by Claudio Maria Maffei
01 LUG –
Dear manager,
a critical intervention of mine on the sentence of Perugia on post-acute care in nursing management had a prompt reply to the contrary from dr. Giancarlo Pizza. I do not go back to the merits of the question (namely the legitimacy and the appropriateness of post-acute hospitalization areas mainly managed by nursing), but I focus on a point that I believe to be systematic: the distinction between “clinical” doctors and doctors ” officials “. These are discussed in the intervention of Dr. Pizza which seems to recognize in my statements “a sort (perhaps) of repentance of doctors (which I have also known in my long professional experience), who, for many reasons (let’s be clear respectable) have decided to specify their profession with the bureaucracy and not with the clinic, abandoning the sick to others. ” Dr. Pizza then clarifies that he also refers to “the famous medical officials on whom the health care system was based before and today many have passed through regions, ministries and companies. And who, probably without realizing it, end up with their proposals, making the life of their colleagues difficult on the field and, at times, pontificating about what is best to do. “
Let’s leave out the color notes (the medical officials who abandon the sick to their colleagues and pontificate about things to do) and the personal data (the health insurance officials have been retired for at least two decades) to focus on a fundamental question: there is a role for doctors specialized and operating in public health disciplines (hygiene in the first place, but then there are also health statistics, health economics, management of health structures, epidemiology, Health Technology Assessment, management of processes for improving the quality of care, etc.) or should the whole system at all levels, including programmers, be entrusted to clinical doctors (a definition that should be done better, however, but now let’s overlook it)?
The answer to me is very clear: “civil servants” are medical specialists in disciplines who deal with planning, organization and management in the field of health and have a precise role and precise methods of analysis and intervention. These are disciplines that have an intense cultural life evidenced by their scientific societies, journals and training and research initiatives. Tracing the role of “official” doctors back to that of doctors who, without even realizing it, make life difficult for doctors who “really work” or is a statement by Dr. Pizza that concerns only me – and then the question does not arise – or it is a widespread position in the world of clinicians and with a generalized value and then the question exists and it is important.
The National Health Service in Italy was born in 1978 thanks to good, indeed excellent, politicians and thanks to good, indeed excellent, doctors often also politicians with a culture of “officials” such as Giovanni Berlinguer, Augusto Giovanardi and Alessandro Seppilli, hygienists. Much of the organizational renewal of Italian hospitals is due to Elio Guzzanti, another hygienist as well as a specialist in diseases of the respiratory system. But I could make a long list of non-clinical doctors and therefore by definition “officials” who have increased the quality of Italian healthcare. At least two I must mention for personal reasons: Professor Giovanni Renga, my teacher at the University, and Giuseppe Zuccatelli, my teacher in the field.
The distinction between the good clinical doctor and the useless medical officer is dangerous because it is clear to anyone that the cultural, organizational and structural redesign of the NHS must take into account the point of view of both as well as that of many other professionals and citizens. . The redesign of the hospital network is an excellent example of this. In many interventions including that of Dr. Pizza once again speaks of the need for a more “adequate” hospital as suggested by the Clinicians Forum, which in fact cites, proposed as opposed to the “minimal” hospital, as defined by Ivan Cavicchi, wanted by the medical officials, editors and supporters of the DM 70, considered one of the typical products of the official culture.
Too bad that while those who in this debate say they represent clinicians limit themselves to the generic proposal of an “adequate” hospital, the so-called “officials” have been working for decades on the definition of adequacy of both hospitals and all structures and all health services for example through the definition of accreditation procedures, the construction of hospital monitoring systems such as the National Outcome Program and the construction of an approach to quality including that of hospitals such as the one proposed by Francesco Di Stanislao on behalf of Asiquas. It is a pity that the Ministerial Decree 70 has at its core the concept of hospital adequacy, making the arduous attempt to provide reference criteria and standards not only on beds, but on clinical networks, volumes of activity and outcomes. But those who criticize the DM 70 do so too often with the attitude of what judges a book from the back cover.
The “clinicians” have a fundamental role not only in the care processes but also in the processes of redesigning the health system, but in this redesigning equal dignity have those who by profession and with equal passion take care of it and take responsibility for it. After all, perhaps even the Clinicians’ Forum thinks this since it has also involved Professor Walter Ricciardi, a very important current figure as a hygienist, in one of its recent initiatives. As there are many hygienists and “officials” who contributed to the birth and growth of the Italian Society of Medical Managers, which later became the Italian Society of Leadership and Management in Medicine. Let them all leave it alone and leave it to whoever is on the pitch?
Claudio Maria Maffei
01 July 2022
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