations per month only among doctors who serve in the emergency room, the term “escape” really seems to me the most appropriate.
Further efforts, at this point, would be necessary in order to understand the many causes of this latter phenomenon, in order to avoid possible exploitation or excessive simplifications which would be misleading and absolutely counterproductive.
Someone said that the main problem is to be found in the inadequacy of salaries but, this aspect, although important, cannot be considered as the only cause of this “flight” (towards freedom?).
On the other hand, confirming the fact that “money isn’t everything and it doesn’t bring happiness”, almost all of the Doctors engaged in public service have abandoned for years the ambition of driving around in luxurious cars and having parties on yachts of millionaires.
Almost everyone has understood and accepted that, in the current socio-economic scenario, a testimonial of panettone or a judge of “dancing with anyone”, economically, “counts” more than a doctor who takes a shift on duty in the emergency room on December 25th (Sic!!! A random day).
Here – also in the light of recent news on the new CCNL which seems destined not to have a significantly positive impact on our payrolls – it might be appropriate to start thinking about solutions that aim to improve the quality of work, giving us back what is necessary ” serenity in treatment”, which we all need to do our job better and to guarantee all our patients the even more necessary “safety in treatment”.
In this regard, fundamental aspects to consider should be “safety in the workplace” – repeatedly brought into play also in relation to repeated episodes of (often unjustified) violence perpetrated against healthcare workers – and a careful evaluation and remodulation of the profiles of responsibility, especially in criminal matters, of the Doctor.
In particular, this last aspect, although considered extremely important by all professionals, has always been treated as a taboo; a sort of “Pandora’s box” to be kept carefully closed and which only a few brave, sporadically, have attempted to open.
Yet, also comparing ourselves with other European countries, a certain discrepancy in treatment between us and colleagues from other countries appears evident, where the predominant model often pursues the path of the “no fault” system; a mechanism that implies the waiver of legal action, which appears to be the norm in the Scandinavian countries and which our French neighbors have already introduced since 2002 on an “optional” basis.
For this purpose, it could also be useful to give the right weight to the infamous “gradations of guilt” (gross negligence and slight negligence), in order to extend in an unequivocal and “courageous” way the cause of exclusion of punishability to all cases of “slight negligence”.
In fact, it should be remembered that today, in Italy, the healthcare professional is liable, by way of fault and in addition to serious fault, even if the event occurred due to slight fault dictated by imprudence or negligence or if the event it occurred due to slight negligence dictated by inexperience in the following two cases:
1) reprehensible error in the execution of the intervention when the concrete case is not regulated by the recommendations of the guidelines or, failing that, by good clinical-care practices;
2) in that of an error in identifying the type of intervention and the relative guidelines (defined inexperience in eligendo) which are not adequate for the concrete case.
For the avoidance of doubt, it should be emphasized that the decriminalization of the medical act does not equate to impunity but, on the contrary, it could guarantee Patients the certainty of compensation (assessed by appropriately trained and selected special commissions) in much quicker times, just like in France.
Any worker – apart from rare cases to be considered pathological – does not like to make mistakes when carrying out their duties, however the error (at any level) is to be considered inherent in doing and working and therefore greater attention to these aspects (especially in the health sector and also as an act of civility) should be a moral obligation of politics and the institutions, in order to give back to all healthcare workers that serenity mentioned above and with the intention of guaranteeing the survival (in health) of our frail but very precious SSN.
Zairo Ferrante
Interventional Radiologist – AOU Ferrara