General medicine in Italy, from citizens’ trusted doctors to doctors subordinate to buildings?

by Pier Luigi Bartoletti

14 OTT – Dear manager,

there are many testimonies for or against the issue of the general practitioner contract, whether dependent or affiliated. Is it the heart of the problem? Does the whole PNRR mission 6 really revolve around the contractual model of general medicine? Or is it just an aspect that has little to do with the reorganization of the public health system but a lot with shop interests or with ideological motivations? On closer inspection, there are no serious ideas and projects behind the money borrowed from Europe.

A lot of concrete, little quality health. Much federalism, little centralism. Colleagues write to the Minister extolling addiction as a panacea, it is a pity that the models where dependence is the primary care contract are characterized by having a public network mainly dedicated to those without insurance, supplementary funds, mutuals, and a large private network. with a lot of “out of pocket” expense. Portugal, cited as a model to be imitated, leaves a million Lisbon citizens on the street without a family doctor. But thinking about our home what is evident is how in 1978 the Mariotti Reform, then Law 833, Institutive of the National Health Service, had a very strong concept and basic idea, we give all Italians a doctor they trust. The word “trust” means a very serious and very strong thing. Trust also means relying on the advice of those who have no relationship of subordination except the code of ethics and therefore work free from any conditioning in the exclusive interest of the citizen who has chosen him.

The exegetes of subordination (dependence) explain to us how to combine the relationship of trust with the relationship of subordination and have the courage to say that it simply means copying and pasting the Hospital Intramoenia. That is, if you want to choose your doctor in the community building, you have to pay. A big leap forward, no doubt about it. Touching the doctor of choice and choice simply means opening the doors to supplementary funds, private healthcare and laying the foundations for a residual public system. With the effect, see USA, of increasing the percentage of spending by citizens. During the pandemic, the only network that had a thousand problems was that of general medicine. If we go back and see how many amazing health buildings remained open during the lockdown, we will have a very different image of proximity health problems.

Then that there are exalted flatterers of subordination in search of armchairs is a matter of course the problem is when the aspiring armchairs at our expense and the aspiring subordinates in search of protections capture the malevolent attention of those who cannot wait to get rid of that box. bulky figure of the general practitioner. Too little conditioning and not subordinate to Taylorian logic of the Healthcare industry. Citizens’ trust for them is a problem not a value. Then for heaven’s sake they will say that many have fled, many have hidden, only a few are the good ones. Of course yes, I would like to see using a war comparison, which happens in a platoon of soldiers also chosen after a bomb explodes in the middle of the group that kills dozens of them. The immediate reaction is to hide, shelter, protect yourself. And so it was. But after a few months, the numbers show that family doctors not only resumed fighting the pandemic, but did so like the partisans, organizing a local resistance, made up not only of courage but also of the ability to manage less complicated cases. to vaccinate millions of Italians, first for the flu, then, despite the lack of vaccines, against Covid.

They have received millions of calls for vaccine advice, millions of calls for vaccine side effects from hubs, they have dealt with all other illnesses, acute and chronic. There were no assaults on the ER, on the contrary. The exegetes of subordination took out the data of the notifications, prescriptions, requests, telephone calls made and received by general medicine. Then we discuss how to improve. But on a basis of intellectual honesty and not on prejudicial or workshop logic. Ultimately there is a choice between being the citizen’s medical officer or the building’s medical officer.

Dr. Pier Luigi Bartoletti
doctor of general medicine
Vie National Deputy Secretary of the FIMMG

October 14, 2021
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