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If general medicine imitates hospital medicine

by admin
If general medicine imitates hospital medicine

by Enzo Bozza

18 LUGDear Director,
it happens, now too often, that the major tragedies of our time have the headlines for a few weeks and then pass into the faded background of oblivion, of the already heard and already seen. The profound crisis in Italian public health is no longer news and if we do not miss at least one dead and some seriously injured, we can sing the matter to ourselves, insiders, with a visibility of the problem equal to the mountain shelters that can only be seen after miles of sweat and good legs.

It happens, now too often, that the major tragedies of our time are narrated and described by the news but never deepened in the search for reasons and for this to try to correct them. There is the social story, the news, the story but the time for reflection and active and decisive awareness no longer exists.

An institutionalized system such as public health needs a main concept, that of the role: it is possible to govern the entire machine only if each operator covers a well-defined role in the competences and in the administrative position. Very easy thing in the hospital structure, impossible in the local medicine. The general practitioner has always been a non-role, he is the figure who in the continuous and assiduous relationship with his clients must have that flexibility and adaptive capacity linked to his major operational tool which is the relationship.

The ability to relate, that is, to establish a unique and dynamic relationship with people through the knowledge of their clinical and human history, is the true role of the general practitioner but it cannot be institutionalized, it cannot fit into any administrative scheme of the eight hours stamped. , so it becomes a non-role, unlike hospital colleagues who operate according to schedule and duties and for whom the relational aspect is almost completely absent: only scientism and technicality, the hospital machine works like this: forward another.

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The decline of basic medicine began with the abandonment of the rhetoric of the medical conduct of the past and the increasingly marked attempt to resemble the hospital doctor for whom, and it is not clear why, general practitioners have always had a certain complex of inferiority and a certain envy.

Centralized medicine in the health houses flourishes, visits by appointment, increasingly advanced instrumental services, and abandonment of the peculiar aspect of the general practitioner: the relationship, the instrument that identifies local medicine. We are imitating hospital medicine by denying what identified us, our non-role, knowing how to talk to people. And this is exactly what people asked the general practitioner, a relationship with which they could understand and manage the technicality of hospital medicine.

Since we failed in our non-role, we have fallen into the role of administrative officials: prescriptions, certificates, requests, everything that denies our vocation as doctors and for this frustrated doctors looking for a role we once had: the non-role of the family doctor.

Two major defeats: ours as doctors and that of our clients who flee to cosmetic medicine, the private one where by paying you get everything immediately but without a relationship made of time and continuity. People have no time, no waiting and no involvement, just a prescription with a drug that defines your disease but does not explain it and you can live it by yourself, perhaps by searching on the internet. Nothing human, we have become just a huge repository of labeled containers with no content. Empty cans to be consumed preferably no later than.

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Enzo Bozza
General practitioner in Vodo and Borca di Cadore

July 18, 2022
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