Home Health For territorial health, the time has come for the “redde rationem”

For territorial health, the time has come for the “redde rationem”

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For territorial health, the time has come for the “redde rationem”

by G.Campo, A.Chiari, A. D’Ercole, B.Bersellini, B.Agnetti


Dear Director,
for years as a study center we have chosen to follow a difficult and impervious but nevertheless exciting route precisely because of its difficulty. We have tried to put together (to compose a concrete reform project of primary care) the conceptual, epistemological and ontological elaborations of our historical reference point Prof. Ivan Cavicchi with the territorial organizational visions and community welfare of Prof. Stefano Zamagni. For us two giants who have always guided our professional practice.

As often happens, the solicitations of prof. Ivan are irresistible and involve us deeply each time. We want to deepen his themes but we also have the desire to participate and share his arguments by providing some of our positions. His last speech explains well how a complete failure of general medicine is looming due to a consociation that unfortunately seems to have canceled all credibility of the companies and trade unions involved in these sub-government practices.

What about Prof.’s colorful and very pleasant reading analyzes if not that they are inevitably and tragically 100% shareable? Even our study group has often expressed concepts and considerations on general medicine and its internal degenerative disease comparable to those of the article on the “redde rationem” which recalls, in great detail, the long counter-reform maneuvers, the absence of a coming out of admission of the complete bankruptcy of the health authorities, of the departments, of some decisions conditioned by the representative majority. The inability of civil society to listen, the debasement of the expressed and unexpressed needs of the clients and professionals are reported even with names and surnames up to the hilarious episode where Prof. Ivan receives the advice (not required) to use a some Prozac! It would be interesting to also flood this list with the names of regional and corporate health managers.

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Despite the pompous DMs, nothing will be seen to enhance the territory and those who lose will always be the usual trench professionals and citizens. Impressive, so much so as to become incredible in its realization (the surplus of the PNRR will be conditioned by the war in progress), are the 1350 Community Houses foreseen that enter, conceptually, immediately in contradiction with the 400 Community Hospitals programmed. The latter, at a minimum, should immediately change their definition otherwise a clamorous and emblematic oxymoron would emerge (they will never be of community but at most of territory having to cover, according to the announced numbers, areas much larger than those commonly referred to as ” community territories “) and therefore, as Cavicchi says, from this point of view the proximity reveals itself as a beautiful nonsense. The patients of series A and series B have always existed in recent years when the structures, called Case della Salute until 6 months ago, have created, over the years, differentiations or discrimination involving both patients and professionals in the disaster.

For some articles even the Professor seems to bend to the inevitable advance of complementary or supplementary insurance and to the ruinous corporate welfare … We are witnessing a story already heard in the past where by law the Medical Guard (garrison) has become Continuity of Assistance and the car became a nurse (with great respect for fellow nurses) etc. Small infinitesimal steps but well designed because the bureaucracy has all the time it needs for a revenge that must be served cold. Furthermore, mandarins, oligarchs and autocrats are very easily able to make the vast majority of patients believe that donkeys fly and that the best general practitioner possible is the one who works as a specialist.

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When a regional councilor or an Ausl health administration are not convinced that they have to deal with certain problems in a timely manner (i.e. with a radical reform of territorial assistance and primary care in a transparent and absolutely fair way), words or writings will certainly not to change these rooted and superordinate beliefs.

The chronic lack of alternations or alternations in the health political-decision-making process, considering the enormous economic and social power entrusted to the regions, can lead to what James Reason, in the clinical field, has defined the “Swiss cheese theory”. Reason, with his hypothesis, has tried to represent how in complex systems (and not only in health care ones) the custom (eg: the gloomy and unbearable question of governance that means nothing more than to command) can cause situations such as to determine subsequent or serial errors that can eventually become even catastrophic (“tranvata”). Each practice is a prisoner of sociology or “context”. The dinosaurs did not take into account the context and disappeared. It did not happen to the small rodents that dug their burrows in the deeper ground.

It will only be time that will be able to give reason and meaning to this political part of the treatment.

Regressive modernism sometimes forgets this aspect to the point of hypothesizing that the ideal citizen should strive for maximum autonomy, freedom, thus tending to leave out the collectivity or life in community.

Finally, with all the utmost respect and devotion we would like to report the invocation of the Supreme Pontiff Pope Francis reported in the title of the QdS article (6 June 2022) on Public Health. “It is a wealth: do not lose it, please, do not lose it”. “Even in the health sector, the temptation to make economic and political advantages of some group prevail to the detriment of the majority of the population”. “Cutting resources for health is an outrage to humanity”

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Giuseppe Campo, Alessandro Chiari, Alessandro D’Ercole, Bruno Bersellini, Bruno AgnettiFISMU Health Programming Study Center (CSPS), Emilia Romagna

07 June 2022
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