by Riccardo Colloca
10 FEB – Dear Director,
As a young General Practitioner I express the deepest regret in observing the vicious screwing into which the institutional debates on the future of General Medicine have entered. The places in which to practice the profession (eg community houses) and the type of contract (convention vs. dependence) seem, perhaps they are, the only elements on which we intend to outline a reform expected for decades. I know I am not saying anything new, but the urgency to repeat it is great, too much.
The popular sayings to sum up the story are wasted: from the elephant in the room to observing the straw and not noticing the beam in the eye. I leave it to the reader to choose the most suitable. The point is that, in my opinion, you pretend not to see.
We pretend not to see that the medical profession, especially in the area, is hyper-bureaucratized and there is not the slightest hint of wanting to reduce this bureaucratic-administrative load. Yet, there would be many ideas to streamline and improve, said and repeated, it would be enough to put them into practice:
self-declaration of the first days of illness: in the covid era, in the UK, this amounted to twenty-eight (28!) in the calendar year. Parenthesis: will it ever be possible to admit that the diagnoses of headache, low back pain, and other unobjectified symptoms cause any attempt at deterrence to be dropped, a subject so dear to the supporters of medical certification “always and in any case”? And understand that these are acts that take away time and energy, given that the law requires a visit for every certificate issued?
the revision of the booking systems for requests through CUP, which very often lead the patient to request the repetition of the requests, still valid by law even if the priority has expired, because the system is not able to respect the waiting times;
the strengthening of the Districts with trained administrative staff dedicated to the management of non-clinical care practices, today the real burden of General Medicine (requests for aids, requests for diapers, requests for certifications of all kinds, etc.);
the implementation and modernization of the already active and widely accessible National Health Card System, from which to manage the basic health information of patients in an accessible way, respecting privacy, regardless of the Region of residence and the related local IT portal, to sometimes a limit rather than an advantage given the absence or very little intercommunication between different systems;
the strengthening of human resources available to social security and protection institutions such as INPS and INAIL;
and we could go on quite a while …
Today the system is not dysfunctional because the General Practitioner is a contracted freelancer, it is because the GP is “used” (and has allowed himself to be used) as an administrative. A system in which for every boring / burdensome problem, typically non-clinical, the answer that reaches the citizen is: “go to your general practitioner”. This system will not solve the problems of citizens by varying the legal status of GPs, neither with the transition to dependence nor with the hours in the Community Houses. Doing so will only move the problem to another place.
The contractual instrument of the convention offers citizens as many guarantees as those of dependence, perhaps even more, if rewritten in a lucid, rational and coherent way. In my opinion, General Medicine should evolve throughout the national territory in associative forms, not only on paper, which, with a number of patients in sustainable care, sharing and mutual support between Colleagues, would allow for the peaceful organization of work, holidays and short periods of sickness, possibly importing from other contracts on a conventional basis the urgent protections for pregnancy and maternity, all leaving that space of organizational autonomy that has pushed and pushes many to choose general medicine in agreement.
However, this structure cannot ignore the recognition of the amount of undeclared work that the vast majority of GPs, dedicated to their social and professional role, support every day. Examples? Phone calls, e-mails, messages, social networks, back office re-evaluation of multi-therapies and complex clinical cases, professional updating, PDTA management, home visits and in facilities for the elderly, etc. Other than 15 hours a week, a cliché that some press, in order not to be vulgar, I limit myself to defining “deployed and pretext”, continues to repeat.
The young colleagues that I have the honor and the burden of representing in my own small way, ask only to be able to be Doctors and to allow this the only way is to invest in the territory, not only in words and not focusing everything on concrete, starting instead. by the Women and Men of General Medicine and continuing with all the structures that today the GP is vicarious with his presence and professional activity.
General Medicine is the last autonomous bulwark of the relationship of care based on the real need of the person, close to the person, let’s not sacrifice it on the altar of privatization that responds to logic of profit.
Dr. Riccardo Colloca
Doctor of general medicine
SNAMI Secretary Pordenone – Friuli Venezia Giulia
February 10, 2022
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