General Medicine and Primary Care (2022)

The publication of the volume is very topical General Medicine and Primary Care which can be an important reference in the ongoing cultural debate.

Advertisement First of all, in fairness I must report my potential conflict of interest. I am one of the 95 authors who contributed to the manual General Medicine and Primary Care, having written a few paragraphs of the chapter dedicated to “Relationship and communication in the consultation in GM”, but this is very little compared to the more than 2000 pages overall. More relevant is being the father of one of the two curators and this inevitably leads me to a biased position. From my perspective I can testify that the book is the result of a painstaking work that lasted about 5 years and that it represented a challenge won for a bet that even to me, in certain moments, seemed not only difficult but impossible. Obviously, I have tried to be absolutely objective in describing the most relevant features of this ambitious publishing project, of which I am certain of its quality. Taking responsibility for my words as it should be, time and readers will decide the success or otherwise of this effort.

A discussion has been underway in our country for some time, which inevitably involves the highest political levels, regarding the need to change the role and functions of general medicine (MG). Even the management of a two-year covid, in the face of a narrative in which hospital operators have been described as heroes, has found its Achilles heel in territoriality, sometimes with a completely excessive media denigration, even in the presence of objective serious organizational flaws. In fact, the credibility crisis of the doctor of general medicine (GP) is a process that has lasted for years, with deep and complex causes that here you do not have the space and the competence to analyze. But there is no doubt that towards the General medicine there are preconceptions and exploitation, with profound dissatisfaction with both the users and the doctors themselves. Abroad the situation is different, in many countries the importance of this figure is recognized and specific and adequate specialization training courses are provided.

The publication of the volume is therefore very topical General Medicine and Primary Care which can be an important reference in the ongoing cultural debate. For the two curators:

the General medicine it is a discipline that exercises a specific knowledge that can be delimited (however transdisciplinary and context-dependent), that can be learned, investigated and always open to new, possible evolutions. A knowledge that is not, as is often mistakenly still believed, a result of the mere sum of the “basic” skills of each specialist branch, but which – on the contrary – requires a jumble of highly specific and characteristic skills, in our opinion, that need to be first revealed, in order to then be able to fill that cognitive and formative void that is the cause (and consequence). (Forte V., Vito C., 2022, p. 31).

The book, with its over 2000 pages, offers a certain and stable basis in indicating what are the competences of doctor of general medicine.

The text constitutes an exhaustive manual which is offered to different levels of reading. From a more meditated one, to understand the general medicine model desired by the authors, or for an immediate consultation by the doctor to obtain operational indications. Furthermore, the intention of becoming a textbook in the Triennial Specialization Training in General medicine. Today in Italy the task of organizing Specific Training for the Regions is delegated to General medicine and each works independently, with a non-homogeneous level of quality, while the degree course in Medicine and Surgery does not generally train young doctors to know the specificities of this essential medical figure, which constitutes the most widespread network present throughout the territory, in which each doctor is appointed to take care of the health of a small community of people, his clients. Therefore, the very important social role played by the doctor of general medicine nor the fact that it requires multiple complex skills: obviously the clinical ones in the first place, but also the organizational ones, the knowledge of the regulations and bureaucratic procedures, to reach “the last but not the least” the relational skills essential to create care pathways shared. One cannot think of a Specialization Course without books to study on, Tombesi notes in the preface, and the text aims to fill this serious gap. The Caimi-Tombesi, or the text “General medicine”, Republished for the last time in 2002 by Utet, today it cannot be found and up to now constituted the only Italian reference text. While there are volumes of this kind abroad (United States, UK, Canada, Australia) and it was precisely the study and comparison with them that constituted the first demanding phase of the curators’ work.

Regarding the structure of the manual, it must be said that the two editors coordinated and standardized the contributions of over 90 authors, mainly recently trained GP doctors. It is fully color, with extensive use of tables, images and even web extensions. The many in-depth boxes and internal references seemed to me particularly useful. The work, published in three volumes, is structured in three sections.

Advertisement The first consists of 8 chapters and constitutes a broad introduction which contains the framework of the systemic framework in which the GP operates. These pages introduce the principles of the health policies of the NHS, with particular reference to primary care; the ethical and regulatory aspects related to prescription, certification and exemptions; the models and values ​​that inspire the training of operators and their research activity. Then we move on to analyze how the study of General medicine and its practical management, while an entire chapter is dedicated to the relationship and communication in this specific medical field;

The second section, consisting of 7 chapters, is aimed at health promotion and prevention and represents the part that devotes more space to social aspects. These pages illustrate the most important environmental and collective factors that affect health and the most significant promotion and prevention practices are presented. Specific space is dedicated to vaccinations, health in the elderly and people at risk of marginalization.

Finally, the third part, the most voluminous, which occupies volumes 2 and 3 with 28 chapters, the true center of the work, is dedicated to “The clinic in General medicine“. For each medical branch (cardiovascular health, pulmonology, metabolic, etc.) the clinical framework is described, through an adequate examination of the major problems of diagnosis of pathologies and management of the various specific clinical activities, not only pharmacological.

As a non-doctor, I particularly appreciated the strong and rigorous methodological imprint and, for the contents, the first part, with a very detailed introduction to the systemic framework in which the operations of the GP are located, which really deals with all aspects, from those fiscal to linguistic ones up to architectural ones, to create a medical study on a human scale. Much attention has also been paid to the relational dimension, in the awareness that it is precisely in the relationship with the person that the effectiveness and quality of medical action are at stake.

Finally, the curators appear aware that the drafting of this manual also represents an attempt at opposition to a stereotypical narration of the role of the doctor of general medicine as necessarily tired, unmotivated, absorbed exclusively by bureaucratic procedures. The effort for the realization of this text, with its desirable diffusion among the doctors of the sector, instead plastically testifies to the presence of a certain number of doctors, young but not necessarily, with a high civic sense of their professional mission, with high demands. formative. A book, therefore, which is not just a single map that allows the GP to orient himself in the universe of the very many possible knowledge in General medicine, but which intends to act as a piece, which can contribute to foreshadowing and achieving a better future in this field, with an ethically positioned, deeply human, clinically prepared and scientifically rigorous medicine. Finally, I believe that the fact that the curators and most of the collaborators are young, almost all with less than a decade of work behind them, with the vitality and freshness of their age, but ready for the challenges of turnover, should be welcomed. generational that the General medicine is inevitably facing in our country.