by Antonino Mazzone, Franco Vimercati
14 DIC –
Dear director,
for about three years now the world community and WHO have had to face a battle or perhaps better a war against the Sars-Cov-2 (Covid 19) infection, which has affected and affects everyone by increasing mortality, especially in the patient setting suffering from polypathologies in polypharmacotherapy and the elderly.
Surely the data demonstrate the shortage of Doctors and Nurses in EDs and in general in hospital wards and everything is also aggravated by the chronic lack of territorial health management.
Scholarships for the specialization of Emergency Medicine remain semi-deserted, demonstrating how this path taken leads to a bankruptcy health organization due to the lack of motivation of professionals also due to an organizational deficiency that allows them to work safely.
It is therefore necessary to think of different organizational models, which provide for a coordination that goes from the emergency room to the territory, which must take charge of the requests of patients suffering from chronic pathologies.
All the masters, in fact imposed to be able to play the role of director of the UOC, highlight how necessary it is to break down the “silos” and create transversality, a role that only Internal Medicine can play in this field for the management of patients with polypathologies.
The controversies that we see today focusing on the ED are often instrumental and do not address the real problem, i.e. the lack of beds, to accommodate acute polypathological patients generally not admitted to specialist wards that manage a single patient’s pathology.
Many patients in these conditions arrive at the ED and often wait three to five days to be admitted.
The problem is the inhumanity of this situation which, in fact, increases the clinical risk and creates discomfort in an elderly segment of the population, which should be protected and pampered for all it has done for the country.
So today we see, for example, neoplastic patients undergoing treatment who, due to an infectious complication or side effect, need hospitalization in internal medicine wards but remain in the ED due to lack of beds dedicated to clinical complexity.
This is just one example of how the setting of the various super specialties is undermining the common vision of our NHS.
We win only if we remain united and pursue clinical goals on the one hand and organizational goals on the other with the necessary involvement of the trade union organizations without which the proposed planning becomes difficult to apply.
We therefore need a call to common sense and face the real problems that are due to the closure of many beds, especially in Internal Medicine.
In the light of the new epidemiology, this could be the only possibility of access, for elderly complex polypathological patients and in polypharmacotherapy, which no one wants due to the actual difficulty of clinical and organizational management.
In this regard, the OECD data demonstrates in an incontrovertible manner, not only that we are the least funded, compared to other countries, but that the number of beds represents the real problem of our country.
From the OECD Health at a Glance 2021 data, the bed places in Italy are 3.0 per 1000 inhabitants (provided but often not activated), in Germany 8.0 per 1000 inhabitants, in France 6.4 per 1000 inhabitants, the European average is 5.0 per 1000 inhabitants..
How can we deal with the emergency room problem if, once the patient has been visited, he remains there because there is a lack of beds to be able to hospitalize him?
Independent OECD data actually proves it.
It is difficult to face the problem, without an overall vision that only FISM, representing 190 scientific societies can give, avoiding the involvement of lobbies that pursue partisan interests, without a holistic vision, thinking from a national point of view of equal healthcare and pharmaceutical assistance for all and not divided into 21 Regions.
“Professionals in the health sector are faced with a whole series of problems that certainly originate in the past, but which the long pandemic parenthesis has contributed to making chronic and which are now exploding in all their seriousness. This is what we wrote in Quotidiano Sanità on 23 September last: “Give a life jacket immediately to save the NHS”.
We hope that this Ministry has the courage to confront those who really, every day, face the real problems looking for a difficult solution, to give relief to the suffering citizen. Certainly difficult choices but which are useful if we want to save the NHS and the civilization of this country.
Antonino MazzoneDirector of the Department of Medical Area ASST West Milanese
IMF Vice President
Franco Vimercati
IMF President
December 14, 2022
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